Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis.

BACKGROUND: Functional constipation is a common functional bowel disorder in the community, which has a varying prevalence across cross-sectional surveys. We did a contemporaneous systematic review and meta-analysis of studies using comparable methodology and all iterations of the Rome criteria to estimate the global prevalence of functional constipation. METHODS: In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Embase Classic from Jan 1, 1990, to Dec 31, 2020, to identify population-based cross-sectional studies comprising at least 50 participants that reported the prevalence of functional constipation in adults (age 18 years and older) according to Rome I, II, III, or IV criteria. We excluded studies that reported the prevalence of functional constipation in convenience samples. We extracted prevalence estimates of functional constipation from eligible studies, according to the study criteria used to define it. For each study, we extracted data for country; method of data collection; criteria used to define functional constipation; whether the study used the Rome I, II, III, or IV diagnostic questionnaires or approximated these definitions of the condition using another questionnaire; the total number of participants providing complete data; age; the number of participants with the condition; the number of male and female participants; and the number of male and female participants with the condition. We calculated pooled prevalence, odds ratios (OR), and 95% CIs. FINDINGS: Of 8174 citations evaluated, 45 studies fulfilled the eligibility criteria, representing 80 separate populations and comprising 275 260 participants. The pooled prevalence of functional constipation was 15·3% (95% CI 8·1-24·4, I2=99·4%) in studies using the Rome I criteria, 11·2% (7·9-14·9; I2=99·6%) in studies that used Rome II criteria, 10·4% (6·5-14·9; I2=99·8%) in those that used Rome III criteria, and 10·1% (8·7-11·6; I2=98·2%) when Rome IV criteria were used. Prevalence of functional constipation was higher in women, irrespective of the Rome criteria used (OR 2·40 [95% CI 2·02-2·86] for Rome I, 1·94 [1·46-2·57] for Rome II, and 2·32 [1·85-2·92] for Rome III; no studies using Rome IV criteria reported prevalence by sex). There was significant heterogeneity between studies in all of our analyses, which persisted even when the same criteria were applied and similar methodologies used. INTERPRETATION: Even when uniform symptom-based criteria are used to define the presence of functional constipation, prevalence varies between countries. Thus, environmental, cultural, ethnic, dietary, or genetic factors can influence reporting of symptoms. Future studies should aim to elucidate reasons for this geographical variability. FUNDING: None.

Positioning of Bristol Stool Form Scale type 3 in constipation treatment satisfaction: A multicenter study in Japan.

BACKGROUND AND AIM: Many patients are not satisfied with chronic constipation (CC) treatments. The aim of this study was to identify factors linked to CC treatment satisfaction or dissatisfaction. METHODS: Our study population included patients who received CC treatment at a clinic or hospital. CC was diagnosed by a physician based on the patient's complaint. Treatment satisfaction was evaluated using the 28th question of the Patient Assessment of Constipation Quality of Life questionnaire. RESULTS: We conducted this study at 28 facilities. We included 167 patients (mean age 66.7 ± 15.2 years, male:female ratio is 1:3.07). Sixty-eight (40.7%) of patients were satisfied with their constipation treatment. Treatment dissatisfaction of CC was significantly associated with frequency of bowel movement <3/week (odds ratio [OR] = 0.376, 95% confidence interval [CI]: 0.156-0.904, P = 0.029) or Bristol Stool Form Scale (BSFS) type 3 (OR = 0.401, 95% CI: 0.170-0.946, P = 0.037). CONCLUSIONS: Our study showed that CC patients with BSFS type3 were not satisfied with constipation treatment. In general, BSFS types 3-5 are defined as normal stools. Therefore, BSFS type 3 may be set as a treatment goal even though the patient is not satisfied. The pathophysiology of CC differs by region and patient background. Therefore, parameters used to define successful treatment will be different by patient or region. We should reconsider the positioning of BSFS type 3 to improve treatment satisfaction for CC.

Constipation Predominant Irritable Bowel Syndrome and Functional Constipation Are Not Discrete Disorders: A Machine Learning Approach.

INTRODUCTION: Chronic constipation is classified into 2 main syndromes, irritable bowel syndrome with constipation (IBS-C) and functional constipation (FC), on the assumption that they differ along multiple clinical characteristics and are plausibly of distinct pathophysiology. Our aim was to test this assumption by applying machine learning to a large prospective cohort of comprehensively phenotyped patients with constipation. METHODS: Demographics, validated symptom and quality of life questionnaires, clinical examination findings, stool transit, and diagnosis were collected in 768 patients with chronic constipation from a tertiary center. We used machine learning to compare the accuracy of diagnostic models for IBS-C and FC based on single differentiating features such as abdominal pain (a "unisymptomatic" model) vs multiple features encompassing a range of symptoms, examination findings and investigations (a "syndromic" model) to assess the grounds for the syndromic segregation of IBS-C and FC in a statistically formalized way. RESULTS: Unisymptomatic models of abdominal pain distinguished between IBS-C and FC cohorts near perfectly (area under the curve 0.97). Syndromic models did not significantly increase diagnostic accuracy (P > 0.15). Furthermore, syndromic models from which abdominal pain was omitted performed at chance-level (area under the curve 0.56). Statistical clustering of clinical characteristics showed no structure relatable to diagnosis, but a syndromic segregation of 18 features differentiating patients by impact of constipation on daily life. DISCUSSION: IBS-C and FC differ only about the presence of abdominal pain, arguably a self-fulfilling difference given that abdominal pain inherently distinguishes the 2 in current diagnostic criteria. This suggests that they are not distinct syndromes but a single syndrome varying along one clinical dimension. An alternative syndromic segregation is identified, which needs evaluation in community-based cohorts. These results have implications for patient recruitment into clinical trials, future disease classifications, and management guidelines.

Biopsychosocial Model and Perceived Constipation Severity According to the Constipation Phenotype.

PURPOSE: Constipation is a frequent complaint of patients with functional bowel disorders. The present study aimed to evaluate the relationship between the perceived constipation severity with demographics, clinical, physiological, and psychological parameters in constipated patients. PATIENTS AND METHODS: Four hundred seven constipated patients were included and had clinical, physiological, and psychological evaluation. The self-reported severity of constipation was analyzed using stepwise linear regression in the total population and within each clinical group. RESULTS: The patients were mainly of female gender (81%) and were 47.4 ± 16.5 years old. They complained of IBS (65%), and 62% had defecation disorders. The depression scale was abnormal in 200 patients (49%). The relationships of the constipation severity varied according to the Rome IV phenotype. In all phenotypes, it was positively associated with bloating severity, and negatively with Bristol stool form. In IBS patients, perceived constipation severity was also associated with abdominal pain severity. CONCLUSION: Our data support the hypothesis that perceived constipation severity is associated with clinical and physiological factors but not demographics and psychological factors. Besides, the relationships of perceived constipation severity with these factors vary according to clinical phenotypes.

[Joint interpretation of 2017 edition of expert consensus on classification and clinical strategy of constipation and guide for surgical diagnosis and treatment of constipation (2017 edition)].

The 2017 edition of expert consensus onclassification and clinical strategy of constipation was released in March 2018. This artide makes a joint interpretation of it with the Guideline for surgical diagnosis and treatment of constipation (2017 edition). The similarities and differences between the two mainly include: (1) The concept of constipation is basically the same, the main difference is that the consensus puts forward the association between constipation and mental disorders. (2) For constipation in terms of etiology, examination methods and evaluation, the consensus does not mention the etiology, but the examination methods are completely consistent. The reference standard of mental and psychological assessment is added in the consensus. (3) For the diagnosis of constipation, the diagnostic criteria and classification of constipation are specified in the guideline, and only the classification of constipation is mentioned briefly, while the consensus further develops the three different degrees of constipation. (4) For the treatment of constipation, the basic principles are the same. In the description of the specific treatment plan, the guideline divides the treatment methods of constipation into two categories: non-surgical treatment and surgical treatment, and then focuses on the suitability and specific operation of surgical treatment, while the consensus focuses more on coping strategies and treatment options for different degrees of constipation, including how to deal with the unavoidable mental and psychological disorders in the diagnosis and treatment of constipation questions. It can be seen that the consensus is a supplement and improvement of the guideline for surgical diagnosis and treatment of constipation. The consensus provides more targeted and applicable clinical reference ideas for clinical practice from different perspectives, especially the better auxiliary clinical decision-making after the quantification of the classification standard of constipation.

Subtype classification of functional constipation in children: polyethylene glycol versus lactulose.

BACKGROUND: This study aimed to evaluate the usefulness, from a therapeutic perspective, of classifying the subtypes of functional childhood constipation using a colon transit time (CTT) test. METHODS: A total of 190 children were enrolled in this study, which was based on data collected from a defecation diary, a CTT test, and medical records. RESULTS: Polyethylene glycol (PEG) 4000 was prescribed in 51.1% (N = 47/92) of normal transit type constipation cases (NT) and 91.8% (N = 90/98) of abnormal transit type constipation cases (P < 0.001). In terms of the subtype of CTT test, PEG 4000 was prescribed in 51.1% (N = 47/92) of NT cases, 96.2% (N = 25/26) of outlet obstruction type cases (OT), and 90.3% (N = 65/72) of slow transit type cases (ST) (P < 0.001). Polyethylene glycol 4000 was administered in 97.2% (N = 35/36) of the fecal incontinence group and 66.2% (N = 102/154) of the non-fecal incontinence group (P < 0.001). In the non-fecal incontinence group, PEG 4000 was prescribed in 47.3% (N = 40/84) of NT cases, 94.4% (N = 17/18) of OT cases, and 86.5% (N = 45/52) of ST cases (P < 0.001). In the fecal incontinence group, PEG 4000 was prescribed in 87.5% (N = 7/8) of NT cases, 100% (N = 8/8) of OT cases, and 100% (N = 20/20) of ST cases (P = 0.165). CONCLUSIONS: Subtype classification of functional constipation based on the CTT test provides important information for the initial choice of drugs in children.

An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation.

Introduction: Chronic constipation is highly prevalent, affecting between 10% and 15% of the population. The Rome IV criteria categorizes disorders of chronic constipation into four subtypes: (a) functional constipation, (b) irritable bowel syndrome with constipation, (c) opioid-induced constipation, and (d) functional defecation disorders, including inadequate defecatory propulsion and dyssynergic defecation. The initial management approach for these disorders is similar, focusing on diet, lifestyle and the use of standard over-the-counter laxatives. If unsuccessful, further therapy is tailored according to subtype.Areas covered: This review covers the definition, epidemiology, diagnostic criteria, investigations and management of the Rome IV disorders of chronic constipation.Expert opinion: By adopting a logical step-wise approach toward the diagnosis of chronic constipation and its individual subtypes, clinicians have the opportunity to tailor therapy accordingly and improve symptoms, quality of life, and patient satisfaction.

Comparison of subjective and objective measures of constipation - Employing a new method for categorizing gastrointestinal symptoms.

INTRODUCTION: Correlations between subjective and objective measures of constipation have seldom been demonstrated. This could be due to multiple confounding factors in clinical studies and the broad span of symptoms represented in questionnaires used to assess constipation. We developed a new method for categorizing gastrointestinal (GI) symptoms into relevant symptom groups, and used this in a controlled experimental study aimed to investigate whether GI transit times and colonic volumes were correlated to self-reported GI symptoms. METHODS: Twenty-five healthy male participants were enrolled in a randomized, double-blinded, placebo-controlled, five-day crossover study with the treatments oxycodone and placebo. Objective measures of GI transit times and colonic volumes were obtained by the means of the 3D-Transit System and magnetic resonance colonography, whereas subjective GI symptoms were measures via three validated questionnaires. The symptoms were then categorized into five groups; "abdominal symptoms", "defecation difficulties", "incomplete bowel evacuation", "reduced bowel movement frequency", and "stool symptoms". Spearman's rank order correlation was used to determine correlations between the five groups of symptoms and the objective measures. RESULTS: No correlations between the GI symptoms and transit times or colonic volumes were found (all P > 0.05). DISCUSSION: GI transit times and colonic volumes were not correlated to self-reported GI symptoms even in a controlled experimental study and when symptoms were categorized into relevant symptom groups. Thus, both subjective and objective measures must be considered relevant when assessing constipation in clinical and research settings, ensuring that both physiological aspects as well as the severity and impact of symptoms experienced by patients can be assessed.

Painful or Mild-Pain Constipation? A Clinically Useful Alternative to Classification as Irritable Bowel Syndrome with Constipation Versus Functional Constipation.

PURPOSE: Abdominal pain is not used to characterize constipated patients. This study aimed to compare clinical, psychological, and physiological features in patients with IBS-constipation (IBS-C) with those in patients with functional constipation (FC) according to the intensity of abdominal pain. METHODS: All patients filled a standard Rome III questionnaire. In addition, they indicated the intensity of constipation, diarrhea, bloating, and abdominal pain on a 10-point Likert scale, and their stool form with the Bristol Stool Form Scale. Anxiety and depression were assessed with the Beck Depression Inventory and the State-Trait Anxiety Inventory. Physiological evaluation included anorectal manometry and total and segmental colonic transit time. MAIN RESULTS: A total of 546 consecutive patients, 245 with IBS-C and 301 with FC, were included. Painful constipation (PFC) was found by cluster analysis and subsequently defined as having a value over four on the Likert scale for abdominal pain. PFC was found in 67% of IBS-C patients and in 22% of FC patients. PFC patients have digestive disorders with greater frequency and report higher levels of constipation and bloating, despite similar stool form. They have higher scores of depression, state and trait anxiety, and shorter terminal transit time than mild-pain constipated patients. Compared to IBS-C patients, PFC patients report higher levels of abdominal pain (P < 0.001). Psychological and physiological parameters were similar in PFC and IBS-C patients. CONCLUSION: Painful constipation and mild-pain constipation could be an alternative way to identify constipated patients than using the diagnosis of IBS-C and FC for clinical evaluation and drug studies.

Guía de práctica clínica: síndrome del intestino irritable con estreñimiento y estreñimiento funcional en adultos: concepto, diagnóstico y continuidad asistencial. (Parte 1 de 2) / Clinical practice guidelines: irritable bowel syndrome with constipation and functional constipation in adults: concept, diagnosis, and healthcare continuity. (Part 1 of 2)

En esta Guía de práctica clínica analizamos el manejo diagnóstico y terapéutico de pacientes adultos con estreñimiento y molestias abdominales, bajo el espectro del síndrome del intestino irritable y el estreñimiento funcional. Tienen una importante repercusión personal, sanitaria y social, afectando a la calidad de vida de los pacientes que las padecen. En el síndrome del intestino irritable con predomino del estreñimiento, este es la alteración deposicional predominante junto con dolor abdominal recurrente, hinchazón y distensión abdominal frecuente. El estreñimiento se caracteriza por la dificultad o la escasa frecuencia en las deposiciones, acompañado por esfuerzo excesivo durante la defecación o sensación de evacuación incompleta. La mayoría no tienen una causa orgánica subyacente, considerándose un trastorno funcional intestinal. Poseen muchas similitudes clínicas y fisiopatológicas, con respuesta similar del estreñimiento a fármacos comunes. La diferencia fundamental es la presencia o ausencia de dolor, pero no de un modo evaluable como «todo o nada». La gravedad depende tantro de la intensidad de los síntomas intestinales como de otros factores: asociación de síntomas gastrointestinales y extraintestinales, grado de afectación, formas de percepción y comportamiento. Los criterios de Roma diagnostican los trastornos funcionales intestinales. Esta Guía está adaptada a los criterios de Roma IV (mayo de 2016) y analiza, en esta primera parte, los criterios de alarma, las pruebas diagnósticas y los criterios de derivación entre Atención Primaria y Aparato Digestivo. En una segunda parte, se revisarán las alternativas terapéuticas disponibles (ejercicio, dieta, tratamientos farmacológicos, neuroestimulación de raíces sacras o cirugía), efectuando recomendaciones prácticas para cada una de ellas (AU)

In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; «all or nothing». The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them (AU)

[Diet and lifestyle rules in chronic constipation in adults: From fantasy to reality ]. / Les règles hygiéno-diététiques dans la constipation chronique de l'adulte : du fantasme à la réalité .

Chronic constipation is one of the most common chronic gastrointestinal complaints and a frequent reason for consultation. Lifestyle modification and dietary advice attract a lot of patients, often dissatisfied with a long-term drug intake. These behavioral modifications are recommended as a first-line approach in the treatment of chronic mild constipation in the majority of current guidelines despite a low level of evidence. Fiber supplementation is probably the most relevant measure because of a satisfactory level of proof. It improves stool frequency and consistency. It has a positive effect on excessive straining and colonic transit time. The recommended daily fiber intake is at least 20 to 25g. To avoid side effects like bloating and abdominal pain, it must be gradually adjusted after a several days period. The benefice of increasing water intake or daily physical exercise in the treatment of chronic constipation have a lack of evidence, except specific situations such as elderly, hospitalized, institutionalized, dehydrated people or people consuming fluids less than 500mL/day. Change in environmental defecation conditions or bowel habits are probably anecdotal recommendations.

Guía de práctica clínica: síndrome del intestino irritable con estreñimiento y estreñimiento funcional en adultos: concepto, diagnóstico y continuidad asistencial. (Parte 1 de 2) / Clinical practice guidelines: irritable bowel syndrome with constipation and functional constipation in adults: concept, diagnosis, and healthcare continuity. (Part 1 of 2)

En esta Guía de práctica clínica analizamos el manejo diagnóstico y terapéutico de pacientes adultos con estreñimiento y molestias abdominales, bajo el espectro del síndrome del intestino irritable y el estreñimiento funcional. Tienen una importante repercusión personal, sanitaria y social, afectando a la calidad de vida de los pacientes que las padecen. En el síndrome del intestino irritable con predomino del estreñimiento, este es la alteración deposicional predominante junto con dolor abdominal recurrente, hinchazón y distensión abdominal frecuente. El estreñimiento se caracteriza por la dificultad o la escasa frecuencia en las deposiciones, acompañado por esfuerzo excesivo durante la defecación o sensación de evacuación incompleta. La mayoría no tienen una causa orgánica subyacente, considerándose un trastorno funcional intestinal. Poseen muchas similitudes clínicas y fisiopatológicas, con respuesta similar del estreñimiento a fármacos comunes. La diferencia fundamental es la presencia o ausencia de dolor, pero no de un modo evaluable como «todo o nada». La gravedad depende tantro de la intensidad de los síntomas intestinales como de otros factores: asociación de síntomas gastrointestinales y extraintestinales, grado de afectación, formas de percepción y comportamiento. Los criterios de Roma diagnostican los trastornos funcionales intestinales. Esta Guía está adaptada a los criterios de Roma IV (mayo de 2016) y analiza, en esta primera parte, los criterios de alarma, las pruebas diagnósticas y los criterios de derivación entre Atención Primaria y Aparato Digestivo. En una segunda parte, se revisarán las alternativas terapéuticas disponibles (ejercicio, dieta, tratamientos farmacológicos, neuroestimulación de raíces sacras o cirugía), efectuando recomendaciones prácticas para cada una de ellas

In this Clinical practice guide, an analysis is made of the diagnosis and treatment of adult patients with constipation and abdominal discomfort, under the spectrum of irritable bowel syndrome and functional constipation. These have an important personal, health and social impact, affecting the quality of life of these patients. In irritable bowel syndrome with a predominance of constipation, this is the predominant change in bowel movements, with recurrent abdominal pain, bloating and frequent abdominal distension. Constipation is characterised by infrequent or difficulty in bowel movements, associated with excessive straining during bowel movement or sensation of incomplete evacuation. There is often no underling cause, with an intestinal functional disorder being considered. They have many clinical and pathophysiological similarities, with a similar response of the constipation to common drugs. The fundamental difference is the presence or absence of pain, but not in a way evaluable way; 'all or nothing'. The severity depends on the intensity of bowel symptoms and other factors, a combination of gastrointestinal and extra-intestinal symptoms, level of involvement, forms of perception, and behaviour. The Rome criteria diagnose functional bowel disorders. This guide is adapted to the Rome criteria IV (May 2016) and in this first part an analysis is made of the alarm criteria, diagnostic tests, and the criteria for referral between Primary Care and Digestive Disease specialists. In the second part, a review will be made of the therapeutic alternatives available (exercise, diet, drug therapies, neurostimulation of sacral roots, or surgery), making practical recommendations for each one of them

Distinct Abnormalities of Small Bowel and Regional Colonic Volumes in Subtypes of Irritable Bowel Syndrome Revealed by MRI.

OBJECTIVES: Non-invasive biomarkers which identify different mechanisms of disease in subgroups of irritable bowel syndrome (IBS) could be valuable. Our aim was to seek useful magnetic resonance imaging (MRI) parameters that could distinguish each IBS subtypes. METHODS: 34 healthy volunteers (HV), 30 IBS with diarrhea (IBS-D), 16 IBS with constipation (IBS-C), and 11 IBS with mixed bowel habit (IBS-M) underwent whole-gut transit and small and large bowel volumes assessment with MRI scans from t=0 to t=360 min. Since the bowel frequency for IBS-M were similar to IBS-D, IBS-M and IBS-D were grouped together and labeled as IBS non-constipation group (IBS-nonC). RESULTS: Median (interquartile range): fasting small bowel water content in IBS-nonC was 21 (10-42), significantly less than HV at 44 ml (15-70), P<0.01 as was the postprandial area under the curve (AUC) P<0.01. The fasting transverse colon volumes in IBS-C were significantly larger at 253 (200-329) compared with HV, IBS-nonC whose values were 165 (117-255) and 198 (106-270) ml, respectively, P=0.02. Whole-gut transit time for IBS-C was prolonged at 69 (51-111), compared with HV at 34 (4-63) and IBS-D at 34 (17-78) h, P=0.03. Bloating score (VAS 0-10 cm) correlated with transverse colon volume at t=405 min, Spearman r=0.21, P=0.04. CONCLUSIONS: The constricted small bowel in IBS-nonC and the dilated transverse colon in IBS-C point to significant differences in underlying mechanisms of disease.

Using the Bristol Stool Scale and Parental Report of Stool Consistency as Part of the Rome III Criteria for Functional Constipation in Infants and Toddlers.

OBJECTIVES: To evaluate among parents of infants and toddlers the agreement between parental report and the Bristol Stool Scale (BSS) in assessing stool consistency and the effect of both methods on determining the prevalence of functional constipation (FC) according to the Rome III criteria. STUDY DESIGN: Parents of children ≤48 months of age who were seen for a well-child visit completed a questionnaire about their child's bowel habits during the previous month. Cohen kappa coefficient (κ) was used to measure intrarater agreement between parental report of stool consistency ("hard," "normal," "soft/mucous/liquid") and the BSS (types 1-2, hard; types 3-5, normal; types 6-7, loose/liquid). The prevalence of FC was assessed based on the questionnaire according to the Rome III criteria, comparing both methods of stool consistency assessment. RESULTS: Parents of 1095 children (median age, 15 months; range, 1-48) were included. Only fair agreement existed between the 2 methods of stool consistency assessment (κ = 0.335; P < .001). According to the Rome III criteria, using parental report the prevalence of FC was 20.5% and using the BSS the prevalence was 20.9% (P = .87). The agreement between these 2 methods for assessing the prevalence of FC was excellent (κ = 0.95; P < .001). CONCLUSIONS: Only fair agreement exists between the BSS and parental report of stool consistency among parents of infants and toddlers. Different methods of stool consistency assessment did not result in a difference in the prevalence of FC.

[Constipation and cancer: Current strategies]. / Constipation et cancer : stratégies actuelles.

Digestive disorders, in particular constipation, are symptoms very often reported by cancer patients as having a major impact on their quality of life. An accurate diagnosis of bowel delayed transit and defecation disorders is required to best adapt therapeutic management. Constipation associated with cancer may be related to several causes, which can be placed in three nosological categories that sometimes overlap: chronic constipation prior to cancer and having its own evolution; constipation related to the cancer condition, in particular the occlusive syndrome, and constipation induced by cancer therapies. The stricter application of diet and lifestyle measures is often necessary and sometimes sufficient. Laxative drug treatments come under various galenic forms and administration routes and must be selected according to the clinical features of constipation. Surgical management can be indicated in case of ileus or pelvic static disorders. In the case of refractory constipation induced by opioids and within the framework of palliative care to treat an advanced pathology, a peripheral morphinic antagonist can offer fast symptom relief. A way forward to improve the patients' quality of life could be to identify the contributing factors (in particular, genetic factors) to determine which patients are the more at risk and anticipate their management.

Analysis of the Chaotic Characteristics of Human Colonic Activities and Comparison of Healthy Participants to Costive Subjects.

Constipation is a common yet distressing disease that has high rates of morbidity and impacts patients' quality of life. However, there is no perfect method to distinguish costive patients from healthy subjects. Is there chaos in human colonic activities? Are there any differences for the chaos indicators of colonic activities between healthy and costive subjects? Can these indicators distinguish patients with constipation from healthy subjects? To answer these questions, colonic pressure data from 16 healthy subjects and 48 patients with constipation were analyzed using the chaos theory. Three chaotic indicators [i.e., the largest Lyapunov exponent (LyE), correlation dimension (CorDim), and Kolmogorov entropy (KoEn)] were calculated and compared between groups with the Wilcoxon rank sum test. As a result, the LyE was greater than zero and the CorDim was fractioned, which showed that human colonic activities have clear chaotic characteristics. Statistically significant differences were observed between groups for CorDim (p < 0.05), whereas LyE did not show statistically significant differences between groups. The chaotic indicator of CorDim was able to differentiate between patients with constipation and healthy subjects. The chaos theory provides a new method for learning the nonlinear dynamics of human gastrointestinal activities.

Categorization of Functional Constipation in Traditional Persian Medicine: A Descriptive Study.

Functional constipation (FC) is a common clinical condition without any specific physiological causes with economic cost and adverse effects on patients' quality of life. The present study aimed to evaluate the causes of nonobstructive constipation in traditional Persian medicine and its prevalence in patients with functional constipation by content analysis of patients' interviews and clinical exams. In this study, almost two thirds of the patients with functional constipation had mild to severe cold distemperament of the gastrointestinal system, and in almost half of them the signs and symptoms were compatible with dry distemperament of the gastrointestinal. This observational study reports high prevalence of gastrointestinal system distemperaments in patients with functional constipation. According to the results, we can consider the proposed management of distemperaments in traditional Persian medicine for functional constipation treatment and pathophysiology explanation. This project is a novel study that provides the opportunity for investigating the epidemiological aspects of these distemperaments and their relationship with functional constipation.

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease?

PURPOSE: Constipation and incontinence are significant problems following pull-through surgery for Hirschsprung disease (HD). There is evidence that these problems improve with time. However, there is also evidence showing no improvements and furthermore, significant long-term data are lacking for the newer endorectal pull-through. We aim to determine if there is clinical evidence that show improvements in functional outcomes with time after an endorectal pull-through surgery for HD. METHODS: We utilized the validated pediatric incontinence and constipation scoring system (PICSS) to score 51 consecutive children 3 months to 15 years posttransabdominal or transanal endorectal pull-through for HD. Cases of total colonic aganglionosis and Down syndrome were excluded. PICSS scores below the age-specific lower limit 95% confidence interval scores represent incomplete continence or constipation, respectively. We performed linear regression to analyze the relationship between PICSS scores and the follow-up duration and then compared the demographics of children with and without incomplete continence and constipation, respectively. Significance was set at p < 0.05. RESULTS: The median age at PICSS interview was 71 months (range, 6-191 months). Incontinence scores obtained from 42 children older than 35 months showed a positive relationship with the follow-up duration (p = 0.03). Constipation scores obtained from 51 children were unrelated to follow-up duration (p = 0.486). When demographics were compared, the continent children had longer follow-up than those with incomplete continence (mean, 111.64 vs. 69.19 months; p = 0.051), however follow-up duration did not differ in the group of constipated children compared with the nonconstipated group (mean, 61.88 vs. 71.80 months; p = 0.321). CONCLUSION: These findings suggest that after an endorectal pull-through, improved continence should be expected with time but constipation often continues to be an ongoing problem.

Quality of life in patients with different constipation subtypes based on the Rome III criteria.

BACKGROUND: Functional constipation and irritable bowel syndrome with constipation are highly prevalent and affect the quality of life of those who suffer from them. AIMS: To evaluate quality of life in patients with functional constipation and irritable bowel disease in accordance with the Rome III criteria, using the PAC-QOL and SF-36 questionnaires. MATERIALS AND METHODS: A cross-sectional study was conducted using self-administered questionnaires. The PAC-QOL, SF-36, and Rome III constipation module questionnaires were applied to patients that complained of constipation at the outpatient clinic of a tertiary care hospital. The constipation subtypes were: functional constipation (no pain), irritable bowel syndrome with constipation (pain and/or discomfort ≥3 days/month), and unclassifiable constipation (pain ≤2 days/month). Data were summarized in proportions, and group comparisons were made between the scores of each of the areas of the PAC-QOL and SF-36 questionnaires using parametric tests (Student's t test and ANOVA). RESULTS: A total of 43 PAC-QOL surveys were analyzed, resulting in cases of irritable bowel syndrome with constipation (14%), functional constipation (37%), and unclassifiable constipation (49%). There were statistically significant differences (P<.05) in Physical discomfort (irritable bowel syndrome with constipation vs. functional constipation and unclassifiable constipation vs. irritable bowel syndrome with constipation), Worries and concerns (irritable bowel syndrome with constipation vs. functional constipation), and Treatment satisfaction (irritable bowel syndrome with constipation vs. functional constipation and unclassifiable constipation vs. irritable bowel syndrome with constipation). A total of 93 SF-36 questionnaires were analyzed, describing cases of irritable bowel syndrome with constipation (23%), functional constipation (27%), and unclassifiable constipation (51%). Lower physical energy was found in relation to irritable bowel syndrome with constipation vs. functional constipation (P<.0221) and unclassifiable constipation (P<.0086), respectively, and there was greater physical pain in the cases of irritable bowel syndrome with constipation vs. unclassifiable constipation (P<.0362). CONCLUSIONS: Differences in quality of life of patients presenting with constipation subtypes were identified using the PAC-QOL and SF-36 questionnaires. The patients that had the irritable bowel syndrome with constipation subtype experienced poorer quality of life in all the evaluated domains.

[FUNCTIONAL BLOATING, CONSTIPATION AND DIARRHEA].

Functional disorders and diseases are usually diagnosed by exclusion when there is no clear presence of inflammatory, anatomic, metabolic, or neoplastic processes which would explain the symptoms and difficulties of the patient. The Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders (FGID) are used in clinical and scientific medicine. Functional disorders of the upper gastrointestinal system in adults are classified into six groups. Group C are functional bowel disorders which include irritable bowel syndrome (C1), functional bloating (C2), functional constipation (C3) and functional diarrhea (4). The symptoms of functional gastrointestinal disorders are often a combination of disrupted physiological functions, such as an increase in motor reactivity of the intestine, visceral hypersensitivity, impaired immune functions and inflammatory intestinal mucosa followed by change in the intestinal bacterial flora and disrupted central nervous system-enteric nervous system regulation because of exposure to different psychosocial and sociocultural factors. The symptoms must be present for at least six months before clinical manifestation of the disease and also must be currently present and diagnostically confirmed in the last three months. Diagnostic procedures are targeted individually, depending on the patient age, nature of symptoms, and other clinical and laboratory characteristics. Treatment is based on health education, nutrition counseling, medication and psychological support.