Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation

Abstract

Treatments for functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C) differ, but symptom criteria do not reliably distinguish between them; some regard FC and IBS-C as parts of a single constipation spectrum. Our goal was to review studies comparing FC and IBS-C to identify possible biomarkers that separate them. A systematic review identified 15 studies that compared physiologic tests in FC vs IBS-C. Pain thresholds were lower in IBS-C than FC for 3/5 studies and not different in 2/5. Colonic motility was decreased more in FC than IBS-C for 3/3 studies, and whole gut transit was delayed more in FC than IBS-C in 3/8 studies and not different in 5/8. Pelvic floor dyssynergia was unrelated to diagnosis. Sympathetic arousal, measured in only one study, was greater in IBS-C than FC. The most reliable separation of FC from IBS-C was shown by a novel new magnetic resonance imaging technique described in this issue of the journal. These authors showed that drinking one liter of polyethylene glycol laxative significantly increased water content in the small intestine, volume of contents in the ascending colon, and time to first evacuation in FC vs IBS-C; and resulted in less colon motility and delayed whole gut transit in FC compared to IBS-C. Although replication is needed, this well-tolerated, non-invasive test promises to become a new standard for differential diagnosis of FC vs IBS-C. These data suggest that FC and IBS-C are different disorders rather than points on a constipation spectrum.

Preventative effects of fermented Chimonobambusa quadrangularis shoot on activated carbon-induced constipation

“…It has previously been demonstrated that the increased fiber gap of FCQS facilitates the improved penetration of water to the fibers and increases its absorbency and water-holding capacity, which increases the volume of excrement that stimulates intestinal peristalsis (17). Furthermore, increased water content in excrement may prevent dry excrement, which increases bowel movements (18). Previous research has demonstrated that fermentation can significantly improve the water-holding ability of bamboo (10), which was confirmed in the present study.…”

Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice

“…However, in deference to new data showing a strong overlap between functional constipation and irritable bowel syndrome with constipation (IBS-C) [15••, 34, 35], the Rome IV criteria state that the patient may fulfill this criterion by meeting symptom criteria for either functional constipation or IBS-C.…”

Irritable bowel syndrome: what do the new Rome IV diagnostic guidelines mean for patient management?

“…In fact only small changes, detailed below, were made in the IBS diagnostic criteria. In part, they were made to address important questions that have been raised about (1) the inclusion of abdominal 'discomfort' as an alternative to pain [2], (2) the most appropriate frequency of pain for IBS classification, and (3) the way Rome III dealt with the comorbidity of constipation-predominant IBS (IBS-C) with functional constipation [3,4]. It is also important to update clinicians on the explosion of new information on the pathophysiology of IBS (e.g.…”