[Chronic constipation in the practice of a therapist: Features of therapy for comorbidity]

To evaluate the clinical efficacy of laxatives with different pharmacological effects in the combination therapy in patients with chronic constipation (CC) concurrent with obesity, hypertensive disease, and type 2 diabetes mellitus (DM).

A total of 110 people (45 men, 65 women) aged 45 to 72 years with CC in the presence of concomitant diseases: grade 1 or 2 hypertensive disease + obesity + type 2 DM. The investigators determined the severity of abdominal pain syndrome and flatulence, by indicating the mean frequency of defecations per week and fecal consistency according to the Bristol stool scale; anthropometric parameters; serum biochemistry tests; and serum lipoprotein phenotyping. Quality of life was assessed by the SF-36 questionnaire. The patients were divided into 3 groups according their use of agents: 1) dietary fiber (psyllium); 2) osmotic laxatives (disaccharides); 3) osmotic laxatives (polyethylene glycol).

The patients taking psyllium to treat constipation showed an increasing frequency of defecations and normalization of stool consistency. Incorporating psyllium into combination therapy was accompanied by a significant decrease in the levels of total cholesterol and low-density lipoprotein cholesterol. A similar trend was observed for serum triglycerides. The patients receiving combination therapy including other laxatives displayed no significant differences between lipid metabolic parameters at the beginning and after the end of treatment.

The whole complex of properties of psyllium (Mucofalk) can be fully realized in patients with comorbidity and chronic constipation, which is accompanied not only by the normalization of bowel emptying, but also by marked positive changes in the main lipid metabolic parameters and by a reduction in overweight.