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. 2023;2(4):573-579.
doi: 10.1016/j.gastha.2023.01.004. Epub 2023 Jan 30.

Unrecognized Functional Dyspepsia Among Those With Refractory Chronic Constipation: Analysis of a Tertiary Cohort

Taylor Boyd  1 , Mary Paz  2 , Imama Ahmad  2 , Fatima Rao  2 , Ahmad Samad  2 , Isabelle Garcia-Fischer  2 , Casey Silvernale  3 , Helen Burton Murray  1   2 , Kyle Staller  1   2
Affiliations

Unrecognized Functional Dyspepsia Among Those With Refractory Chronic Constipation: Analysis of a Tertiary Cohort

Taylor Boyd et al. Gastro Hep Adv. 2023.

Abstract

Background and aims: Patients with functional constipation (FC) are frequently dissatisfied with current treatment options which may be related to persistent, unaddressed symptoms. We hypothesized that refractory FC may actually represent functional dyspepsia (FD) overlap. Among adults presenting with refractory FC, we sought to (1) identify the prevalence of concurrent FD and (2) identify the symptoms and presentations most frequently associated with concurrent FD and FC.

Methods: We assembled a retrospective cohort of 308 patients sequentially presenting to a tertiary neurogastroenterology clinic for evaluation of refractory FC, defined as having failed first-line therapy. Using Rome IV criteria, trained raters identified the presence and characteristics of concurrent FD in addition to demographics, presenting complaints, and psychological comorbidities.

Results: Among 308 patients presenting with refractory FC (average of 3.0 ± 2.3 constipation treatments tried unsuccessfully), 119 (38.6%) had concurrent FD. Aside from meeting FD criteria, the presence of concurrent FD was associated with patient complaints of esophageal symptoms (Odds ratio = 3.1; 95% confidence interval, 1.80-5.42) and bloating and distension (Odds ratio = 2.67; 95% confidence interval, 1.50-4.89). Patients with concurrent FD were more likely to have a history of an eating disorder (21.0% vs 12.7%) and were also more likely to present with current avoidant/restrictive food intake disorder-related symptoms (31.9% vs 21.7%).

Conclusion: Almost 40% of adult patients referred for refractory FC met criteria for concurrent FD in a tertiary-level cohort. The presence of both FC and FD was associated with greater esophageal symptoms and bloating/distention. Determining presence of concurrent FD may represent an additional therapeutic opportunity in refractory patients who may attribute symptoms to FC alone.

Keywords: Disorders of Gut-Brain Interaction; Functional Constipation; Functional Dyspepsia; Overlap.

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Conflict of interest statement

Conflicts of Interest: These authors disclose the following: K.S. has received research support from Ironwood and Urovant, has served as a speaker for Shire, and has served as a consultant to Arena, Gelesis, GI Supply, and Shire. H.B.M. receives royalties from Oxford University Press her forthcoming book on rumination syndrome. The remaining authors disclose no conflicts.

Figures

Figure
Figure
Associations between FD, functional constipation, and avoidant restrictive food intake disorder. The ways in which symptoms of FD and functional constipation are associated with symptoms of avoidant restrictive food intake disorder are shown.
See this image and copyright information in PMC

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