Constipation

Grading of Recommendation and Levels of Evidence Category/Grade Definition Grading of Recommendation A B C Levels of Evidence I II III IV V Recommendations supported by two or more level I trials without conflicting evidence from other level I trials Recommendations based on evidence from a single level I trial OR recommendations based on evidence from two or more level II trials with conflicting evidence from other level I trials OR supported by evidence from two or more level II trials Recommendations based on level III evidence RCTs with p < 0.05, adequate sample sizes and appropriate methodology RCTs with p > 0.05, or inadequate sample sizes and/or inappropriate methodology Non-randomized trials with contemporaneous controls Non-randomized trials with historical controls Case series Sources Abbreviations ARM, anorectal manometry; BET, balloon expulsion test; CC, chronic constipation; CCK, cholecystokinin; CTT, colonic transit test; EMG, electromyography; GI, gastrointestinal; IBS-C, irritable bowel syndrome with concurrent constipation; RCT, randomized, controlled trial; SCFA, short-chain fatty acids; WMC, wireless motility capsule Bharucha AE. Constipation. Best Pract Res Clin Gastroenterol. 2007;21(4):709-731. PMID: 17643910 Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol 2005;100(Suppl 1):S5-22. PMID: 16008641 Rao SSC. Approach to the patient with constipation. In: Yamada T, ed. Principles of Clinical Gastroenterology. Oxford, UK: Wiley-Blackwell Publishing; 2008:373-398. Rao SSC, Go JT. Update on the management of constipation in the elderly: new treatment options. Clinical Interv Aging. 2010;5:163-171. PMID: 20711435 Remes-Troche JM, Rao SS. Diagnostic testing in patients with chronic constipation. Curr Gastroenterol Rep. 2006;8(5):416-424. PMID: 16968610 Sackett DL. Rules of evidence and clinical recommendations on use of antithrombotic agents. Chest. 1986;89(2 Suppl):2S-3S. PMID: 3943408 Disclaimer This Guideline attempts to define principles of practice that should produce high-quality patient care. It is applicable to specialists, primary care, and providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, ANMS, nor the authors endorse any product or service associated with the distributor of this clinical reference tool. PRINTCODE 5740 Executive Drive Suite 218 Baltimore, MD 21228 TEL: 410-869-3332 • FAX: 410-744-2150 For additional copies: orders@GuidelineCentral.com Copyright © 2012 All rights reserved

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