We agree with the comments by Lisi on the lack of a "gold standard" in evaluating constipation. For this reason, we choose the treatment of the disorder, through the use of laxatives, as the case definition for the study outcome, on the grounds that people with constipation are much more likely to be given laxatives than those without constipation.1 Only doses actually administered, not scheduled, or as occasion requires were used in the analysis. We attempted to control for the possible confounders in this study through measuring mobility with an activities of daily living scale and mental status through the Folstein Mini-Mental State Examination. As correctly pointed out, we were unable to control for diet, motility disorders, and inflammation. Nonetheless, there is no reason to expect that these variables were differentially distributed among patients and control subjects. In fact, it is more likely that these factors were nondifferentially distributed,
Monane M, Avorn J, Beers MH, Everitt DE. Drug-Induced Constipation-Reply. Arch Intern Med. 1994;154(4):465–468. doi:10.1001/archinte.1994.00420040143020
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