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New Approaches to Treating Chronic Constipation

Summary & Participants

Treating constipation starts with lifestyle changes and laxatives. But when they are not enough, a brand new approach that regulates the transmission of nerve signals in the gut might help.

Medically Reviewed On: March 17, 2005

Webcast Transcript

LAWRENCE R. SCHILLER, MD: The intestine is a very carefully regulated structure. We often don't give it much thought. We eat our food and go about our business without thinking about all the miracles that are happening inside our bodies. The nervous system of the intestine is very complex. There are as many nerve cells in the wall of the intestine as there are in the entire spinal cord.

JOHN F. JOHANSON, MD: We've found that serotonin is an important neurotransmitter or a chemical that facilitates movement of the gut. What happens is the serotonin will stimulate other neurotransmitters which make the colon work the way it should. There're neurotransmitters that cause contraction. There're neurotransmitters that cause relaxation and so what the serotonin does is make that coordinated effort so that downstream the colon will relax, upstream it will contract and move things through.

ANNOUNCER: A new drug targets these nervous-system pathways to combat constipation.

LAWRENCE R. SCHILLER, MD: The newest drug introduced to treat chronic constipation is Zelnorm or tegaserod. This is an agent that mimics the effect of serotonin on a special kind of serotonin receptor in the nerves in the gut. And this is a very specific activity that enhances peristalsis in the intestine.

ANNOUNCER: Tegaserod is approved for patients 65 and under, for periods of up to twelve weeks. Studies show as many as 45 percent of patients experienced an improvement in their constipation using tegaserod, a 17 point increase over the number of patients who improved on a placebo.

JOHN F. JOHANSON, MD: The main side effects that we see in patients with constipation are headache. Some people will get nausea. These are relatively low occurring events, probably less than 5 percent. The headache is a little bit more common. But in clinical practice, I've just not seen that. The third one is diarrhea and that one occurs about 8 to 10 percent of individuals with constipation. Again, in my practice, most of my chronically constipated patients are happy when they get diarrhea.

ANNOUNCER: Only a short time ago, doctors were taught that constipation was usually "in a patient's head." But research has shown the problem is often a disorder of the nervous system. Now, doctors take complaints of constipation seriously. And they have a wide range of therapies to provide relief.

LAWRENCE R. SCHILLER, MD: I think the important message to remember about constipation is that physicians can help many patients who have this problem to reduce their symptoms and allow them to lead fuller lives. We realize now that constipation is a problem that can affect people's quality of life and is something that is deserving of treatment to improve that quality of life. And I urge people who are suffering with this to consult with their doctors to see what can be done to help them with this important problem.

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