Painful and Painless Constipation: All Roads Lead to (A Change in) Rome

Excerpt

Disease classifications are useful to the extent that they facilitate an understanding of the pathophysiology, guide the diagnosis or treatment, or predict the natural history of the condition. In the field of gastroenterology (GI), disease classifications have long been used for functional syndromes that have largely eluded diagnosis based on conventional criteria such as histological, serological, or biochemical data. The Rome criteria classify chronic constipation as: functional constipation (FC), constipation-predominant IBS (IBS-C), and defecatory disorder (DD). FC is defined by the presence of two or more of six bowel symptoms such as excessive straining to defecate. IBS-C is defined by abdominal pain that is associated, in time, with bowel disturbances (harder or less frequent stools) and/or relief of pain with defecation. DD, which is defined by symptoms of FC or IBS-C combined with objective evidence of impaired rectal evacuation, respond to pelvic floor biofeedback therapy rather than to laxatives. Increased perception of visceral sensations is more prevalent in IBS-C than in FC [1]. The dose and the efficacy of medications such as lubiprostone or linaclotide differ between FC and IBS-C [2]. These features suggest that idiopathic constipation is not a homogenous entity, providing the raison d’être for classifying constipation according to response to therapy. …