Abstract
BackgroundAccording to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy.MethodsDuring a 2-month period, 52 Italian gastroenterologists recorded clinical data of FC, IBS-C and NRC patients, using Bristol scale, PAC-SYM and PAC-QoL questionnaires. In addition, gastroenterologists were also asked to record whether the patients were clinically assessed for CC for the first time or were in follow up. Diagnostic tests and prescribed therapies were also recorded.ResultsEight hundred seventy-eight consecutive CC patients (706 F) were enrolled (FC 62.5%, IBS-C 31.3%, NRC 6.2%). PAC-SYM and PAC-QoL scores were higher in IBS-C than in FC and NRC. 49.5% were at their first gastroenterological evaluation for CC. In 48.5% CC duration was longer than 10 years. A specialist consultation was requested in 31.6%, more frequently in IBS-C than in NRC. Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. Faecal calprotectin, thyroid tests, celiac serology, breath tests were more frequently suggested in IBS-C and anorectal manometry in FC. More than 90% had at least one treatment suggested on chronic constipation, most frequently dietary changes, macrogol and fibers. Antispasmodics and psychotherapy were more frequently prescribed in IBS-C, prucalopride and pelvic floor rehabilitation in FC.ConclusionsPatients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. Digital rectal examination was often not performed but at least one diagnostic test was prescribed to most patients. Colonoscopy and blood tests were the “first line” diagnostic tools. Macrogol was the most prescribed laxative, and prucalopride and pelvic floor rehabilitation represented a “second line” approach. Diagnostic tests and prescribed therapies increased by increasing CC severity.
Highlights
According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C)
Study population and questionnaires Fifty two gastroenterologists belonging to different gastroenterological units in Italy on behalf of the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO), recorded clinical and demographic data of all patients consecutively referred for CC in a two month period (September-October 2013)
According to Rome III criteria the patients were classified as FC: 549 (62.5%); IBS-C: 275 (31.3%); No Rome constipation (NRC): 54 (6.2%)
Summary
According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). A considerable amount (16 to 40%) of CC patients in different countries use laxatives, and their use is related to increasing age, symptom frequency and duration of constipation; in the USA more than $800 million are spent on laxatives each year [10, 11]. The most widely used criteria to assess CC are the Rome Criteria [12] (Table 1) which separate constipation in functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients consider themselves constipated even when not showing signs or symptoms consistent with Rome criteria (here defined as “NoRome Constipation”, NRC) [13]
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