Senna Versus Magnesium Oxide for the Treatment of Chronic Constipation: A Randomized, Placebo-Controlled Trial

<jats:sec> <jats:title>INTRODUCTION:</jats:title> <jats:p>This is the first prospective, double-blinded, randomized, placebo-controlled trial to evaluate the safety and efficacy of a stimulant laxative compared with an osmotic agent for the treatment of chronic idiopathic constipation.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS:</jats:title> <jats:p>Patients were randomly administered stimulant laxative (senna, 1.0 g), osmotic agent (magnesium oxide [MgO], 1.5 g), or placebo for 28 consecutive days. The primary endpoint was overall symptom improvement. Secondary endpoints were spontaneous bowel movement (SBM), complete SBM, and patient assessment of constipation quality of life (QOL).</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS:</jats:title> <jats:p>Ninety patients (mean age, 42 years; 93% women; mean duration of symptoms, 9.9 years) were enrolled; all completed the study. The response rate for overall improvement was 11.7% in the placebo group, 69.2% in the senna group, and 68.3% in the MgO group (<jats:italic toggle="yes">P</jats:italic> < 0.0001). Change in SBM was significantly greater in the senna and MgO groups than that in the placebo group (<jats:italic toggle="yes">P</jats:italic> < 0.001). Similarly, change in complete SBM was significantly greater in the senna and MgO groups than that in the placebo group (<jats:italic toggle="yes">P</jats:italic> < 0.01). On the patient assessment of constipation QOL, significant improvements were seen in the senna and MgO groups compared with those in the placebo group (senna, <jats:italic toggle="yes">P</jats:italic> < 0.05; MgO, <jats:italic toggle="yes">P</jats:italic> < 0.001). The frequency of severe treatment-related adverse events was 0%.</jats:p> </jats:sec> <jats:sec> <jats:title>DISCUSSION:</jats:title> <jats:p>Senna and MgO significantly improved the frequency of bowel movements and QOL score and seem to be effective in the treatment of constipation.</jats:p> </jats:sec>