Background
Methods
Literature search
Guideline selection and data extraction
Quality appraisal and recommendation
Statistical analysis
Results and discussion
Literature search
Guideline characteristics
Title | Year | Country | Organization | Type of constipation | Topics covered | Update | No. of reference | Guideline page | Publication types | Systematic search | Evidence-based | Financial |
---|---|---|---|---|---|---|---|---|---|---|---|---|
American Gastroenterological Association Medical Position Statement: Guidelines on Constipation [9] | 2000 | USA | AGA | Slow-Transit Constipation, Pelvic Floor Dysfunction, Combination Syndromes | Diagnosis,treatment | Not reported | 1 | 6 | Journal | Not reported | Not reported | Not reported |
Practice Guidelines for the Management of Constipation in adults [10] | 2002 | USA | Not reported | Constipation in adults | Treatment | Not reported | 203 | 51 | Special website (http://www.arna.com.au/) | Not reported | Not reported | Not reported |
Prevention of constipation in the older adult population [11] | 2005 | Canada | RNAOPA | Older adult populations | Prevention | Yes | 226 | 16 | Not reported | Yes | Not reported | |
Management of chronic constipation: recommendations from a consensus panel [12] | 2005 | USA | None | Chronic constipation | Diagnosis,treatment | Not reported | 55 | 8 | Journal | Yes | Not reported | Yes,Pharmaceuticals Cor. |
Evaluation and Treatment of Constipation in Infants and Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition [13] | 2006 | USA | NASPGHAN Constipation Guideline Committee | Infants and Children constipation | Diagnosis,treatment | Yes | 96 | 13 | Journal | Not reported | Yes | Not reported |
Putting evidence into practice:evidence-based inventions for the prevention and management of constipation in patients with cancer [14] | 2008 | USA | ONS | constipation in patients with cancer | Prevention,treatment | Not reported | 72 | 21 | Journal | Not reported | Yes | Not reported |
The management of constipation in palliative care: clinical practice recommendations [15] | 2008 | Ireland | The European Consensus Group on Constipation in Palliative Care | Constipation | Diagnosis,treatment | Not reported | 43 | 13 | Journal | Not reported | Yes | Yes,Pharmaceuticals Cor. |
Management of constipation [16] | 2009 | UK | NICE | Older adults | Prevention,treatment | Not reported | 34 | 10 | Special website (AHRQ) | Yes | Yes | Not reported |
National Consensus on The Management of Constipation in Indonesia 2010 [17] | 2010 | Indonesia | ISG | Constipation | Diagnosis,treatment | Not reported | 18 | 8 | Journal | Not reported | No | Not reported |
Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care [18] | 2010 | UK | NCC-WCH | Constipation in children and young people | Diagnosis,treatment | Not reported | 140 | 255 | Special website (NICE) | Yes | Yes | Not reported |
Consensus Recommendations for the Management of Constipation in Patients with Advanced, Progressive Illness [19] | 2010 | Canada | The Canadian Consensus Development Group | Patients with Advanced, Progressive Illness | Diagnosis,treatment | Not reported | 20 | 13 | Journal | Not reported | Yes | Yes (edu cational grant from Wyeth) |
Prucalopride for the treatment of chronic constipation in women [20] | 2010 | UK | NICE | Chronic constipation in women | Treatment | Not reported | 11 | 38 | Special website (Cancer Care Ontario Website) | Not reported | Yes | Not reported |
Common views on diagnosis and treatment of chronic constipation with Chinese medicine [21] | 2011 | China | CACM | Chronic constipation | Diagnosis,treatment | Yes | 24 | 5 | Journal | Not reported | No | Not reported |
World Gastroenterology Organisation Global Guideline Constipation-A Global Perspective [22] | 2011 | Sweden | WGO | Adult patients | Diagnosis,treatment | Not reported | 0 | 5 | Journal | Not reported | Yes | None |
2012 | Italy | AIGO/SICCR | Chronic constipation and obstructed defecation | Diagnosis Treatment | Not Reported | 364 | 30 | Journal | Not reported | Yes | Associazione Italiana Gastroenterologi and Endoscopisti Digestivi Ospedalieri | |
Practical Treatments for Constipation in Korea [25] | 2012 | Korea | KSNM | Constipation | Diagnosis,,treatment | Not reported | 63 | 9 | Journal | Not reported | Not reported | Not reported |
Diagnosis and Treatment Guideline of Chronic Constipation in China [26] | 2013 | China | CMAG/CMAS | Chronic constipation | Diagnosis,treatment | Not reported | 63 | 8 | Journal | Not reported | Not reported | Not reported |
Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN [27] | 2013 | USA | ESPGHAN and NASPGHAN | Functional Constipation in Infants and Children | Diagnosis, treatment | Yes | 111 | 17 | Journal | Yes | Yes | NASPGHAN and ESPGHAN |
Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Too l [28] | 2013 | Asia | ANMA | Chronic Constipation | Diagnosis,,treatment | Not reported | 124 | 12 | Journal | Not reported | No | educational grant was receive d from Janssen Pharmaceuticals and Boehringer Ingelheim |
American Gastroenterological Association Medical Position Statement on Constipation [29] | 2013 | USA | AGA | Chronic Constipation | Diagnosis,treatment | Yes | 1 | 7 | Journal | Not reported | Yes | Not reported |
Lubiprostone for treating chronic idiopathic constipation [30] | 2014 | UK | NICE | Chronic idiopathic constipation | Treatment | Not reported | 0 | 9 | Special website (NICE) | Yes | Yes | NICE |
Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation [31] | 2014 | USA | None | Opioid-induced constipation | Prevention,diagnosis,treatment | Not reported | 61 | 10 | Journal | Not reported | Not reported | AstraZeneca |
Title | Scope and Purpose | Stakeholder | Rigour | Clarity | Applicability | Editorial Independence | Recommendation |
---|---|---|---|---|---|---|---|
American Gastroenterological Association Medical Position Statement: Guidelines on Constipation [9] | 31 % | 11 % | 7 % | 44 % | 15 % | 0 % | Not recommended |
Practice Guidelines for the Management of Constipation in adults [10] | 44 % | 22 % | 36 % | 44 % | 25 % | 0 % | Not recommended |
Prevention of constipation in the older adult population [11] | 81 % | 39 % | 58 % | 72 % | 54 % | 54 % | Strongly recommended |
Management of chronic constipation: recommendations from a consensus panel [12] | 39 % | 14 % | 9 % | 53 % | 17 % | 33 % | Not recommended |
Evaluation and Treatment of Constipation in Infants and Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition [13] | 56 % | 31 % | 46 % | 58 % | 31 % | 0 % | Recommended |
Putting evidence into practice:evidence-based inventions for the prevention and management of constipation in patients with cancer [14] | 64 % | 28 % | 45 % | 47 % | 33 % | 0 % | Recommended |
The management of constipation in palliative care: clinical practice recommendations [15] | 56 % | 17 % | 41 % | 67 % | 23 % | 21 % | Not recommended |
Management of constipation [16] | 75 % | 31 % | 63 % | 67 % | 44 % | 29 % | Recommended |
National Consensus on The Management of Constipation in Indonesia 2010 [17] | 56 % | 8 % | 3 % | 69 % | 10 % | 0 % | Not recommended |
Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care [18] | 78 % | 61 % | 50 % | 75 % | 54 % | 71 % | Strongly recommended |
Consensus Recommendations for the Management of Constipation in Patients with Advanced, Progressive Illness [19] | 50 % | 19 % | 40 % | 64 % | 21 % | 50 % | Recommended |
Prucalopride for the treatment of chronic constipation in women [20] | 56 % | 39 % | 33 % | 72 % | 58 % | 50 % | Recommended |
Common views on diagnosis and treatment of chronic constipation with Chinese medicine [21] | 17 % | 8 % | 11 % | 56 % | 23 % | 0 % | Not recommended |
World Gastroenterology Organisation Global Guideline Constipation-A Global Perspective [22] | 36 % | 14 % | 14 % | 47 % | 21 % | 83 % | Not recommended |
50 % | 19 % | 48 % | 50 % | 21 % | 17 % | Not recommended | |
Practical Treatments for Constipation in Korea [25] | 44 % | 11 % | 16 % | 39 % | 21 % | 33 % | Not recommended |
Diagnosis and Treatment Guideline of Chronic Constipation in China [26] | 25 % | 11 % | 15 % | 47 % | 19 % | 0 % | Not recommended |
Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN [27] | 81 % | 25 % | 66 % | 83 % | 23 % | 38 % | Recommended |
Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool [28] | 50 % | 36 % | 22 % | 53 % | 23 % | 38 % | Recommended |
American Gastroenterological Association Medical Position Statement on Constipation [29] | 33 % | 17 % | 25 % | 61 % | 42 % | 25 % | Not recommended |
Lubiprostone for treating chronic idiopathic constipation [30] | 75 % | 39 % | 46 % | 44 % | 38 % | 67 % | Recommended |
Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation [31] | 42 % | 22 % | 15 % | 36 % | 25 % | 42 % | Not recommended |
Total (\( \overline{X} \)±SD) | 51.77 ± 18.24 | 23.73 ± 13.16 | 32.23 ± 19.24 | 56.73 ± 12.91 | 29.14 ± 13.55 | 29.59 ± 25.91 | - |
Appraisal of guidelines
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Domain 6
Overall assessment
Stratification of CPG quality
Subgroups | Scope & Purpose | Stakeholders | Rigour | Clarity | Applicability | Editorial Independence |
---|---|---|---|---|---|---|
Year of publication | ||||||
≤ 2010 (n = 12) | 57.17 ± 15.41 | 26.67 ± 14.93 | 35.92 ± 19.77 | 61.00 ± 11.4 | 32.08 ± 16.62 | 25.67 ± 25.98 |
> 2010 (n = 10) | 45.30 ± 20.18 | 20.20 ± 10.53 | 27.80 ± 18.80 | 51.60 ± 13.34 | 25.67 ± 25.98 | 34.30 ± 26.39 |
P values | 0.146 | 0.249 | 0.337 | 0.096 | 0.247 | 0.451 |
Publication Type | ||||||
Journal (n = 16) | 44.72 ± 15.14 | 18.33 ± 7.88 | 25.72 ± 17.65 | 53.94 ± 12.35 | 24.17 ± 8.30 | 24.83 ± 22.83 |
Database (n = 6) | 68.17 + 14.74 | 38.5 + 12.93 | 47.67 + 11.84 | 62.33 + 14.43 | 45.5 + 12.49 | 45.17 + 26.63 |
P values | 0.003 | 0.01 | 0.004 | 0.239 | 0.007 | 0.134 |
Type of development group | ||||||
Individual (n = 4) | 50.00 ± 16.79 | 22.25 ± 6.95 | 30.75 ± 24.42 | 50.00 ± 13.29 | 27.75 ± 11.47 | 26.00 ± 18.17 |
Medical society (n = 18) | 52.17 ± 19.07 | 24.06 ± 14.39 | 32.59 ± 18.85 | 58.22 ± 12.74 | 29.44 ± 14.17 | 30.39 ± 27.70 |
P values | 0.829 | 0.718 | 0.896 | 0.318 | 0.808 | 0.707 |
Systematic search | ||||||
No (n = 14) | 47.57 ± 16.55 | 19.79 ± 10.70 | 29.50 ± 17.86 | 55.43 ± 11.51 | 26.79 ± 113.64 | 22.00 ± 27.5 |
Yes (n = 8) | 59.13 + 20.01 | 30.63 + 15.07 | 37.00 + 22.5 | 59.00 + 15.70 | 33.25 + 13.02 | 42.88 + 17.03 |
P values | 0.190 | 0.1 | 0.428 | 0.585 | 0.288 | 0.04 |
Financial | ||||||
No (n = 14) | 46.08 ± 15.97 | 19.23 ± 9.74 | 25.31 ± 18.73 | 52.31 ± 10.78 | 23.77 ± 8.63 | 15.08 ± 17.59 |
Yes (n = 8) | 60.00 ± 19.21 | 30.22 ± 15.39 | 42.22 ± 16.22 | 63.11 ± 13.68 | 36.89 ± 15.85 | 50.56 ± 21.48 |
P values | 0.46 | 0.97 | 0.51 | 0.91 | 0.10 | 0.18 |
Evidence-based | ||||||
No (n = 13) | 46.08 ± 15.97 | 19.23 ± 9.74 | 25.31 ± 18.73 | 52.31 ± 10.78 | 23.77 ± 8.63 | 15.08 ± 17.59 |
Yes (n = 9) | 60.00 ± 19.20 | 30.22 ± 15.39 | 42.22 ± 16.22 | 63.11 ± 13.68 | 36.89 ± 15.85 | 50.56 ± 21.48 |
P values | 0.09 | 0.08 | 0.04 | 0.07 | 0.04 | 0.00 |
Discussion
Domain | Scope and purpose | Stakeholder involvement | Rigor of development | Clarity of presentation | Applicability | Editorial independence |
---|---|---|---|---|---|---|
Constipation mean scores | 52 | 24 | 32 | 57 | 29 | 30 |
International mean scores | 64 | 35 | 43 | 60 | 22 | 30 |
Title | Items | Recommendations |
---|---|---|
Prevention of constipation in the older adult population [11] | Practice Recommendations | Assess client history (dietary fibre, medications), Physical activity, Evaluate client response for ongoing interventions |
Education Recommendation | Comprehensive education programs | |
Organization & Policy Recommendations | Establish an interdisciplinary team | |
Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care [18] | History-taking | Stool patterns, Symptoms associated with defecation, History, Timing of onset of constipation and potential precipitating factors, Passage of meconium, Growth and general wellbeing, Symptoms in legs/locomotor development, Abdomen, Diet and fluid intake |
Physical examination | Inspection of perianal area: appearance, position, patency, etc.; Abdominal examination; Spine/lumbosacral region/gluteal examination; Lower limb neuromuscular examination including tone and strength, reflexes | |
Laxatives | Macrogols (Polyethylene glycol3350 + electrolytes), Osmotic laxatives (Lactulose); Stimulant laxatives (Sodium picosulfate, Bisacodyl, Senna) | |
Diet and lifestyle | Infant formula, weaning, insufficient fluid intake; Adequate fluid intake; Adequate fibre | |
Clinical investigations | Endoscopy, Test for coeliac disease and hypothyroidism, Test for coeliac disease and hypothyroidism, plain abdominal radiograph, Transit studies, Rectal biopsy, Ultrasound; biofeedback; Antegrade colonic enema procedure |