American Gastroenterological Association medical position statement on constipation.

This document presents the official recommendations of the American Gastroenterological Association (AGA) on onstipation. It was drafted by the AGA Institute Medical Poition Panel, reviewed by the Clinical Practice and Quality Mangement Committee, and approved by the AGA Institute Govrning Board. This medical position statement is published in onjunction with a technical review1 on the same subject, and nterested readers are encouraged to refer to this publication for n-depth considerations of topics covered by these questions. he technical review was begun before the AGA’s decision to dopt the GRADE system. However, a GRADE methodologist orked with the authors and panel to rank the quality of the vidence and strength of recommendations. The medical position statement presents information by ddressing clinically related questions and summarizing key oints from the technical review. When specific recommendaions about medical interventions or management strategies for atients with constipation are stated, the “strength of recomendation” and the “quality of evidence” are provided. The trength of recommendation is either judged as “weak” or strong” and quality of evidence is ranked as high, moderate, ow, or very low in accordance with GRADE criteria. Recomendations are highlighted by appearing within a text box. A trong recommendation implies that, based on available evience, the benefits outweigh risks and there is less variability in atient’s values and preferences. A weak recommendation imlies that benefits, risks, and the burden of intervention are ore closely balanced, or appreciable uncertainty exists in reards to patient’s values and preferences. Applying this aproach, high-quality evidence does not always result in strong ecommendations and, conversely, strong recommendations ay emerge from lower-quality evidence. Symptoms of constipation are extremely common; the prevlence is approximately 16% in adults overall and 33% in adults lder than 60 years. Many people seek medical care for constiation, but fortunately most do not have a life-threatening or isabling disorder and the primary need is for control of sympoms, although rare, life-threatening, or treatable conditions ust be excluded. If therapeutic trials of laxatives fail, specialzed testing should be considered. We suggest the following ractice guidelines for the symptom of constipation; our ratioale for these guidelines is supported by the accompanying echnical review. Constipation is a symptom that can rarely be associated with ife-threatening diseases. Current recommendations will relate o (1) rational and, where possible, more judicious diagnostic pproaches and (2) more rational and efficacious therapies that ill improve symptoms, both of which should have beneficial scal and logistic impacts on the health care system. Although he overall classification of chronic constipation into 3 categoies (ie, normal transit, isolated slow transit, and defecatory isorders) and several recommendations in this version are imilar to the prior version, there are 3 substantive changes. irst, these guidelines recommend assessment of colonic transit t a later stage, that is, only for patients who do not have a efecatory disorder or patients with a defecatory disorder that as not responded to pelvic floor retraining. Second, the evience supporting these recommendations has been evaluated sing the GRADE system, in which the strength of recommenation is rated as strong or weak and the quality of evidence is ated as high, moderate, low, or very low. Third, therapeutic ecommendations have been updated to include newer agents nd delete certain older agents.