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

Bharucha, Adil E.; Sharma, Mayank

doi:10.1007/s10620-018-5027-2

Cited by 12 publications

(11 citation statements)

References 12 publications

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“…IBS-C patients are more likely to predominantly have abdominal pain, heightened rectal sensation, 8 upper gastrointestinal symptoms (eg, heartburn, dyspepsia), anxiety and depression, and urinary symptoms. 9,10 However, blurring the distinction between FC and IBS-C, 1 study found that approximately 90% of patients with IBS-C also met criteria for FC and 44% of the FC patients also met criteria for IBS-C. 11 In approximately onethird of patients, symptoms shift over time between FC and IBS-C. 11 In individual patients, a diagnosis of either FC or IBS-C is possible only because the Rome criteria specify that patients with symptoms of IBS-C and FC be designated as IBS-C not FC.…”

Section: Definition and Classificationmentioning

confidence: 99%

Mechanisms, Evaluation, and Management of Chronic Constipation

2020

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Section: Definition and Classificationmentioning

confidence: 99%

Mechanisms, Evaluation, and Management of Chronic Constipation

2020

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“…Conversely, approximately 44% of patients with FC also IBS-C criteria. 7 The Rome criteria specify that patients who have symptoms of IBS-C and FC should be diagnosed as having IBS-C. An alternative, perhaps simpler, approach is to classify constipation based on the presence or absence of severe abdominal pain, regardless of the relationship between abdominal pain and bowel symptoms, into constipation with or without moderate or severe pain. Compared with constipated patients with no or mild pain, patients with severe pain report more somatic symptoms, worse overall health, and a greater impact of bowel symptoms on quality of life.…”

Section: Definition and Classification Of Constipationmentioning

confidence: 99%

“…Compared with constipated patients with no or mild pain, patients with severe pain report more somatic symptoms, worse overall health, and a greater impact of bowel symptoms on quality of life. 7…”

Section: Definition and Classification Of Constipationmentioning

confidence: 99%

Chronic Constipation

Bharucha

Wald

2019

Mayo Clinic Proceedings

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163

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Constipation is a common symptom that may be primary (idiopathic or functional) or associated with a number of disorders or medications. Although most constipation is self-managed by patients, 22% seek health care, mostly to primary care physicians (>50%) and gastroenterologists (14%), resulting in large expenditures for diagnostic testing and treatments. There is strong evidence that stimulant and osmotic laxatives, intestinal secretagogues, and peripherally restricted m-opiate antagonists are effective and safe; the lattermost drugs are a major advance for managing opioid-induced constipation. Constipation that is refractory to available laxatives should be evaluated for defecatory disorders and slow-transit constipation using studies of anorectal function and colonic transit. Defecatory disorders are often responsive to biofeedback therapies, whereas slow-transit constipation may require surgical intervention in selected patients. Both efficacy and cost should guide the choice of treatment for functional constipation and opiate-induced constipation. Currently, no studies have compared inexpensive laxatives with newer drugs that work by other mechanisms.

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“…By recording pH, the SmartPill TM capsule can determine when the capsule empties into the small intestine and thereafter into the colon, hence measure gastric, small intestinal, and colonic transit. In addition to discriminating between normal and slow colon transit, and identifying delayed gastric emptying and small intestinal transit in constipated patients, the colonic pressure measurements are useful for discriminating among subtypes of chronic constipation, being greater in IBS (or “painful”) than isolated slow transit (or “painless” constipation) . However, because the precise location of the SmartPill TM capsule in the colon is unknown, regional colonic transit cannot be assessed.…”

Section: Ingestible Capsules—smartpilltm and Motilis 3d‐transit Systemmentioning

confidence: 99%

“…In addition to discriminating between normal and slow colon transit, and identifying delayed gastric emptying and small intestinal transit in constipated patients, the colonic pressure measurements are useful for discriminating among subtypes of chronic constipation, being greater in IBS (or "painful") than isolated slow transit (or "painless" constipation). [26][27][28] However, because the precise location of the SmartPill TM capsule in the colon is unknown, regional colonic transit cannot be assessed. Table 1 pressures.…”

Section: Ing E S Tib Le C Apsule S-s Martpill Tm and Motilis 3d -Trmentioning

confidence: 99%

More movement with evaluating colonic transit in humans

Bharucha

Anderson

Bouchoucha

2019

Neurogastroenterology Motil

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Background Colonic functions (ie, absorption of fluids and electrolytes, digestion of selected nutrients, harbor for microbes, and elimination of excreta) necessitate complex patterns of storage and transit. Indeed, colonic transit accounts for a major part of the mouth‐to‐anus transit time. Colonic transit assessments are useful for understanding the pathophysiology of disease, the pharmacodynamic effects of new medications and to diagnose slow transit constipation. Currently, radiopaque markers, scintigraphy, and a colonic pH‐pressure capsule are used to measure overall colonic transit. Radioopaque markers, scintigraphy, and the electromagnetic capsule, which is a newer technique, also evaluate regional colonic transit. The pH‐pressure capsule also measures colonic pressures. Magnetic resonance imaging and a radio‐frequency identification‐based device are evolving methods for assessing colonic transit. Purpose This mini‐review, which accompanies a study evaluating the assessment of colon transit with the electromagnetic capsule, evaluates and compares existing and evolving methods for evaluating colonic transit in humans (Neurogastroenterol Motil. 2018; in press). In addition to overall and regional colonic transit, the electromagnetic capsule evaluates colonic motor patterns without radiation exposure. These patterns are summarized by analyzing the characteristics (ie, distance and velocity) of discrete antegrade and retrograde capsule movements as they travel in the colon. However, the electromagnetic capsule does not measure pressure or colonic wall movement (ie, contractions). The motor patterns identified by this capsule should be compared with motor patterns identified with manometry. The next challenge is to harness different techniques to evaluate the relationships between colonic pressures and transit or, even better, the trifecta of colonic contractions, pressure events, and transit.

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

Cited by 12 publications

References 12 publications

Mechanisms, Evaluation, and Management of Chronic Constipation

Mechanisms, Evaluation, and Management of Chronic Constipation

Chronic Constipation

More movement with evaluating colonic transit in humans

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