Year 2016 / Volume 108 / Number 12
Review
Use of polyethylene glycol in functional constipation and fecal impaction

790-806

DOI: 10.17235/reed.2016.4571/2016

Miguel Mínguez, Antonio López Higueras, Javier Júdez,

Abstract
Objective: The objective of this study was to evaluate in an analytical and descriptive manner the evidence published so far on the use of polyethylene glycol (PEG), with or without electrolytes, in the management of functional constipation and the treatment of fecal impaction. Methodology: Search on MEDLINE, EMBASE and Cochrane databases until May 2016 of all publications adjusted to the following terms: constipation AND/OR fecal impaction AND (PEG OR polyethylene glycol OR macrogol OR movicol OR idralax OR miralax OR transipeg OR forlax OR golytely OR isocolan OR mulytely) NOT colonoscopy. Critical reading of selected articles (English or Spanish), sorting their description according to group age (adult/pediatric age) and within those, in accordance with study features (efficacy evaluation versus placebo, doses query, safety, comparison with other laxatives, observational studies and monographic review articles of polyethylene glycol or meta-analysis). Results: Fifty-eight publications have been chosen for descriptive analysis; of them, 41 are clinical trials, eight are observational studies and nine are systematic reviews or meta-analysis. Twelve clinical trials evaluate PEG efficacy versus placebo, eight versus lactulose, six are dose studies, five compare polyethylene glycol with and without electrolytes, two compare its efficacy with respect to milk of magnesia, and the rest of the trials evaluate polyethylene glycol with enemas (two), psyllium (one), tegaserod (one), prucalopride (one), paraffin oil (one), fiber combinations (one) and Descurainia sophia (one). Conclusions: Polyethylene glycol with or without electrolytes is more efficacious than placebo for the treatment of functional constipation, either in adults or in pediatric patients, with great safety and tolerability. These preparations constitute the most efficacious osmotic laxatives (more than lactulose) and are the first-line treatment for functional constipation in the short and long-term. They are as efficacious as enemas in fecal impaction, avoid the need for hospital admission and are well tolerated by patients (mainly when administered without electrolytes).
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References
1. Lacy BE, Mearin F, Chang L, et al. Bowel Disorders. Gastroenterology. 2016; 150: 1393-407. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/27144627
2. Andorsky RI, Goldner F. Colonic lavage solution (polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double-blind, placebo-controlled study. Am J Gastroenterol. 1990; 85(3): 261-5. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/2178398
3. Baldonedo YC, Lugo E, Uzcátegui AA, et al. [Evaluation and use of polyethylene glycol in constipated patients]. G E N. 1991; 45(4): 294-7. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/1843963
4. Klauser AG, Mühldorfer BE, Voderholzer WA, et al. Polyethylene glycol 4000 for slow transit constipation. Z Gastroenterol. 1995; 33(1): 5-8. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/7886986
5. Corazziari E, Badiali D, Habib FI, et al. Small volume isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in treatment of chronic nonorganic constipation. Dig Dis Sci. 1996; 41(8): 1636-42. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/8769292
6. Di Palma J, MacRae D, Reichelderfer M, et al. Braintree polyethylene glycol (PEG) laxative for ambulatory and lomg-term care facility constipation patients: report of randomized, crossover trials. Online J Dig Health. 1999; 1: 1-7.
7. Corazziari E, Badiali D, Bazzocchi G, et al. Long term efficacy, safety, and tolerabilitity of low daily doses of isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in the treatment of functional chronic constipation. Gut. 2000; 46(4): 522-6. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/10716682
8. DiPalma JA, DeRidder PH, Orlando RC, et al. A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol. 2000; 95(2): 446-50. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/10685748
9. Cleveland MV, Flavin DP, Ruben RA, et al. New polyethylene glycol laxative for treatment of constipation in adults: a randomized, double-blind, placebo-controlled study. South Med J. 2001; 94(5): 478-81. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/11372795
10. Di Palma JA, Smith JR, Cleveland M. Overnight efficacy of polyethylene glycol laxative. Am J Gastroenterol. 2002; 97(7): 1776-9. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/12135034
11. Dipalma JA, Cleveland MV, McGowan J, et al. A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. Am J Gastroenterol. 2007; 102(7): 1436-41. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/17403074
12. Chaussade S, Minić M. Comparison of efficacy and safety of two doses of two different polyethylene glycol-based laxatives in the treatment of constipation. Aliment Pharmacol Ther. 2003; 17(1): 165-72. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/12492746
13. Seinelä L, Sairanen U, Laine T, et al. Comparison of polyethylene glycol with and without electrolytes in the treatment of constipation in elderly institutionalized patients: a randomized, double-blind, parallel-group study. Drugs Aging. 2009; 26(8): 703-13. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/19685935
14. Wang HJ, Liang XM, Yu ZL, et al. A Randomised, Controlled Comparison of Low-Dose Polyethylene Glycol 3350 plus Electrolytes with Ispaghula Husk in the Treatment of Adults with Chronic Functional Constipation. Clin Drug Investig. 2004; 24(10): 569-76. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/17523718
15. Di Palma JA, Cleveland MV, McGowan J, et al. A randomized, multicenter comparison of polyethylene glycol laxative and tegaserod in treatment of patients with chronic constipation. Am J Gastroenterol. 2007; 102(9): 1964-71. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/17573794
16. Cinca R, Chera D, Gruss HJ, et al. Randomised clinical trial: macrogol/PEG 3350+electrolytes versus prucalopride in the treatment of chronic constipation -- a comparison in a controlled environment. Aliment Pharmacol Ther. 2013; 37(9): 876-86. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/23480216
17. Culbert P, Gillett H, Ferguson A. Highly effective new oral therapy for faecal impaction. Br J Gen Pract. 1998; 48(434): 1599-600. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/9830188
18. Chen CC, Su MY, Tung SY, et al. Evaluation of polyethylene glycol plus electrolytes in the treatment of severe constipation and faecal impaction in adults. Curr Med Res Opin. 2005; 21(10): 1595-602. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/16238899
19. Tran LC, Di Palma JA. Lack of lasting effectiveness of PEG 3350 laxative treatment of constipation. J Clin Gastroenterol. 2005; 39(7): 600-2. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/16000928
20. Di Palma JA, Cleveland MV, McGowan J, et al. An open-label study of chronic polyethylene glycol laxative use in chronic constipation. Aliment Pharmacol Ther. 2007; 25(6): 703-8. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/17311603
21. Ramkumar D, Rao SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005; 100(4): 936-71. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/15784043
22. Paré P, Fedorak RN. Systematic review of stimulant and nonstimulant laxatives for the treatment of functional constipation. Canadian journal of gastroenterology & hepatology. 2014; 28(10): 549-57. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/25390617
23. Lee-Robichaud H, Thomas K, Morgan J, et al. Lactulose versus Polyethylene Glycol for Chronic Constipation. Cochrane Database Syst Rev. 2010; (7): CD007570. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/20614462
24. Belsey JD, Geraint M, Dixon TA. Systematic review and meta analysis: polyethylene glycol in adults with non-organic constipation. Int J Clin Pract. 2010; 64(7): 944-55. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/20584228
25. Katelaris P, Naganathan V, Liu K, et al. Comparison of the effectiveness of polyethylene glycol with and without electrolytes in constipation: a systematic review and network meta-analysis. BMC Gastroenterol. 2016; 16: 42. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/27029340
26. Attar A, Lémann M, Ferguson A, et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut. 1999; 44(2): 226-30. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/9895382
27. Bouhnik Y, Neut C, Raskine L, et al. Prospective, randomized, parallel-group trial to evaluate the effects of lactulose and polyethylene glycol-4000 on colonic flora in chronic idiopathic constipation. Aliment Pharmacol Ther. 2004; 19(8): 889-99. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/15080850
28. Thomson MA, Jenkins HR, Bisset WM, et al. Polyethylene glycol 3350 plus electrolytes for chronic constipation in children: a double blind, placebo controlled, crossover study. Arch Dis Child. 2007; 92(11): 996-1000. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/17626140
29. Nurko S, Youssef NN, Sabri M, et al. PEG3350 in the treatment of childhood constipation: a multicenter, double-blinded, placebo-controlled trial. J Pediatr. 2008; 153(2): 254-61, 61.e1. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/18534221
30. Gremse DA, Hixon J, Crutchfield A. Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Clin Pediatr (Phila). 2002; 41(4): 225-9. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/12041718
31. Voskuijl W, de Lorijn F, Verwijs W, et al. PEG 3350 (Transipeg) versus lactulose in the treatment of childhood functional constipation: a double blind, randomised, controlled, multicentre trial. Gut. 2004; 53(11): 1590-4. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/15479678
32. Dupont C, Leluyer B, Maamri N, et al. Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children. J Pediatr Gastroenterol Nutr. 2005; 41(5): 625-33. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/16254521
33. Candy DC, Edwards D, Geraint M. Treatment of faecal impaction with polyethelene glycol plus electrolytes (PGE + E) followed by a double-blind comparison of PEG + E versus lactulose as maintenance therapy. J Pediatr Gastroenterol Nutr. 2006; 43(1): 65-70. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/16819379
34. Wang Y, Wang B, Jiang X, et al. Polyethylene glycol 4000 treatment for children with constipation: A randomized comparative multicenter study. Exp Ther Med. 2012; 3(5): 853-6. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/22969980
35. Treepongkaruna S, Simakachorn N, Pienvichit P, et al. A randomised, double-blind study of polyethylene glycol 4000 and lactulose in the treatment of constipation in children. BMC Pediatr. 2014; 14: 153. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/24943105
36. Savino F, Viola S, Erasmo M, et al. Efficacy and tolerability of peg-only laxative on faecal impaction and chronic constipation in children. A controlled double blind randomized study vs a standard peg-electrolyte laxative. BMC Pediatr. 2012; 12: 178. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/23152962
37. Llerena ED, Varea Calderón V, Pujol Muncunill G, et al. [Comparison of the effectiveness and safety of polyethylene glycol with and without electrolytes in the treatment of chronic constipation]. An Pediatr (Barc). 2015. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/26601572
38. Loening-Baucke V, Pashankar DS. A randomized, prospective, comparison study of polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence. Pediatrics. 2006; 118(2): 528-35. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/16882804
39. Ratanamongkol P, Lertmaharit S. Polyethylene glycol 4000 without electrolytes versus milk of magnesia for the treatment of functional constipation in infants and young children: a randomized controlled trial. Asian Biomedicine. 2009; 3(4): 391-9.
40. Rafati M, Karami H, Salehifar E, et al. Clinical efficacy and safety of polyethylene glycol 3350 versus liquid paraffin in the treatment of pediatric functional constipation. Daru. 2011; 19(2): 154-8. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/22615652
41. Nimrouzi M, Sadeghpour O, Imanieh MH, et al. Flixweed vs. Polyethylene Glycol in the Treatment of Childhood Functional Constipation: A Randomized Clinical Trial. Iran J Pediatr. 2015; 25(2): e425. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/26196006
42. Quitadamo P, Coccorullo P, Giannetti E, et al. A randomized, prospective, comparison study of a mixture of acacia fiber, psyllium fiber, and fructose vs polyethylene glycol 3350 with electrolytes for the treatment of chronic functional constipation in childhood. J Pediatr. 2012; 161(4): 710-5.e1. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/22677568
43. Dupont C, Leluyer B, Amar F, et al. A dose determination study of polyethylene glycol 4000 in constipated children: factors influencing the maintenance dose. J Pediatr Gastroenterol Nutr. 2006; 42(2): 178-85. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/16456412
44. Dziechciarz P, Horvath A, Szajewska H. Polyethylene glycol 4000 for treatment of functional constipation in children. J Pediatr Gastroenterol Nutr. 2015; 60(1): 65-8. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/25162362
45. Pashankar DS, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr. 2001; 139(3): 428-32. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/11562624
46. Pashankar DS, Bishop WP, Loening-Baucke V. Long-term efficacy of polyethylene glycol 3350 for the treatment of chronic constipation in children with and without encopresis. Clin Pediatr (Phila). 2003; 42(9): 815-9. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/14686553
47. Hardikar W, Cranswick N, Heine RG. Macrogol 3350 plus electrolytes for chronic constipation in children: a single-centre, open-label study. J Paediatr Child Health. 2007; 43(7-8): 527-31. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/17635680
48. Infante Pina D, Miserachs Barba M, Segarra Canton O, et al. [Safety and efficacy of polyethylene glycol 3350 plus electrolytes for the treatment of functional constipation in children]. An Pediatr (Barc). 2011; 75(2): 89-95. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/21429833
49. Loening-Baucke V, Krishna R, Pashankar DS. Polyethylene glycol 3350 without electrolytes for the treatment of functional constipation in infants and toddlers. J Pediatr Gastroenterol Nutr. 2004; 39(5): 536-9. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/15572895
50. Michail S, Gendy E, Preud'Homme D, et al. Polyethylene glycol for constipation in children younger than eighteen months old. J Pediatr Gastroenterol Nutr. 2004; 39(2): 197-9. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/15269628
51. Alper A, Pashankar DS. Polyethylene glycol: a game-changer laxative for children. J Pediatr Gastroenterol Nutr. 2013; 57(2): 134-40. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/23591910
52. Kuizenga-Wessel S, Benninga MA, Tabbers MM. Reporting outcome measures of functional constipation in children from 0 to 4 years of age. J Pediatr Gastroenterol Nutr. 2015; 60(4): 446-56. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/25406527
53. Gordon M, Naidoo K, Akobeng AK, et al. Cochrane Review: Osmotic and stimulant laxatives for the management of childhood constipation (Review). Evid Based Child Health. 2013; 8(1): 57-109. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/23878124
54. Chen SL, Cai SR, Deng L, et al. Efficacy and complications of polyethylene glycols for treatment of constipation in children: a meta-analysis. Medicine (Baltimore). 2014; 93(16): e65. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/25310742
55. Bekkali NL, van den Berg MM, Dijkgraaf MG, et al. Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG. Pediatrics. 2009; 124(6): e1108-15. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/19948614
56. Miller MK, Dowd MD, Friesen CA, et al. A randomized trial of enema versus polyethylene glycol 3350 for fecal disimpaction in children presenting to an emergency department. Pediatr Emerg Care. 2012; 28(2): 115-9. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/22270500
57. Youssef NN, Peters JM, Henderson W, et al. Dose response of PEG 3350 for the treatment of childhood fecal impaction. J Pediatr. 2002; 141(3): 410-4. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/12219064
58. Boles EE, Gaines CL, Tillman EM. Comparison of Polyethylene Glycol-Electrolyte Solution vs Polyethylene Glycol-3350 for the Treatment of Fecal Impaction in Pediatric Patients. J Pediatr Pharmacol Ther. 2015; 20(3): 210-6. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/26170773
59. Jordan-Ely J, Hutson JM, Southwell BR. Disimpaction of children with severe constipation in 3-4 days in a suburban clinic using polyethylene glycol with electrolytes and sodium picosulphate. J Paediatr Child Health. 2015; 51(12): 1195-8. Accesible en: http://www.ncbi.nlm.nih.gov/pubmed/26059611
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Publication history

Received: 03/08/2016

Accepted: 10/10/2016

Online First: 22/11/2016

Published: 30/11/2016

Article Online First time: 111 days

Article editing time: 119 days


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