Chronic constipation diagnosis and treatment evaluation: the “CHRO.CO.DI.T.E.” study

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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0556-7) contains supplementary material, which is available to authorized users.

Different perception of chronic constipation between patients and gastroenterologists

“…In parallel with these data, the Bristol scale revealed a softer fecal consistency in NRC and a less frequent use of laxatives and enemas in NRC than IBS‐C and FC. These data are substantially in agreement with recent findings provided by the ChroCoDiTE study on constipated patients . In IBS‐C and FC higher values of ODS, CSI and PAC‐QoL were detected identifying CC subjects with a greater clinical impact and a worse quality of life.…”

“…In parallel with these data, the Bristol scale revealed a vs IBS-C (−6.0 P < .05); NRC vs FC (−5.6 P < .05); Patients vs APs, (+1.9 P < .05); CSI, NRC vs IBS-C (−12.9 P < .05); NRC vs FC (−12.5 P < .05); Patients vs APs, (+4.7 P < .05); PACQOL, NRC vs IBS-C (+0.69 P < .05); NRC vs FC (+0.53 P < .05); Patients vs APs, +0.38 (ns).TA B L E 3 Mean values of ODS, CSI and PACQoL in SDC subjects related to diagnosis softer fecal consistency in NRC and a less frequent use of laxatives and enemas in NRC than IBS-C and FC. These data are substantially in agreement with recent findings provided by the ChroCoDiTE study on constipated patients 15. In IBS-C and FC higher values of ODS, CSI and PAC-QoL were detected identifying CC subjects with a greater clinical impact and a worse quality of life.Some interesting findings were also observed in the sub-analysis of the constipation scales between groups.…”

“…Constipation is often self‐diagnosed and self‐treated by patients who tend to use their own criteria and vocabulary, often not encompassed by medical classifications . The subjective perception of being constipated, here referred as SDC, is the starting point for requiring medical help, independently from the presence/absence of the Rome criteria.…”

“…Constipation is often self-diagnosed and self-treated by patients who tend to use their own criteria and vocabulary, often not encompassed by medical classifications. 15 The subjective perception Moreover, the enrolment of APs, although these cannot be considered as matched controls (see also below), allowed us to assess the clinical features, the severity of symptoms, and the impairment of the quality of life in a non-selected group, not requiring any medical help for their constipation. In the SDC group ODS and CSI scores were lower in APs compared with patients even though in the PAC-Qol only a general trend was detectable.…”

“…Indeed, in a previous study carried out on a general population sample never consulting a physician for gastrointestinal symptoms, we found that 9% of these subjects declared they were constipated. 15 In addition, we were surprised from the low number of subjects excluded from the study due to the concomitant presence of organic disease or use of constipating medications.…”