Continuing Medical Education Questions: June 2023 : Official journal of the American College of Gastroenterology | ACG

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CME Questions

Continuing Medical Education Questions: June 2023

Lanspa, Stephen J. MD, FACG

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The American Journal of Gastroenterology 118(6):p 934, June 2023. | DOI: 10.14309/ajg.0000000000002308


Article Title: American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation


After this activity, the participant will be able to describe the pharmacological modalities available for management of chronic idiopathic constipation.


During a routine checkup, a 30-year-old woman reports generally good health but several years of mild constipation. Her family history is negative. Her review suggests a steady weight, an active lifestyle, good fluid intake, and a meat-and-potatoes diet. Her physical exam, including vital signs and rectal exam, is normal. Complete blood count (CBC), thyroid stimulating hormone (TSH), serum electrolytes, and glucose are normal. Which of the following is the most appropriate treatment plan?

  •  A. Increased fluid intake and exercise daily
  •  B. Supplemental psyllium with/without polyethylene glycol (PEG)
  •  C. Stimulant laxative (senna or bisacodyl) daily
  •  D. Secretagogue (lubiprostone, linaclotide, or plecanatide) daily


A 35-year-old woman is referred for chronic constipation. She has had intermittent lower abdominal pain, severe bloating, infrequent stooling (less than twice a week), and a sense of incomplete evacuation for at least 5 years. She tried fiber supplements, and multiple over-the-counter laxatives (PEG, magnesium citrate, bisacodyl) with suboptimal results. She also endorses intermittent nausea and headaches which limit her quality of life. Recent evaluations have included a normal CBC, TSH, serum electrolytes, glucose, and computed tomography of her head. Her review shows a steady weight, an active lifestyle, and a high-fiber diet. She has no family history of colorectal cancer.

Which of the following is the most appropriate treatment plan?

  •  A. Linaclotide
  •  B. Lactulose
  •  C. Lubiprostone
  •  D. Prucalopride


How long has PEG been shown to provide a durable response?

  •  A. Up to 6 weeks
  •  B. Up to 3 months
  •  C. Over 6 months
  •  D. Long-term use is not recommended

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