Natural Treatment for Chronic Constipation in United States Patients

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A partially randomized, comparative effectiveness trial was carried out, evaluating kiwi fruit, psyllium, and prunes in U.S. patients with CC. Randomization was carried out to 3 natural treatments and eligible patients had less than 3 complete spontaneous bowel movements (CSBMs) per week and were randomized to green kiwi fruit (2 per day), prunes
(100 grams per day), or psyllium (12 grams per day), for 4 weeks. The primary endpoint was the
proportion of patients in each group reporting an increase of greater than 1 CSBM per week,
compared with baseline for at least 2 of 4 treatment weeks.

Key secondary outlines included stool frequency, stool consistency and straining assessed daily. Treatment satisfaction and adverse events (AEs) were also measured. Standard statistical measures were used.

A total of 79 patients with CC (mean age 42.7 years, 87% female and 77% white), were partially randomized. Complete data were available for 75 patients. For the primary endpoint, proportions of CSBM responders were similar for the
treatments. For secondary outcomes, comparing treatment weeks 3 and 4 to baseline, there was a significant increase in weekly CSBM rate with all 3 treatments. Stool consistency significantly improved with kiwifruit and prunes and straining significantly improved with kiwifruit, prunes and psyllium. Patients randomized to the kiwi fruit group reported significant improvement in bloating scores. AEs were most common with psyllium and least common with kiwi fruit.

At the end of treatment, a smaller proportion of patients were dissatisfied with kiwifruit, compared with prunes or psyllium.

It was concluded that all 3 improved constipation symptoms in patients with CC, but kiwifruit was associated with the lowest rate of AEs and the lowest rate of dissatisfaction with therapy.

Chey, S., Chey, W., Jackson, K., Eswaran, S. “Exploratory Comparative Effectiveness Trial of Green Kiwifruit, Psyllium, or Prunes in U.S. Patients with Chronic Constipation.” American Journal of Gastroenterology, 2021; Vol. 116, pp. 1304-1312.

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