Differentiation of functional constipation and constipation predominant irritable bowel syndrome based on Rome III criteria: a population-based study.
BACKGROUND
While the Rome III classification recognises functional constipation (FC) and constipation predominant IBS (IBS-C) as distinct disorders, recent evidence has suggested that these disorders are difficult to separate in clinical practice.


OBJECTIVE
To identify whether clinical and lifestyle factors differentiate Rome III-defined IBS-C from FC based on gastrointestinal symptoms and lifestyle characteristics.


METHODS
3260 people randomly selected from the Australian population returned a postal survey. FC and IBS-C were defined according to Rome III. The first model used logistic regression to differentiate IBS-C from FC based on lifestyle, quality-of-life and psychological characteristics. The second approach was data-driven employing latent class analysis (LCA) to identify naturally occurring clusters in the data considering all symptoms involved in the Rome III criteria for IBS-C and FC.


RESULTS
We found n = 206 (6.5%; 95% CI 5.7-7.4%) people met strict Rome III FC whereas n = 109 (3.5%; 95% CI 2.8-4.1%) met strict Rome III IBS-C. The case-control approach indicated that FC patients reported an older age at onset of constipation, were less likely to exercise, had higher mental QoL and less health care seeking than IBS-C. LCA yielded one latent class that was predominantly (75%) FC, while the other class was approximately half IBS-C and half FC. The FC-dominated latent class had clearly lower levels of symptoms used to classify IBS (pain-related symptoms) and was more likely to be male (P = 0.046) but was otherwise similar in distribution of lifestyle factors to the mixed class.


CONCLUSIONS
The latent class analysis approach suggests a differentiation based more on symptom severity rather than the Rome III view.
Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
N A
NA
Koloski
M
M
Jones
M
M
Young
N J
NJ
Talley
D000328:Adult; D000368:Aged; D001315:Australia; D003248:Constipation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000503:physiopathology*; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*