Elobixibat alleviates chronic constipation in hemodialysis patients: a questionnaire-based study

Background Hemodialysis patients are prone to constipation, which can adversely affect their quality of life (QOL). Elobixibat, a highly selective inhibitor of the ileal bile acid transporter, can increase the bile acid level in the colon and, subsequently, enhance colonic motility and secretion. In hemodialysis patients with chronic constipation, it may have a novel action mechanism. However, the effect of elobixibat on such patients' QOL had not been reported. This study aimed to evaluate the effect of elobixibat on the QOL of hemodialysis patients with chronic constipation. Methods This was a multicenter, observational study that used the Japanese version of the Patient Assessment of Constipation-Quality of Life (PAC-QOL) questionnaire on 27 patients (18 men and nine women, age range 47-90 years), who satisfied the Rome 3 diagnostic criteria for functional constipation and were already taking other drugs for constipation. These patients were administered elobixibat 10 mg/day and were asked to respond to the PAC-QOL questionnaire at baseline and after 4 weeks. Bayesian statistics were used to confirm our results. Results The number of spontaneous bowel movements per week increased significantly from 2.6 +/- 1.2 to 4.1 +/- 2.1 (p < 0.001), and the Bristol Stool Form Scale score significantly improved from 1.9 +/- 0.8 to 3.6 +/- 0.7 (p < 0.001). The Cronbach's alpha was 0.95, and the Guttman split-half reliability coefficient was 0.90. There were significant decreases in the physical discomfort scores from 1.94 +/- 0.79 to 0.97 +/- 0.72 (p < 0.001); psychosocial discomfort from 1.16 +/- 0.93 to 0.63 +/- 0.58 (p < 0.001); worries/ concerns from 1.84 +/- 0.73 to 1.27 +/- 0.59 (p < 0.001), and satisfaction from 2.79 +/- 0.61 to 1.98 +/- 0.77 (p < 0.001). The total PAC-QOL score significantly decreased from 1.83 +/- 0.79 to 1.17 +/- 0.56 (p < 0.001). Bayesian statistics confirmed the results' significance. Conclusions Elobixibat reduced the PAC-QOL scores for hemodialysis patients with chronic constipation and improved the patients' QOL. It may serve as a new option for treating constipation in hemodialysis patients.