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Results: 8

Polyethylene Glycol should be used in preference to Lactulose in the treatment of Chronic Constipation.

Constipation is a common clinical problem, encompassing much more than reduced stool frequency. In this review we compared two commonly used osmotic laxatives, Lactulose and Polyethylene Glycol (PEG).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Comparing Drugs for Chronic Constipation

How do the drugs used to treat chronic constipation and irritable bowel syndrome with predominant constipation compare?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: November 1, 2007

There is insufficient evidence to confirm or exclude whether nonabsorbable disaccharides have an effect on patients with hepatic encephalopathy

Nonabsorbable disaccharides (lactulose or lactitol) are considered the treatment of choice for hepatic encephalopathy. When all the identified trials were combined, nonabsorbable disaccharides appeared to have a modest effect on improving encephalopathy. However, this effect was not seen when only trials of high quality were analysed. Antibiotics appeared to be superior to nonabsorbable disaccharides in improving hepatic encephalopathy, but it is unclear whether this difference in treatment effect is important to patients. Too few patients have been randomised to establish whether lactulose and lactitol have comparable effect.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Laxatives for the management of childhood constipation

Constipation within childhood is an extremely common problem. Despite the widespread use of laxatives by health professionals to manage constipation in children, there has been a long standing lack of evidence to support this practice.This review included eighteen studies with a total of 1643 patients that compared nine different agents to either placebo (inactive medications) or each other. The results of this review suggest that polyethylene glycol preparations may increase the frequency of bowel motions in constipated children. Polyethylene glycol was generally safe, with lower rates of minor side effects compared to other agents. Common side effects included flatulence, abdominal pain, nausea, diarrhoea and headache. There was also some evidence that liquid paraffin (mineral oil) increased the frequency of bowel motions in constipated children and was also safe. Common side effects with liquid paraffin included abdominal pain, distention and watery stools. There was no evidence to suggest that lactulose is superior to the other agents studied, although there were no trials comparing it to placebo. The results of the review should be interpreted with caution due to methodological quality and statistical issues in the included studies. In addition, these studies were relatively short in duration and so it is difficult to assess the long term effectiveness of these agents for the treatment of childhood constipation. Long term effectiveness is important, given the often chronic nature of this problem in children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Laxatives or methylnaltrexone for the management of constipation in palliative care patients

Palliative care patients commonly experience constipation. This is as a result of the use of medications (in particular opioids) for pain control, as well as disease, dietary and mobility factors. This review aimed to determine the effectiveness of laxatives for the management of constipation in palliative care patients. Two review authors assessed study quality and extracted data. Seven studies involving 616 people were included. The drugs evaluated were lactulose, senna, danthron combined with poloxamer, misrakasneham and magnesium hydroxide combined with liquid paraffin. Methylnaltrexone, a drug only recently licensed, was also evaluated for this updated review. There is some evidence that methylnaltrexone is effective (in comparison with a placebo) at inducing laxation (bowel relaxation) in patients taking opioids who have not had a good response to conventional laxatives. The evidence in the other studies was more limited due to lack of overlap in laxatives evaluated. Further rigorous, independent trials with longer follow up are needed to evaluate the effectiveness of laxatives, including methylnaltrexone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Probiotics for patients with hepatic encephalopathy

Hepatic encephalopathy is a disorder of the brain function as a result of liver failure and/or portosystemic shunt. It results in confusion, drowsiness, coma, and in some patients, in death. While the cause of hepatic encephalopathy is not fully understood, it is thought to develop as a result of the failure to clear various toxic substances, such as ammonia, from the blood, either because of poor function of the liver cells or because the blood from the intestine is shunted around the liver and is not seen by the liver cells. Protein metabolising bacterial species in the intestine of hepatic encephalopathy patients contribute to ammonia production. Probiotics are live microorganisms who may reduce the prevalence of these harmful ammonia‐producing bacteria. This review identified seven trials of which 550 participants were randomised. Each trial used different types of probiotics. Duration of administration of the experimental intervention varied from 10 days to 180 days. The authors of the review assessed a range of outcomes including death, recovery, adverse events, and quality of life. There was no benefit of probiotics shown for any of the primary outcomes including mortality. The authors of the review found a significant difference in plasma ammonia concentration after one month, and a significant change in plasma ammonia concentration at three months treatment compared with no treatment. However, this finding is of questionable importance. Therefore, the use of probiotics for patients with hepatic encephalopathy cannot be currently recommended. Furtehr randomised clinical trials are required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

No convincing evidence that branched‐chain amino acids have a beneficial effect on patients with hepatic encephalopathy was identified

Hepatic encephalopathy occurs in patients with chronic liver disease or fulminant liver failure and is associated with changes in mental state, ranging from minor signs of altered brain function to deep coma. Treatment with branched‐chain amino acids has been proposed to ameliorate the symptoms. When all the identified trials were combined, branched‐chain amino acids appeared to have a modest effect in improving encephalopathy. However, this effect was not seen when only trials of high quality were included. Thus, this review did not provide convincing evidence to support the use of branched‐chain amino acids for patients with hepatic encephalopathy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Drug treatment for faecal incontinence in adults

Faecal incontinence (inability to control bowel movements or leakage of stool or faeces) is a common healthcare problem, affecting up to one in 10 of adults living at home. This affects daily activities in about one or two in 100 people. It is more common in people living in residential care. Leakage of urine often occurs as well. Faecal incontinence can be debilitating and embarrassing. Treatments include pelvic floor muscle training, electrical stimulation, surgery and drugs. This review looked at drugs for the treatment of faecal incontinence. These included anti‐diarrhoea drugs or laxatives to regulate stools, and drugs to try to enhance the tone of muscle around the anus which help to keep it closed. Sixteen small trials were found, including 558 participants. The review of these trials found some evidence that anti‐diarrhoea drugs may reduce faecal incontinence for people having liquid stools. However, these drugs were associated with some side effects. There was some evidence that drugs to enhance the tone of the muscle around the anus may help, but more research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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