Background and Aim Clinical trials have demonstrated the efficacy of osmotic and stimulant laxatives, as well as prucalopride and linaclotide, in treating chronic constipation. However, some medications have only been evaluated specifically for functional constipation (FC) or irritable bowel syndrome with constipation (IBS-C) and their real-world effectiveness remains unclear. This audit aimed to evaluate which pharmacological interventions are effective in patients diagnosed with Rome IV FC and IBS-C in a secondary care clinical practice within the UK. Methods Demographic data and treatment outcomes (Table 1) were retrospectively reviewed for patients diagnosed with Rome IV FC and IBS-C between January 2016 and May 2026 at a single UK neurogastroenterology clinic. The analysis included only patients with documented follow-up until a patient-reported satisfactory treatment was achieved. Results are mean ± standard deviation (SD) or frequency (%) and have been analysed using Chi-square or Fisher’s exact test. Results Two hundred and six patients were enrolled (FC n=66; IBS-C n=170). IBS-C were older (50±16.7 vs 48±18.5 years; p=0.044), more frequently females (82.94% vs 71.21%; p=0.045). Duration of symptoms at first consultation was longer in FC than IBS-C (17±16 vs 14±16.6 years; p=0.02), with no difference in the duration of follow-up (IBS-C= 33 ± 24 vs FC=40 ± 28.3; p=0.08).FC reported a higher treatment satisfaction during follow-up (77% vs 59.8%; p=0.024), more frequently with combination of stimulant and prokinetic laxative (FC=18.18% vs IBS-C= 8.57%; p=0.04) and of trans anal irrigation (TAI) with laxative (FC=25% vs IBS-C= 12.86%; p=0.02). Successful management of IBS-C included combination of TAI with osmotic and stimulant laxatives (12.86% of whom 5.71% also received neuromodulators), or dietary changes (IBS-C= 17.14% vs FC= 0%; p=0.0001), linaclotide (IBS-C=12.85% vs FC=0%; p=0.002) and neuromodulators in monotherapy (IBS-C=10% vs FC=0%; p=0.01). Conclusion This audit suggests that FC is likely a motor disorder, responding to stimulant laxatives and prokinetics and TAI, whereas IBS-C is predominantly driven by visceral hypersensitivity, necessitating a multimodal approach including neuromodulators.
Differentiating therapeutic responses in Rome IV functional constipation and irritable bowel syndrome with predominant constipation diagnosed in a secondary care center in the UK / Mocci, C., Sbarigia, C., Copia, C.A., Kuttalek, D., Cicognani, B., Lambiase, C., Butt, M., Darie, A.-M., Mohanan, A., Bush, D., Isherwood, G., Lewis-Lawson, T., Card, T.R., Corsetti, M.. - (2026). (UEG Barcellona ).
Differentiating therapeutic responses in Rome IV functional constipation and irritable bowel syndrome with predominant constipation diagnosed in a secondary care center in the UK
C. Mocci;
2026
Abstract
Background and Aim Clinical trials have demonstrated the efficacy of osmotic and stimulant laxatives, as well as prucalopride and linaclotide, in treating chronic constipation. However, some medications have only been evaluated specifically for functional constipation (FC) or irritable bowel syndrome with constipation (IBS-C) and their real-world effectiveness remains unclear. This audit aimed to evaluate which pharmacological interventions are effective in patients diagnosed with Rome IV FC and IBS-C in a secondary care clinical practice within the UK. Methods Demographic data and treatment outcomes (Table 1) were retrospectively reviewed for patients diagnosed with Rome IV FC and IBS-C between January 2016 and May 2026 at a single UK neurogastroenterology clinic. The analysis included only patients with documented follow-up until a patient-reported satisfactory treatment was achieved. Results are mean ± standard deviation (SD) or frequency (%) and have been analysed using Chi-square or Fisher’s exact test. Results Two hundred and six patients were enrolled (FC n=66; IBS-C n=170). IBS-C were older (50±16.7 vs 48±18.5 years; p=0.044), more frequently females (82.94% vs 71.21%; p=0.045). Duration of symptoms at first consultation was longer in FC than IBS-C (17±16 vs 14±16.6 years; p=0.02), with no difference in the duration of follow-up (IBS-C= 33 ± 24 vs FC=40 ± 28.3; p=0.08).FC reported a higher treatment satisfaction during follow-up (77% vs 59.8%; p=0.024), more frequently with combination of stimulant and prokinetic laxative (FC=18.18% vs IBS-C= 8.57%; p=0.04) and of trans anal irrigation (TAI) with laxative (FC=25% vs IBS-C= 12.86%; p=0.02). Successful management of IBS-C included combination of TAI with osmotic and stimulant laxatives (12.86% of whom 5.71% also received neuromodulators), or dietary changes (IBS-C= 17.14% vs FC= 0%; p=0.0001), linaclotide (IBS-C=12.85% vs FC=0%; p=0.002) and neuromodulators in monotherapy (IBS-C=10% vs FC=0%; p=0.01). Conclusion This audit suggests that FC is likely a motor disorder, responding to stimulant laxatives and prokinetics and TAI, whereas IBS-C is predominantly driven by visceral hypersensitivity, necessitating a multimodal approach including neuromodulators.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
