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

Area of Science:

• Gastroenterology
• Clinical Medicine
• Patient Outcomes

Background:

• Chronic constipation (CC) encompasses functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C), with some patients not meeting Rome criteria (NRC).
• Understanding the clinical presentation and management of these distinct CC subtypes is crucial for effective patient care.

Purpose of the Study:

• To evaluate the clinical presentation and management strategies for FC, IBS-C, and NRC in an Italian cohort.
• To identify differences in symptom severity, quality of life, diagnostic approaches, and therapeutic interventions among CC subtypes.

Main Methods:

• A 2-month prospective study involving 52 Italian gastroenterologists.
• Data collection on 878 CC patients (FC, IBS-C, NRC) using Bristol scale, PAC-SYM, and PAC-QoL questionnaires.
• Recording of diagnostic tests, prescribed therapies, and patient evaluation history.

Main Results:

• IBS-C patients reported significantly higher PAC-SYM and PAC-QoL scores, indicating more severe symptoms and poorer quality of life.
• 49.5% of patients were undergoing their first gastroenterological evaluation for CC, with 48.5% having symptoms for over 10 years.
• While digital rectal examination was underutilized (56.4%), diagnostic tests were prescribed to 80.0% of patients, with colonoscopy and blood tests being common first-line tools.

Conclusions:

• IBS-C is associated with greater symptom burden and reduced quality of life compared to FC and NRC.
• Diagnostic workup and therapeutic interventions, including macrogol, prucalopride, and pelvic floor rehabilitation, are tailored to CC severity.
• Despite underutilization of DRE, a comprehensive diagnostic approach is generally employed, with management escalating based on disease severity.