#45 Polyethylene Glycol (PEG) for Paediatric and Adult Chronic Constipation
CLINICAL QUESTION
How effective is Polyethylene Glycol (PEG) in paediatric and adult chronic constipation?
BOTTOM LINE
In adults and paediatric patients with chronic constipation, PEG is as or more effective than other agents. Compared to placebo, it relieves constipation in one in every 2-3 patients and adds 1-3 bowel movements per week. Maintenance treatment up to 24 weeks appears to be effective and safe in pediatric patients.
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EVIDENCE
At least ten systematic reviews of constipation with PEG versus other laxatives and/or placebo (range 5-25 trials, 594-2310 participants 2-52 weeks long):1-10
- Adults outcomes, statistically significant:
- PEG versus placebo:1,2,3,4
- Relief of constipation: Number Needed to Treat (NNT)=2-3.
- Increased stool frequency: 2-3 more per week.
- PEG versus lactulose:3,5
- Increased stool frequency by 1-2 more per week; reduced need for additional interventions.
- PEG versus placebo:1,2,3,4
- Paediatrics outcomes, statistically significant:
- PEG versus placebo:6,7
- Increased stool frequency: 1.5 to 3 more per week.
- PEG versus lactulose:5,6,7
- Increased stool frequency: 0.7 to 1.5 more per week.
- Increased likelihood of successful disimpaction: NNT 5
- PEG versus milk of magnesia:7
- Increase in stool frequency: 0.7 more per week.
- Multiple outcomes improved such as resolved constipation, reduced abdominal pain, and reduced need for additional interventions.5,7
- One review found no difference between PEG and other laxatives but excluded relevant studies.8
- PEG versus placebo:6,7
- Other reviews found similar.9,10
- Chronic constipation impacts quality of life similar to diabetes and stable ulcerative colitis.15
- Compared to lactulose, PEG may be better tolerated2 and is cost effective16 at approximately $1.00 per day (at 17 grams/day).
- Although types of PEG vary in trials, this seems to have little impact on success.5,6
- Current guidelines recommend PEG as the first line agent in paediatric17,18 and adult constipation.19
- In reviews of multiple agents versus placebo, PEG has better evidence (versus senna or docusate)2 or better NNT (than psyllium or prucalopride).1,2
- Dosing:
- Adults, 17 grams daily.6
- Paediatrics, 0.6 grams/kg/day (or 5-12 grams/day).6
- Higher PEG doses (0.7 grams/kg/day) increases stool frequency over lower doses (0.3 grams/kg/day) by 1-2 more per week with no increase in adverse effects or fecal incontinence.5
- Titrate doses to symptom relief and adverse events (diarrhea).
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