Gut relief revisited: plecanatide in chronic idiopathic constipation and irritable bowel syndrome with constipation - a systematic review and meta-analysis with GRADE assessment

Chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) are prevalent gastrointestinal disorders with limited effective treatment options. CIC affects approximately 14% of the population worldwide, particularly women, and is marked by difficult defecation, while IBS-C also includes abdominal pain as a core of symptom. Plecanatide, a guanylate cyclase-C (GC-C) agonist approved in 2017, has shown promise in improving stool consistency and symptoms; however, its optimal therapeutic dose remains unclear.

A comprehensive literature search was conducted through (PubMed, Cochrane CENTRAL, Scopus, Web of Science, and Embase) for randomized controlled trials comparing plecanatide with placebo until August 2025. Primary outcomes included changes in complete spontaneous bowel movements (CSBMs), spontaneous bowel movements (SBMs), and stool consistency.