The effect of psyllium on chronic constipation in adults, with a special focus on the elderly

Chronic constipation can affect people of all ages, but older people are particularly vulnerable. Based on clinical practice, a high-fiber diet is usually recommended.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202317 Registration no: 2023/179

Question

What systematic reviews have been published regarding the effect of psyllium (as a fiber supplement or bulking agent) on chronic constipation in adults in general and the elderly specifically?

Method

A systematic literature search was performed using the following databases: Medline (Ovid), CINAHL (EBSCO), and Embase.

Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Six relevant systematic reviews were identified, of which one focused on the elderly [1–6]. The risk of bias was considered to be high in all reviews, therefore the results and conclusions are not reported.

References

  1. Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol. 2005;100 Suppl 1:S5-S21.
  2. Fleming V, Wade WE. A review of laxative therapies for treatment of chronic constipation in older adults. Am J Geriatr Pharmacother. 2010;8(6):514-50. Available from: https://doi.org/10.1016/S1543-5946(10)80003-0.
  3. McRorie JW, Jr., Fahey GC, Jr., Gibb RD, Chey WD. Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation. J Am Assoc Nurse Pract. 2020;32(1):15-23. Available from: https://doi.org/10.1097/JXX.0000000000000346.
  4. Mueller-Lissner SA, Wald A. Constipation in adults. BMJ Clin Evid. 2010;2010.
  5. Ramkumar D, Rao SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005;100(4):936-71. Available from: https://doi.org/10.1111/j.1572-0241.2005.40925.x.
  6. van der Schoot A, Drysdale C, Whelan K, Dimidi E. The Effect of Fiber Supplementation on Chronic Constipation in Adults: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Clin Nutr. 2022;116(4):953-69. Available from: https://doi.org/10.1093/ajcn/nqac184.

Search strategies

Medline via OvidSP 27 March 23

Title: Treatment of constipation with psyllium

/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. exp constipation/ 15,917
2. (Constipation or obstipation or gut transit time).mp. or ((stool* or bowel movement*) adj4 (output* or hard or frequency or infrequent or consistency or difficult)).ti,ab,kf. 37,886
3. 1 or 2 37,886
Intervention:
4. Plantago/ 978
5. Psyllium/ 729
6. Laxatives/ 1,784
7. dietary fiber/ 19,467
8. exp Plants, Medicinal/ 62,320
9. exp Herbal Medicine/ 2,489
10. exp Dietary Supplements/ 98,656
11. (Psyllium or lspaghula or Ispagula or Plantago or Semen Plantaginis or Metamucil or Plantaglucide or lspaghule Gum or lsogel or Reguval).ti,ab,kf. 2,429
12. (herbal medicine* or traditional medical therap* or over-the-counter or dietary supplement* or fiber).ti,ab,kf. 241,811
13. laxative*.ti,ab,kf. 6,290
14. 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 403,193
Study types: systematic reviews and meta-analysis
15. (Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/) 423,008
Combined sets:
16. 3 and 14 5,513
17. 15 and 16 308
Final result
18. 17 308

CINAHL via EBSCO 27 March 2023

Title: Treatment of constipation with psyllium

TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); MH = Exact subject heading, indexed keywords; TX = All text; PT = Publication type; Nn = Near. Proximity operator retrieving terms within n words from each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TI(Constipation or obstipation or gut transit time or ((stool* or ‘bowel movement*) N3 (output* or hard or frequency or infrequent or consistency or difficult))) OR AB(Constipation or obstipation or gut transit time or ((stool* or ‘bowel movement*) N3 (output* or hard or frequency or infrequent or consistency or difficult))) OR SU(Constipation or obstipation or gut transit time or ((stool* or ‘bowel movement*) N3 (output* or hard or frequency or infrequent or consistency or difficult))) 12,614
Intervention:
2. MH "Cathartics+" 6,938
3. MH "Medicine, Herbal" 14,836
4. MH "Dietary Supplements+" 36,479
5. MH "Dietary Fiber" 8,331
6. TI(Psyllium or lspaghula or Ispagula or Plantago or Semen Plantaginis or Metamucil or Plantaglucide or lspaghule Gum or lsogel or Reguval) OR AB(Psyllium or lspaghula or Ispagula or Plantago or Semen Plantaginis or Metamucil or Plantaglucide or lspaghule Gum or lsogel or Reguval) OR SU(Psyllium or lspaghula or Ispagula or Plantago or Semen Plantaginis or Metamucil or Plantaglucide or lspaghule Gum or lsogel or Reguval) 526
7. TI(herbal medicine* or traditional medical therap* or over-the-counter) OR AB(herbal medicine* or traditional medical therap* or over-the-counter) OR SU(herbal medicine* or traditional medical therap* or over-the-counter) 24,111
8. TI(dietary supplement* or dietary supplements or fiber or laxative*) OR AB(dietary supplement* or dietary supplements or fiber or laxative*) OR SU(dietary supplement* or dietary supplements or fiber or laxative*) 92,962
9. S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 127,511
Study types: systematic reviews and meta-analysis
10. ((TI((systematic N3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic N3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic N3 review) OR "meta analys*" OR metaanalys*)) OR (PT "Systematic Review" OR PT "meta analysis")) NOT (MH "Case Studies" OR PT "Commentary" OR PT "Editorial" OR PT "Letter") 232,692
Combined sets:
11. S1 AND S9 2,829
12. S10 AND S11 212
Final result
13. S12 212

Embase via Elsevier 27 March 23

Title: Treatment of constipation with psyllium

/de = Term from the EMTREE controlled vocabulary; /exp = Term from the EMTREE controlled vocabulary, including all narrower terms in the hierarchy; ti = Title; ab = Abstract; kw = Author keywords; it = Publication type; NEAR/n = Near. Proximity operator retrieving terms within n words from each other.; * = Truncation; ‘ ‘ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. 'constipation'/exp 110884
2. constipation:ti,ab,kw OR obstipation:ti,ab,kw OR 'gut transit time':ti,ab,kw OR (((stool* OR 'bowel movement*') NEAR/4 (output* OR hard OR frequency OR infrequent OR consistency OR difficult)):ti,ab,kw) 60614
3. 1 or 2 126349
Intervention:
4. 'plantago ovata'/de 351
5. 'laxative'/exp 194840
6. 'diet supplementation'/de 99300
7. 'herbaceous agent'/de 59774
8. psyllium:ab,ti,kw OR ispagula:ab,ti,kw OR lspaghula:ab,ti,kw OR plantago:ab,ti,kw OR 'semen plantaginis':ab,ti,kw OR metamucil:ab,ti,kw OR plantaglucide:ab,ti,kw< 3256
9. 'herbal medicine':ti,ab,kw OR 'traditional medical therap*':ti,ab,kw OR 'over-the-counter':ti,ab,kw OR 'dietary supplement*':ti,ab,kw OR fiber:ti,ab,kw 271534
10. 'laxative*':ti,ab,kw 10541
11. 4 or 5 or 6 or 7 or 8 or 9 or 10 596367
Study types: systematic reviews and meta-analysis
12. ('systematic review'/de OR 'meta analysis'/de OR [cochrane review]/lim OR ((systematic NEAR/4 review):ti,ab) OR 'meta analys*':ti,ab OR metaanalys*:ti,ab) NOT ('case report'/de OR 'editorial'/it OR 'letter'/it OR 'note'/it) 624238
Combined sets:
13. 3 and 11 17373
14. 12 and 13 950
Final result
15. 14 950
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