Prevalence estimates for chronic constipation(CC) in North America range from10% to 30%. In the United States, approximately2.5 million physician visits annuallymay be due to this disorder; 85% result in alaxative prescription. Cost estimates forOTC laxatives are approximately $800 millionannually. These numbers are probablyunderestimates, however, since many individualsattempt to self-treat this condition.
Traditional treatments for CC lack sustainedefficacy, do not alleviate the constellationof symptoms, and may generateadverse effects. In a recent issue of AlimentaryPharmacology and Therapeutics, J.Johanson, MD, reviewed data from 2 randomized,double-blind, placebo-controlled,international trials of tegaserod for the treatmentof CC. Tegaserod is a serotonin type 4receptor agonist with proven efficacy in thetreatment of women with irritable bowel syndromewith constipation. In 2 studies of 2612patients with CC, responder rates for numberof complete spontaneous bowel movementsin patients taking tegaserod 2 mg or 6mg bid were significantly higher, comparedwith those who received placebo. Statisticallysignificant improvements in secondaryefficacy variables (quality of bowel movements,abdominal bloating and distention)also were evident among tegaserod users,versus those in the placebo groups. Adverseevents with tegaserod were similar to thosewith placebo.