From the Guidelines
For constipation in patients on PEG feeds, the best approach is to start with osmotic laxatives such as polyethylene glycol (Miralax) at a dose of 17g mixed in 4-8 ounces of water given daily through the feeding tube, as recommended by the American Gastroenterological Association and supported by recent studies 1. This approach is based on the strongest and most recent evidence, which suggests that polyethylene glycol is effective in increasing bowel movements and improving stool form in patients with chronic constipation. Some key points to consider when managing constipation in patients on PEG feeds include:
- Ensuring adequate hydration by providing additional water flushes through the feeding tube
- Considering the use of fiber supplements, such as psyllium, to help promote regular bowel movements
- Monitoring bowel movements regularly to adjust the treatment plan as needed
- Being aware of potential side effects of laxatives, such as bloating, flatulence, and diarrhea, and adjusting the treatment plan accordingly It's also important to note that constipation in tube-fed patients can occur due to a variety of factors, including immobility, medication side effects, inadequate fluid intake, and insufficient fiber in the feeding formula. Therefore, a comprehensive approach that addresses these underlying factors and incorporates regular monitoring and adjustment of the treatment plan is essential for effective management of constipation in patients on PEG feeds, as supported by studies 1.
From the Research
Treatment Options for Constipation on PEG Feeds
- Polyethylene glycol (PEG) is a commonly used laxative for treating constipation, and its effectiveness has been studied in various populations, including children 2, 3, 4, 5, 6.
- Senna, a stimulant laxative, has been shown to be effective in treating constipation in children with anorectal malformations, and may be considered as an alternative to PEG 2.
- The choice of laxative may depend on individual patient needs and circumstances, such as age, medical history, and presence of other health conditions.
Efficacy of Polyethylene Glycol
- PEG has been shown to be effective in treating functional constipation in both adults and children, with a good safety profile and high tolerability 3, 4, 5, 6.
- PEG is considered a first-line treatment for functional constipation in children, and is recommended for both disimpaction and maintenance treatment 6.
- The efficacy of PEG is dose-dependent, and the optimal dose may vary depending on individual patient needs 4, 6.
Comparison with Other Laxatives
- PEG has been compared to other laxatives, such as lactulose, and has been shown to be more efficacious in some studies 5.
- Senna has been compared to PEG in one study, and was found to be more effective in treating constipation in children with anorectal malformations 2.
- The choice of laxative may depend on individual patient needs and circumstances, and may involve consideration of factors such as efficacy, safety, and tolerability.