Thread by @john_damianosMD

#Constipation can be a debilitating symptom

#ACG2021 @LinChangMD @GregSayuk

Need to ask our #constipation patients about

#IBS-C and #CIC have overlapping pathophysioogy

Type 1-2 are associated with longer transit time, while 6-7 is associated with faster transit times

#IBS-C and #CIC exist on a spectrum (same with IBS-D and functional diarrhea)

Overlap between #IBS-C and CIC, and severity of symptoms

Abdominal symptoms are associated with ⬆️ care seeking but ⬇️ satisfaction with care.

Abdominal symptoms are BOTHERSOME, drive healthcare visits, and affects hrQoL

Dyssynergic defecation may coexist with #IBS and #CIC

✅anorectal physiology testing
❌routine colonoscopy

<1 in 5 patients is on a prescription medication to control their #IBS-C or #CIC

PEG should NOT be used for #IBS-C because while it's a great laxative, it does NOT do a great job with abdominal symptoms such as pain.

@AmCollegeGastro guidelines for #IBS-C
✅GC activators
✅Cl- channel activators
👍 5-HT4 agonist
✅soluble fiber
✅TCAs
👍peppermint
👍gut-directed hypnotherapy
👍low-FODMAP #diet

Neuromodulators and gut-directed psychotherapies target the brain-gut axis

✅Linaclotide and Plecanatide

GC-C agonists not only treat constipation, but also abdominal symptoms including pain, bloating, and global #IBS symptoms

Case!

Make a POSITIVE diagnosis.

Why does it matter to distinguish #IBS-C or CIC? IBS has visceral hypersensitivity which should be treated.

Factors that can help diagnosis #IBS-C
👍symptoms
👍biomarkers
👍psychological markers
✅all combined (LR 8.48)

Psychological comorbidities are associated with worse disease course and prognosis

#IBS-C and #CIC can evolve into the other over time.

The course of #constipation may vary with time.

Treatment of #IBS-C and #CIC

Assess patient considerations to guide therapy.
More bowel-related symptoms: luminal and gut-directed therapies
More abdominal symptoms: gut-brain therapies and brain-gut therapies 🧠

Improvement in #constipation may not correlate with ⬇️ of abdominal pain.

Sleep is hugely important in managing #constipation. Exercise and #diet are also 🔑

@GregSayuk on discussing pharmacotherapy with patients: #IBS-C and #CIC are chronic conditions just like diabetes or hypertension!

@LinChangMD: if someone is diagnosed with dyssynergic defecation, they should absolutely be referred for biofeedback. If not available, pelvic floor PT can also be very helpful