Mo1078 Management of Chronic Constipation by Gastroenterologists

Abstract

Background: Constipation is a common symptom, encountered by primary care physicians (PCPs) and gastroenterologists (GIs). We recently examined the management of chronic constipation by PCPs, and found that only a minority of PCPs use established criteria for diagnosis. PCPs were found to rarely use published imagery to improve accuracy of patient reported stool form. It also gave an insight into the preferred 1st-line laxatives used by PCPs. This follow up study focused on GIs to understand their approach to management of chronic constipation and to compare it with PCPs. Methods: 129 PCPs had participated in the earlier survey. In this study 27 GIs from 3 large urban teaching community hospitals in NYC were surveyed. Both surveys (PCP & GI) were multiple-choice questionnaires that addressed similar issues about prevalence and diagnosis of constipation. However, additional questions focused on management were included for specialists. Responses between groups were compared. Results: Prevalence differed between groups. The majority of GIs reported a prevalence of 15-20% while the majority of PCPs reported 20-25%. Reported usage of Rome classification criteria for GIs vs PCPs was 63% vs 29% respectively. Bristol images for stool consistency were not widely used in either group (38% of GIs and 13% of PCPs). 54% of patients encountered by GIs report using OTC laxatives. Whereas ,20% of patients reported using OTC laxatives to 73% of PCPs. 37% of GIs initiated further work up for constipation in patients who failed a trial of laxatives. Only 11% of PCPs referred their patients to GIs if patients did not respond to initial laxative use. The preferred 1st-line choice of laxatives for GIs was Polyethylene Glycol whereas for PCPs it was Bisacodyl. 69% of GIs and 70% of PCPs recommend colonoscopy only if the patient presents with alarm symptoms in conjunction with constipation. Most of the PCPs (75%) and GIs (74%) were aware of Melanosis Coli and counseled their patients regarding the stimulant laxative induced side effect. Most GIs modified their prep for colonoscopy in patients with chronic constipation. The most common modification was a 2 day liquid diet before Polyethylene Glycol. 80% of PCPs were satisfied with the assistance they received from their GI counterparts in the management of constipation. 30% of GIs routinely coordinate care with PCPs to optimize therapy. Conclusion: This study highlighted differences between PCPs and GIs in diagnosis and treatment of chronic constipation. In comparison to GIs only a minority of PCPs use established criteria to diagnose constipation. Managing patients with chronic conditions like constipation requires reassurance and well coordinated care by all members of their medical team. This survey should initiate the process for further improving care and coordination in the management of chronic constipation.