(May 28, 2008 - Insidermedicine) Prucalopride, a selective 5-hydroxytryptamine type 4 receptor agonist, safely and effectively increases bowel movement frequency in adults with chronic constipation, according to a clinical trial in the New England Journal of Medicine.

Here are some recommendations for the use of endoscopy from the American Society for Gastrointestinal Endoscopy:

•    Patients with constipation should undergo colonoscopy if they have rectal bleeding, heme-positive stool, iron deficiency anemia, weight loss, obstructive symptoms, recent onset of constipation, rectal prolapse, or change in stool caliber.

•    Chronic constipation may be a risk factor for colorectal cancer. Patients complaining of constipation who are over the age of 50 and who have not previously had colon cancer screening should have a colonoscopy.

•    In younger patients, flexible sigmoidoscopy may be adequate.

Researchers from the Mayo Clinic in Rochester randomized 620 adults with chronic constipation, defined as having two or fewer bowel movements per week, to daily treatment with 2 mg of prucalopride, 4 mg of prucalopride, or a placebo.

Over 12 weeks, about 47% of patients in each of the prucalopride treatment groups had an increase in the number of complete, spontaneous bowel movements of one or more per week, compared with only 26% in the placebo group. Approximately 30% of prucalopride-treated patients but only 12% of placebo-treated patients had three or more bowel movements per week. The drug was well-tolerated, with no significant cardiovascular effects encountered.

We had a chance to speak with Dr. Michael Camilleri, one of the primary investigators of this study, who offered some further insight for clinicians.

Today's research highlights the efficacy of a low dose of prucalopride for safely improving both the symptoms of constipation and patients' self-reported disease-related quality of life.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.