Elobixibat Versus Prucalopride in Functional Constipation: A Prospective Comparative Effectiveness Study.
Emergingsuggested applicable standard· American Gastroenterological Association & American College of Gastroenterology, "American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation" (Chang L, Chey WD, Imdad A, et al.), 2023
Decision at stakethe choice of second-line therapy in functional constipation
No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.
Our full summary of this standard
In adults with chronic idiopathic constipation, the AGA-ACG panel makes 10 GRADE-based pharmacological recommendations, and the strength tier is part of the recommendation. Unqualified as to prior therapy: STRONG recommendation (moderate certainty) for polyethylene glycol; STRONG recommendation (moderate certainty) for bisacodyl or sodium picosulfate, but explicitly qualified as short-term or rescue therapy; CONDITIONAL suggestion for fiber supplementation (low certainty), magnesium oxide (very low certainty), and senna (low certainty). Reserved for patients who do not respond to, fail, or are intolerant of over-the-counter agents: STRONG recommendation (moderate certainty) for linaclotide, plecanatide, and prucalopride; CONDITIONAL suggestion for lubiprostone (low certainty) and lactulose (very low certainty). The guideline states no specific doses, no mandatory ordering algorithm, and no fixed trial duration; it notes only that nonpharmacological therapies 'often represent the initial steps in management' and directs clinicians to shared decision making incorporating patient preference, cost, and availability. The guideline explicitly does not cover anorectal evacuation disorders, referring those to the ACG 2021 benign anorectal guideline.