Table 7.
Quality of evidence supporting different pharmacologic agents for constipation-predominant irritable bowel syndrome and chronic constipation
| Pharmacologic agent | Quality of evidence for IBS-C | Quality of evidence for CC |
| Laxatives | ||
| Psyllium | No RCTs | Moderate |
| Docusate sodium | No RCTs | Low |
| Lactulose | No RCTs | Moderate |
| PEG | Moderate | High |
| Senna | No RCTs | Low |
| Bisacodyl | No RCTs | Moderate |
| Prokinetics | ||
| Prucalopride | No RCTs | High |
| Naronapride | No RCTs | Low |
| Velusetrag | Low | Low |
| Rose-010 | Moderate | No RCTs |
| Secretagogues | ||
| Lubiprostone | High | High |
| Linaclotide | High | High |
| Plecanatide | Low | Low |
| Bile acid modulators | ||
| CDC | Low | Low |
| Elobixibat | No RCTs | Moderate |
The quality of evidence was assessed according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system[86], which defines study quality as high (further research is very unlikely to change confidence in the estimated effect); moderate (further research is likely to have an important impact on confidence in the estimated effect and may change the estimate); low (further research is very likely to have an important impact on confidence in the estimated effect and is likely to change the estimate); or very low (any estimate of effect is very uncertain). CC: Chronic constipation; CDC: Chenodeoxycholate; IBS-C: Constipation-predominant irritable bowel syndrome; PEG: Polyethylene glycol; RCT: Randomized controlled trials.