Association between Anticholinergic Burden and Constipation: A Systematic Review

Area of Science:

• Pharmacology
• Gastroenterology
• Evidence-Based Medicine

Background:

• The relationship between anticholinergic medication use and constipation is not well-established.
• Anticholinergic drugs are commonly prescribed, and constipation is a frequent side effect.

Purpose of the Study:

• To systematically review the existing literature on the association between anticholinergic burden and constipation.
• To synthesize findings from studies investigating this correlation.

Main Methods:

• A systematic review was conducted across five major databases (Medline, Embase, Cochrane, CINAHL, Scopus) from January 2006 to December 2020.
• Eleven studies (six cross-sectional, four retrospective cohort, one RCT post hoc analysis) involving 211,921 patients were included after screening 2507 articles.
• Data extraction was performed independently by two researchers.

Main Results:

• Nine of the 11 included studies reported a statistical association between anticholinergic burden and constipation.
• A total of 13 positive associations were found out of 24 measurements.
• The association was demonstrable in studies encompassing 207,795 patients, though most studies had limitations in design and adjustment for confounders.

Conclusions:

• A correlation between anticholinergic burden and constipation appears to exist.
• Higher quality evidence is required, particularly studies that account for confounding factors like non-pharmacological causes of constipation.