Dependence-related screening positivity among regular stimulant-laxative users with chronic constipation: a multicenter prospective observational study

BACKGROUND: Chronic constipation is common, and the appropriate use of stimulant laxatives remains challenging. Although dependence due to habitual stimulant-laxative use is frequently observed, the long-term effects of regular use on dependence and tolerance have not been fully elucidated. This study aimed to characterize the clinical features and substance use-related symptoms associated with stimulant-laxative use in patients with chronic constipation. METHODS: This multicenter prospective observational study was conducted at three centers and enrolled patients with chronic constipation, including those meeting the Rome IV criteria. Patients were categorized based on stimulant-laxative use into None (N), Short-term/Rescue (SR), and Regular (R), defined as the use of stimulant laxatives ≥ 3 per week for > 1 year. Substance use-related symptoms were assessed using the CAGE-AID questionnaire (≥ 2 point), and self-reported ICD-11 and DSM-5-TR substance use disorder criteria. RESULTS: A total of 280 patients were included (N = 197, SR = 51, R = 32). Baseline characteristics did not differ significantly among groups. CAGE-AID positivity was 5.1%, 58.8%, and 90.6% in the N, SR, and R groups, respectively. ICD-11 criteria were markedly higher in the R group (65.6%) compared with the N (0%) and SR (11.8%) groups. DSM-5-TR criteria showed a similar pattern (0%, 15.7%, and 65.6%, respectively). The R group consistently demonstrated higher positive screening rates across all tools. CONCLUSIONS: Long-term stimulant-laxative use is associated with increased substance use-related symptoms and features suggestive of habituation in patients with chronic constipation. TRIAL REGISTRATION: The study was registered in the University Hospital Medical Information Network (UMIN000051617) on July 15, 2023.