Best Practices for the Management of Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation: A Roundtable Discussion and Review.

Abstract

Chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) are highly prevalent conditions that affect a significant proportion of the US population. Pathogenic, diagnostic, and treatment paradigms for patients with constipation have changed considerably over time. A clinical roundtable consisting of experts from across the United States was convened (virtually) to discuss the burden of constipation and current evidence-based diagnostic and management tools at a mechanistic level, with a primary goal of determining realistic clinical strategies to improve outcomes in patients with CIC or IBS-C. This 4-part supplement provides a critical review and discussion of the burden of illness and strategies for the diagnosis and management of CIC and IBS-C. These common and bothersome disorders of gut–brain interaction present a spectrum of stool-related symptoms such as infrequent bowel movements, hard stools, excessive straining, and an overall sensation of incomplete evacuation or obstruction. In addition, patients commonly report a variety of non‒stool-related abdominal symptoms that are often directly related to the patients' severity of CIC or IBS-C. The overlapping symptomatology of CIC and IBS-C have a significant impact on health-related quality of life, with individuals reporting frustration, shame, and embarrassment, along with an overall sense of helplessness. Many patients cycle through multiple treatment options in an attempt to manage their abdominal symptoms and to regulate bowel frequency and stool consistency. For healthcare providers, central to the management of patients with CIC or IBS-C is the utilization of a patient-centered communication approach that ensures understanding of symptom type and intensity, accurate symptom reporting, and compliance to treatment. Although treatment strategies for patients with CIC and IBS-C can often be challenging—with many patients unaware of available treatment options and instead choosing to self-medicate with diet or over-the-counter strategies—it is vital that patients are educated about symptomatology and available treatments, actively monitored for changes in symptom severity and response to treatment, and appropriately managed to maximize clinical outcomes such as patient adherence and cost benefit. My colleagues and I hope that this supplement provides practitioners, such as gastroenterologists, and the medical community at-large with a better understanding of the burden and unmet needs of patients with CIC or IBS-C. With this recognition, we hope to improve management outcomes. CONFLICTS OF INTEREST Guarantor of the article: Darren M. Brenner, MD. Specific author contributions: Darren M. Brenner moderated and participated in the advisory board discussions, contributed to the drafting of the manuscript, provided critical revision of all manuscript drafts for important intellectual content, and approved the final version for publication. Financial support: This supplement was funded by Salix Pharmaceuticals, Inc. Potential competing interests: D.M.B. is a consultant, advisor, and/or speaker for Salix, AbbVie (Allergan), Ironwood, Takeda, RedHill, Alnylam, AlphaSigma, Bayer, Arena Pharmaceuticals, GI Health Foundation, IFFGD, and the Rome Foundation. His research is sponsored by an unrestricted grant from the Irene D. Pritzker Foundation.