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.