Reviews for Primary Care - Fall 2007 - (Page 13) Chronic Constipation and Functional Bowel Disorders presence of symptoms on at least 3 days a month during the last 3 months with the onset of symptoms at least 6 months prior to the diagnosis.2 More than half of the gut gastrointestinal disorders encountered by gastroenterologists and primary care clinicians are functional in nature.4 Over the past several decades, significant strides have led to the current understanding that FGIDs are heterogeneous disorders, encompassing both psychosocial and physiological factors to a variable degree, that interact to produce specific behaviors and symptomatology.2 Therefore, in the absence of reliable biomarkers, FGIDs are best categorized by patient symptomatology. Unfortunately, there can be substantial overlap with the myriad of FGIDs, further complicating the evaluation and treatment of these patients. Although originally designed to assist researchers in identifying classes of FGIDs and to streamline research initiatives in the field of FGIDs,5 the Rome criteria have proved useful to office-based health care providers. The most recent version of the Rome criteria, Rome III, represents a significant progression from earlier versions.6 This monograph focuses on the diagnosis and treatment of 3 commonly seen FGIDs: chronic constipation, IBS, and dyssynergic defecation. Relevant definitions and diagnostic criteria from the recently released Rome III criteria and gastroenterologic professional societies will provide clinicians with knowledge that will allow them to effectively discern the differences among IBS, chronic constipation, and dyssynergic defecation and recommend appropriate therapeutic options for patients with these disorders. Expert advice pertaining to a relevant case study and commonly asked questions will help demonstrate how to introduce this knowledge into clinical practice. have been integrated into many routine clinical practice settings. Periodically, as knowledge about FGIDs broadens, the Rome criteria are updated. The most recent iteration, the Rome III diagnostic criteria,6 contains several changes that appear to make this version less restrictive than previous versions, although validation of these new criteria in clinical practice is still pending. Rome III Criteria for Functional Chronic Constipation The Rome III diagnostic criteria for functional chronic constipation are shown in Figure 1.6 The length of time the patient has had symptoms is crucial to distinguishing FBDs such as chronic constipation from occasional constipation or IBS. Rome III Criteria for IBS IBS is defined in the Rome III criteria as a functional bowel disorder in which abdominal pain or discomfort (ie, an uncomfortable sensation not described as pain) is associated with a change in bowel movement form or frequency (or both) that may or may not be relieved with defecation.6 The Rome III criteria for IBS are shown in Figure 2.6 The History of the Rome Criteria and Diagnosis of Functional Gastrointestinal Disorders The process to develop the Rome criteria began 15-20 years ago with the formation of the Rome committee on FGIDs.5 Composed of a group of international experts, this committee was created to increase the recognition of FGIDs and to aid in the development of a classification system that could be used for research purposes. The symptom-based diagnostic criteria created by the Rome committee have served as the basis for recent clinical trials of IBS therapies and Figure 1. Rome III diagnostic criteria* for chronic constipation. Adapted from Longstreth GF et al.6 • Chronic constipation must include 2 or more of the following: During at least 25% of defecations Straining Lumpy or hard stools Sensation of incomplete evacuation Sensation of anorectal obstruction/ blockage Manual maneuvers to facilitate defecations 3 defecations per week • Loose stools are rarely present without the use of laxatives • There are insufficient criteria for IBS *Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis. VOL. 1 NO. 1 2007 REVIEWS FOR PRIMARY CARE 13
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