Prevalence estimates for chronic constipation (CC) in North America range from 10% to 30%. In the United States, approximately 2.5 million physician visits annually may be due to this disorder; 85% result in a laxative prescription. Cost estimates for OTC laxatives are approximately $800 million annually. These numbers are probably underestimates, however, since many individuals attempt to self-treat this condition.
Traditional treatments for CC lack sustained efficacy, do not alleviate the constellation of symptoms, and may generate adverse effects. In a recent issue of Alimentary Pharmacology and Therapeutics, J. Johanson, MD, reviewed data from 2 randomized, double-blind, placebo-controlled, international trials of tegaserod for the treatment of CC. Tegaserod is a serotonin type 4 receptor agonist with proven efficacy in the treatment of women with irritable bowel syndrome with constipation. In 2 studies of 2612 patients with CC, responder rates for number of complete spontaneous bowel movements in patients taking tegaserod 2 mg or 6 mg bid were significantly higher, compared with those who received placebo. Statistically significant improvements in secondary efficacy variables (quality of bowel movements, abdominal bloating and distention) also were evident among tegaserod users, versus those in the placebo groups. Adverse events with tegaserod were similar to those with placebo.