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The Egyptian Journal of Internal Medicine
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The management of constipation-related functional gastrointestinal disorder (constipation-predominant irritable bowel syndrome)

The Egyptian Journal of Internal Medicine volume 27, pages 127–132 (2015)Cite this article

Abstract

The terminology constipation-related functional gastrointestinal disorders was applied to embrace two conditions – constipation-predominant irritable bowel syndrome ( IBS-C) and chronic constipation – because of the similarity in the etiology between the two conditions. The cardinal symptoms of IBS-C are abdominal pain or discomfort associated with constipation. The current symptom-based Rome III criteria are used to confirm the diagnosis. Many patients with IBS-C initially treat their symptoms with lifestyle modifications and exclusion diets, together with treatment of symptoms such as constipation by using fiber supplements, over-the-counter laxatives, or probiotics. Less commonly, the patients may also undergo various forms of psychotherapy. Despite these therapeutic modalities, many IBS patients are disappointed with their symptomatic response. There are several drugs that are being proposed for its treatment in the future, one of which is linaclotide, a 14-amino acid synthetic peptide that improves stool frequency and consistency and intestinal transit. Four-week treatment with Bifidobacterium lactis showed superior results when compared with placebo in decreasing the abdominal distention and improving orocecal and colonic transit.

References

  1. Quigley EM. Disturbances of motility and visceral hypersensitivity in irritable bowel syndrome: biological markers or epiphenomenon. Gastroenterol Clin North Am 2005; 34: 221–233, vi.

    PubMed  Google Scholar 

  2. Stivland T, Camilleri M, Vassallo M, Proano M, Rath D, Brown M, et al. Scintigraphic measurement of regional gut transit in idiopathic constipation. Gastroenterology 1991; 101: 107–115.

    CAS  PubMed  Google Scholar 

  3. Rao SS, Welcher KD, Leistikow JS. Obstructive defecation: a failure of rectoanal coordination. Am J Gastroenterol 1998; 93: 1042–1050.

    CAS  PubMed  Google Scholar 

  4. Prott G, Shim L, Hansen R, Kellow J, Malcolm A. Relationships between pelvic floor symptoms and function in irritable bowel syndrome. Neurogastroenterol Motil 2010; 22: 764–769.

    CAS  PubMed  Google Scholar 

  5. Lembo A, Camilleri M. Chronic constipation. N Engl J Med 2003; 349: 1360–1368.

    CAS  PubMed  Google Scholar 

  6. Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology 1995; 109: 40–52.

    CAS  PubMed  Google Scholar 

  7. Bouin M, Plourde V, Boivin M, Riberdy M, Lupien F, Laganière M, et al. Rectal distention testing in patients with irritable bowel syndrome: sensitivity, specificity, and predictive values of pain sensory thresholds. Gastroenterology 2002; 122: 1771–1777.

    PubMed  Google Scholar 

  8. Lawal A, Kern M, Sidhu H, Hofmann C, Shaker R. Novel evidence for hypersensitivity of visceral sensory neural circuitry in irritable bowel syndrome patients. Gastroenterology 2006; 130: 26–33.

    PubMed  Google Scholar 

  9. O’Malley D, Quigley EM, Dinan TG, Cryan JF. Do interactions between stress and immune responses lead to symptom exacerbations in irritable bowel syndrome? Brain Behav Immun 2011; 25: 1333–1341.

    PubMed  Google Scholar 

  10. Attaluri A, Jackson M, Valestin J, Rao SS. Methanogenic flora is associated with altered colonic transit but not stool characteristics in constipation without IBS. Am J Gastroenterol 2010; 105: 1407–1411.

    PubMed  Google Scholar 

  11. Trowell H. Definition of dietary fiber and hypotheses that it is a protective factor in certain diseases. Am J Clin Nutr 1976; 29: 417–427.

    CAS  PubMed  Google Scholar 

  12. Longstreth GF. Definition and classification of irritable bowel syndrome: current consensus and controversies. Gastroenterol Clin North Am 2005; 34: 173–187.

    PubMed  Google Scholar 

  13. Thompson WG. Irritable bowel syndrome: pathogenesis and management. Lancet 1993; 341: 1569–1572.

    CAS  PubMed  Google Scholar 

  14. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. In: Drossman DA, editor. Rome III: the functional gastrointestinal disorders. 3rd ed. McLean, VA: Dagnon Associates; 2006. 491.

  15. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology 2006b; 130: 1480–1491.

  16. Furman DL, Cash BD. The role of diagnostic testing in irritable bowel syndrome. Gastroenterol Clin North Am 2011; 40: 105–119.

    PubMed  Google Scholar 

  17. Saito YA, Schoenfeld P, Locke GR III. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol 2002; 97: 1910–1915.

    PubMed  Google Scholar 

  18. Talley NJ, O’Keefe EA, Zinsmeister AR, Melton LJ III. Prevalence of gastrointestinal symptoms in the elderly: a population-based study. Gastroenterology 1992; 102: 895–901.

    CAS  PubMed  Google Scholar 

  19. Jung HK, Halder S, McNally M, Locke GR III, Schleck CD, Zinsmeister AR, Talley NJ. Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population. Aliment Pharmacol Ther 2007; 26: 453–461.

    PubMed  Google Scholar 

  20. Olafsdottir LB, Gudjonsson H, Jonsdottir HH, Thjodleifsson B. Stability of the irritable bowel syndrome and subgroups as measured by three diagnostic criteria – a 10-year follow-up study. Aliment Pharmacol Ther 2010; 32: 670–680.

    CAS  PubMed  Google Scholar 

  21. Andrews EB, Eaton SC, Hollis KA, Hopkins JS, Ameen V, Hamm LR, et al. Prevalence and demographics of irritable bowel syndrome: results from a large web-based survey. Aliment Pharmacol Ther 2005; 22: 935–942.

    CAS  PubMed  Google Scholar 

  22. Hungin AP, Chang L, Locke GR, Dennis EH, Barghout V. Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther 2005; 21: 1365–1375.

    CAS  PubMed  Google Scholar 

  23. Minocha A, Johnson WD, Abell TL, Wigington WC. Prevalence, sociodemography, and quality of life of older versus younger patients with irritable bowel syndrome: a population-based study. Dig Dis Sci 2006; 51: 446–453.

    PubMed  Google Scholar 

  24. Talley N. Irritable bowel syndrome [chapter 118]. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s gastrointestinal and liver disease. 9th ed. St. Louis, MO: W.B. Saunders; 2010, Chap 118.

  25. Spiegel BM, Gralnek IM, Bolus R, Chang L, Dulai GS, Mayer EA, Naliboff B. Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Arch Intern Med 2004; 164: 1773–1780.

    PubMed  Google Scholar 

  26. Agarwal N, Spiegel BM. The effect of irritable bowel syndrome on health-related quality of life and health care expenditures. Gastroenterol Clin North Am 2011; 40: 11–19.

    PubMed  Google Scholar 

  27. Ringel Y, Williams RE, Kalilani L, Cook SF. Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2009; 7: 68–72.

    PubMed  Google Scholar 

  28. Thompson WG, Creed FH, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disease and functional abdominal pain. Gastroenterol Int 1992; 5: 75–91.

    Google Scholar 

  29. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut 1999; 45 (Suppl 2): II43–II47.

    PubMed  PubMed Central  Google Scholar 

  30. Ford AC, Talley NJ, Veldhuyzen van Zanten SJ, Vakil NB, Simel DL, Moayyedi P. Will the history and physical examination help establish that irritable bowel syndrome is causing this patient’s lower gastrointestinal tract symptoms? JAMA 2008; 300: 1793–1805.

    CAS  PubMed  Google Scholar 

  31. Jellema P, van der Windt DA, Schellevis FG, van der Horst HE. Systematic review: accuracy of symptom-based criteria for diagnosis of irritable bowel syndrome in primary care. Aliment Pharmacol Ther 2009; 30: 695–706.

    CAS  PubMed  Google Scholar 

  32. Whitehead WE, Palsson OS, Feld AD, Levy RL, Von Korff M, Turner MJ, Drossman DA. Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome. Aliment Pharmacol Ther 2006; 24: 137–146.

    CAS  PubMed  Google Scholar 

  33. Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS. Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis. Gastroenterology 2004; 126: 1721–1732.

    PubMed  Google Scholar 

  34. Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, et al. American College of Gastroenterology Task Force on Irritable Bowel Syndrome. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 (Suppl 1): S1–35.

    PubMed  Google Scholar 

  35. Camilleri M, Andresen V. Current and novel therapeutic options for irritable bowel syndrome management. Dig Liver Dis 2009; 41: 854–862.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Ford AC, Talley NJ, Spiegel BM, Foxx-Orenstein AE, Schiller L, Quigley EM, Moayyedi P. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 2008; 337: a2313.

    PubMed  PubMed Central  Google Scholar 

  37. Miller V, Lea R, Agrawal A, Whorwell PJ. Bran and irritable bowel syndrome: the primary-care perspective. Dig Liver Dis 2006; 38: 737–740.

    CAS  PubMed  Google Scholar 

  38. Whitehead WE, Holtkotter B, Enck P, Hoelzl R, Holmes KD, Anthony J, et al. Tolerance for rectosigmoid distention in irritable bowel syndrome. Gastroenterology 1990; 98 (Pt 1): 1187–1192.

    CAS  PubMed  Google Scholar 

  39. Saad RJ. Peripherally acting therapies for the treatment of irritable bowel syndrome. Gastroenterol Clin North Am 2011; 40: 163–182.

    PubMed  Google Scholar 

  40. Cuppoletti J, Malinowska DH, Tewari KP, Li QJ, Sherry AM, Patchen ML, Ueno R. SPI-0211 activates T84 cell chloride transport and recombinant human ClC-2 chloride currents. Am J Physiol Cell Physiol 2004; 287: C1173–C1183.

    CAS  PubMed  Google Scholar 

  41. Lang L. The Food and Drug Administration approves lubiprostone for irritable bowel syndrome with constipation. Gastroenterology 2008; 135: 7.

    PubMed  Google Scholar 

  42. Owen RT. Lubiprostone – a novel treatment for irritable bowel syndrome with constipation. Drugs Today (Barc) 2008; 44: 645–652.

    CAS  Google Scholar 

  43. Vahedi H, Merat S, Rashidioon A, Ghoddoosi A, Malekzadeh R. The effect of fluoxetine in patients with pain and constipation-predominant irritable bowel syndrome: a double-blind randomized-controlled study. Aliment Pharmacol Ther 2005; 22: 381–385.

    CAS  PubMed  Google Scholar 

  44. Bryant AP, Busby RW, Bartolini WP, Cordero EA, Hannig G, Kessler MM, et al. Linaclotide is a potent and selective guanylate cyclase C agonist that elicits pharmacological effects locally in the gastrointestinal tract. Life Sci 2010; 86: 760–765.

    CAS  PubMed  Google Scholar 

  45. Chey W, Lembo A, MacDougall JE, Lavins BJ, Schneier H, Johnston JM, et al. Efficacy and safety of once-daily linaclotide administered orally for 26 weeks in patients with IBS-C: results from a randomized, double-blind, placebo-controlled phase 3 trial. Gastroenterology 2011a; 140: S135.

  46. Carson R, Tourkodimitris S, Lewis BE, et al. Effect of linaclotide on quality of life in adults with irritable bowel syndrome with constipation: pooled results from two randomized, double-blind, placebo-controlled phase 3 trials. Gastroenterology 2011;140(5 suppl 1): S51.

  47. Rao S, Lembo A, Shiff SJ, Shi K, Johnston JM, Schneier H. Efficacy and safety of once daily linaclotide in patients with irritable bowel syndrome with constipation: a 12-week, randomized, double-blind, placebo-controlled phase 3 trial followed by a 4-week randomized withdrawal period. Gastroenterology 2011; 140: S138.

    Google Scholar 

  48. Rao AS, Wong BS, Camilleri M, Odunsi-Shiyanbade ST, McKinzie S, Ryks M, et al. Chenodeoxycholate in females with irritable bowel syndrome-constipation: a pharmacodynamic and pharmacogenetic analysis. Gastroenterology 2010; 139: 1549–1558. 1558.e1

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Agrawal A, Houghton LA, Morris J, Reilly B, Guyonnet D, Goupil Feuillerat N, et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2009; 29: 104–114.

    CAS  PubMed  Google Scholar 

  50. Lui J, Yang M, Liu Y, Wei M, Grimsgaard S. Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2006; 1: CD004116.

    Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, Cairo University, Flat 10, Third Floor, 9 Shannan Street, 11613, Cairo, Egypt

    Amal F. Radwan & Nagwa R. Ahmed MD

  2. Department of Endecrinology and Metabolism, National Nutrition Institute, Cairo, Egypt

    Eman A. Sultan

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  1. Amal F. Radwan
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  2. Nagwa R. Ahmed MD
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Correspondence to Nagwa R. Ahmed MD.

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Radwan, A.F., Ahmed, N.R. & Sultan, E.A. The management of constipation-related functional gastrointestinal disorder (constipation-predominant irritable bowel syndrome). Egypt J Intern Med 27, 127–132 (2015). https://doi.org/10.4103/1110-7782.174926

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