Reader responds to "review of the treatment options for chronic constipation".

TL;DRAbstract

To the Editor: I appreciate reading “Review of the Treatment Options for Chronic Constipation” by Dr. J.F. Johanson,[1] a well-known expert on drug treatment of this disease. It is a well-written editorial thoroughly examining a commonly neglected functional disease, though perceived as disabling by patients. However, I feel that some points need to be raised on the nonpharmacologic treatment of chronic constipation. Dr. Johanson's statement of the general poor quality of research studies related to biofeedback needs some refinement. It has been historically correct. However, we published last year in Gastroenterology (2006;130:657-664) a randomized controlled trial (RCT) showing that biofeedback therapy was effective treatment in normal-transit constipation secondary to dyssynergic defecation, where macrogol was not. The number of patients included (over 100 and not 54, as erroneously cited) and the posttreatment follow-up (up to 24 months) were both adequate and comparable to many

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