title: Chronic constipation diagnosis and treatment evaluation: the "CHRO.CO.DI.T.E." study.
abstract: According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy.
  
  
  
  During a 2-month period, 52 Italian gastroenterologists recorded clinical data of FC, IBS-C and NRC patients, using Bristol scale, PAC-SYM and PAC-QoL questionnaires. In addition, gastroenterologists were also asked to record whether the patients were clinically assessed for CC for the first time or were in follow up. Diagnostic tests and prescribed therapies were also recorded.
  
  
  
  Eight hundred seventy-eight consecutive CC patients (706 F) were enrolled (FC 62.5%, IBS-C 31.3%, NRC 6.2%). PAC-SYM and PAC-QoL scores were higher in IBS-C than in FC and NRC. 49.5% were at their first gastroenterological evaluation for CC. In 48.5% CC duration was longer than 10 years. A specialist consultation was requested in 31.6%, more frequently in IBS-C than in NRC. Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. Faecal calprotectin, thyroid tests, celiac serology, breath tests were more frequently suggested in IBS-C and anorectal manometry in FC. More than 90% had at least one treatment suggested on chronic constipation, most frequently dietary changes, macrogol and fibers. Antispasmodics and psychotherapy were more frequently prescribed in IBS-C, prucalopride and pelvic floor rehabilitation in FC.
  
  
  
  Patients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. Digital rectal examination was often not performed but at least one diagnostic test was prescribed to most patients. Colonoscopy and blood tests were the "first line" diagnostic tools. Macrogol was the most prescribed laxative, and prucalopride and pelvic floor rehabilitation represented a "second line" approach. Diagnostic tests and prescribed therapies increased by increasing CC severity.
authors.affiliation: Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Via Paradisa, 2, 56127, Pisa, Italy. mbellini@med.unipi.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellini
authors.affiliation: Brotzu Hospital, Gastroenterology Unit, Cagliari, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Usai-Satta
authors.affiliation: AORN "A. Cardarelli", Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bove
authors.affiliation: Malatesta Novello, Private Hospital, Cesena, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Bocchini
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Galeazzi
authors.affiliation: Cardinal Massaia Hospital, Gastroenterology Unit, Asti, Italy.
authors.forename: Edda
authors.initials: E
authors.lastname: Battaglia
authors.affiliation: San Luca Hospital, Digestive Endoscopy Unit, Lucca, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Alduini
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Maggiore Hospital, Crema, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Buscarini
authors.affiliation: Gastrointestinal and Hepatology Section, Clinical & Experimental Medicine, Perugia, Italy.
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003113:Colonoscopy; D003248:Constipation / Q000175:diagnosis* / Q000628:therapy; D019841:Defecography; D051517:Digital Rectal Examination; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000628:therapy; D007558:Italy; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D063189:Symptom Assessment / Q000379:methods*
keywords: Diagnosis; Functional constipation; Irritable bowel syndrome; Treatment