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| 09/26/04 03:25 PM |
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What Differentiates Chronic Constipation From IBS With Constipation?
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Update on the Management of Chronic Constipation: What Differentiates Chronic Constipation From IBS With Constipation
Authors: Brooks Cash, MD, FACP; William D. Chey, MD, FACG, FACP
Release Date: August 26, 2004;
The irritable bowel syndrome (IBS) and chronic constipation (CC) are 2 of the most common conditions seen in primary care offices and are among the most common reasons for gastroenterology referral in the United States. IBS is a functional gastrointestinal disorder in which altered motility, abnormal visceral sensation, and psychosocial factors interplay to cause symptoms. Because of the overlap in symptoms reported by patients with IBS and a predominant bowel complaint of constipation (IBS-C) and CC, clinicians often find it challenging to differentiate between these 2 disorders. This Clinical Update will focus on the epidemiology, clinical and economic impact, and diagnosis and management of patients with chronic constipation. Important differences between CC and IBS-C will be highlighted in order to emphasize the differential diagnostic and management approaches to the 2 conditions.
Presentation, Epidemiology, and Clinical Impact of Chronic Constipation
The meaning of the word constipation varies widely among physicians and patients. While physicians generally equate constipation with reduced stool frequency, patients often use this term to describe a variety of defecatory complaints. Generally speaking, constipation refers to unsatisfactory defecation characterized by some combination of infrequent stools, straining, incomplete evacuation, hard/lumpy stools, increased time to stool, use of manual maneuvers to stool, or sense of difficulty passing stool.
These points speak to the difficulty in estimating the prevalence of constipation in the general population. Most population-based studies from North America suggest that the prevalence of CC is approximately 15%.[1] Studies indicate that prevalence estimates derived from self-reported constipation differ significantly from estimates based upon the Rome criteria for functional constipation. As is also the case with IBS, the Rome criteria for functional constipation undoubtedly fail to identify a large population of patients who feel that they are constipated. This point was recently borne out by a population-based study from Canada that found a prevalence of self-reported constipation of 27% as opposed to a prevalence of 15% using the Rome II criteria.[2]
Not unlike IBS, observational studies indicate that CC occurs more commonly in women than men. There is also evidence to suggest that the elderly, non-whites, and persons of lower socioeconomic status are more likely to report CC.[1] Almost a third of children with severe constipation will continue to suffer with symptoms beyond puberty.[3]
Only a minority of symptomatic patients seek care for constipation. Despite this, constipation accounts for 2.5 million physician visits and over 90,000 hospitalizations per year in the United States.[4] Although the vast majority of patients are cared for in the primary care setting, CC still remains one of the most commonly recorded diagnoses rendered by gastroenterologists.[5] It has been estimated that hundreds of millions of dollars are spent on an annual basis for laxative therapies.
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http://www.medscape.com/viewprogram/3375
