Abstract
BackgroundPolyethylene glycol is commonly used to manage constipation and is available with or without electrolytes. The addition of electrolytes dates back to its initial development as lavage solutions in preparation for gastrointestinal interventions. The clinical utility of the addition of electrolytes to polyethylene glycol for the management of constipation is not established.The objective of this systematic review and network meta-analysis (NMA) was to assess the relative effectiveness of polyethylene glycol with (PEG + E) or without electrolytes (PEG) in the management of functional constipation in adults.MethodsA systematic review was conducted to identify randomised controlled clinical trials that assessed the use of polyethylene glycol in functional constipation. The primary outcome was the mean number of bowel movements per week.ResultsNineteen studies were included in the NMA (PEG N = 9, PEG + E N = 8, PEG versus PEG + E N = 2; involving 2247 patients). PEG and PEG + E are both effective, increasing the number of bowel movements per week by 1.8 (95 % Crl 1.0, 2.8) and 1.9 (95 % Crl 0.9, 3.0) respectively versus placebo and by 1.8 (95 % Crl 0.0, 3.5) and 1.9 (95 % Crl 0.2, 3.6) respectively versus lactulose. There was no efficacy difference between PEG + E and PEG (0.1, 95 % Crl −1.1, 1.2) and there were no differences in safety or tolerability.ConclusionsPolyethylene glycol with and without electrolytes are effective and safe treatments for constipation in adults. The addition of electrolytes to polyethylene glycol does not appear to offer any clinical benefits over polyethylene glycol alone in the management of constipation.
Highlights
Polyethylene glycol is commonly used to manage constipation and is available with or without electrolytes
After review of the abstracts, 36 full-text publications were assessed of which 20 studies were included in the final systematic review and 19 in the network meta-analysis (NMA) [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]
Our results suggest that both polyethylene glycol without electrolytes (PEG) and PEG + E are more effective than lactulose a result that is consistent with other meta-analyses [7, 32, 33]
Summary
Polyethylene glycol is commonly used to manage constipation and is available with or without electrolytes. Constipation may adversely impact quality of life and increase the use of Polyethylene glycol, a minimally absorbed osmotic laxative, is commonly used to manage constipation in both adults and children. It is a mixture of different sized compounds with an approximate mean molecular weight of either 3350 or 4000 g/mol and is available in formulations with the addition of electrolytes (PEG + E) or without electrolytes (PEG). Its use is not associated with marked shifts in water from the body, as it essentially only binds with water that is orally ingested [4] As it lacks any electrical charge, it does not influence the movement of other solutes [3]. It is expected to exert its full osmotic effect with fewer side effects (such as bloating and flatulence) than the nonabsorbable sugar laxatives, as there is no fermentative production of intestinal gas [4, 5]
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