Optimal management of constipation associated with irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is a common chronic functional disorder of the gastrointestinal tract, meanly characterized by recurrent abdominal pain or discomfort and altered bowel habit. It is a complex disorder involving biological, environmental, and psychosocial factors. The diagnosis is achieved according to the Rome III criteria provided that organic causes have been excluded. Although IBS does not constitute a life-threatening condition, it has a remarkable prevalence and profoundly reduces the quality of life with burdening socioeconomic costs. One of the principal concerns about IBS is the lack of effective therapeutic options. Up to 40% of patients are not satisfied with any available medications, especially those suffering from chronic constipation. A correct management of IBS with constipation should evolve through a global approach focused on the patient, starting with careful history taking in order to assess the presence of organic diseases that might trigger the disorder. Therefore, the second step is to examine lifestyle, dietary habits, and psychological status. On these bases, a step-up management of disease is recommended: from fiber and bulking agents, to osmotic laxative drugs, to new molecules like lubiprostone and linaclotide. Although new promising tools for relief of bowel-movement-related symptoms are being discovered, a dedicated doctor-patient relationship still seems to be the key for success.

Keywords: IBS; functional gastrointestinal disorders; laxatives.

Figure 1

Diagnostic flowchart of patients referring to specialists for chronic constipation and abdominal discomfort. Abbreviations: CC, chronic constipation; CT, computed tomography; FOBT+, fecal occult blood test positive; IBS-C, irritable bowel syndrome constipation variant; LhBT, Lactulose breath test; OCTT, orocecal transit time.

Figure 2

Therapeutic flowchart of patients referring for IBS-C Notes: Use of prucalopride in IBS is considered off-label. Although illustrated at the end of therapeutic process, psychological approaches might be considered alongside the other treatment options. Abbreviations: ↑, increase; FODMAPs, fermentable, oligo-, di-, monosaccharides, and polyols; IBS, irritable bowel syndrome; IBS-C, IBS constipation variant; OCTT, orocecal transit time.