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Published on: July 5, 2024
Functional constipation masked as irritable bowel syndrome
Monica Tosto1, Paola D'Andrea2, Ignazio Salamone3
1Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
Insights
Many children diagnosed with Irritable Bowel Syndrome with diarrhea (IBS-D) or mixed IBS (IBS-M) may actually have functional constipation. Treating constipation effectively resolved symptoms in most cases, suggesting a re-evaluation of diagnoses.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
Background:
- Rome IV criteria recommend treating constipation in children suspected of Irritable Bowel Syndrome with Constipation (IBS-C).
- This study investigated if functional constipation is misdiagnosed as Irritable Bowel Syndrome with diarrhea (IBS-D) or Irritable Bowel Syndrome with mixed pattern (IBS-M).
Purpose of the Study:
- To determine if functional constipation is misdiagnosed as IBS-D or IBS-M in pediatric patients.
- To assess the efficacy of treating presumed functional constipation in children diagnosed with IBS-D or IBS-M.
Main Methods:
- Prospective enrollment of 10 children with IBS-D and 16 with IBS-M based on Rome IV criteria.
- Children with suspected "occult constipation" received Polyethylene glycol 3350 bowel cleansing, followed by re-evaluation at 2 months and 6 months follow-up.
- A control group of 16 children with IBS-C was included for comparison.
Main Results:
- 80% of IBS-D and 87% of IBS-M patients met endpoints, showing reduced abdominal pain and resolved diarrhea.
- Treatment response in IBS-D and IBS-M groups was comparable to the IBS-C control group (93% response).
Conclusions:
- A significant number of pediatric patients diagnosed with IBS-D or IBS-M may have undiagnosed functional constipation.
- Management of functional constipation should be considered for children presenting with IBS-D or IBS-M symptoms.
Background:
Rome IV criteria for functional gastrointestinal disorders state that children suspected of having Irritable Bowel Syndrome (IBS) with Constipation (IBS-C) should be preliminarily treated for constipation. We aimed at verifying if functional constipation may indeed lead to an erroneous diagnosis of IBS with diarrhea (IBS-D) or IBS with mixed pattern of diarrhea and constipation (IBS-M).
Methods:
We prospectively enrolled in an unblinded fashion 10 and 16 consecutive children referred to our center who met Rome IV criteria for a diagnosis of IBS-D and IBS-M, respectively. Patients who fulfilled criteria for suspect "occult constipation" were then given a bowel cleaning regimen with Polyethylene glycol 3350, re-evaluated at 2 months and followed up for at least 6 months. Sixteen additional patients with IBS with Constipation (IBS-C) referred in the same period served as control. The endpoints were: 1) a decrease of more than 50% in abdominal pain intensity and frequency scores; and 2) for patients with IBS-D and IBS-M: resolution of diarrhea.
Results:
The endpoints were met by 8 (80%) and 14 (87%) of the patients with IBS-D and IBS-M, respectively, with decrease of abdominal pain and resolution of "diarrhea". The response was not significantly different from that observed in 15 (93%) of the IBS-C control group.
Conclusion:
Acknowledging the limitations of the small number of patients and of the uncontrolled nature of the study, we suggest that a possibly large number of patients labeled as IBS-D or IBS-M may actually simply present functional constipation and should be managed as such.
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