Guía de Práctica Clínica. Síndrome del intestino irritable con estreñimiento y estreñimiento funcional en adultos. Tratamiento (Parte 2)✩

Abstract

In this Clinical Practice Guide, we analyze diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, under the confluence of the spectrum of the irritable bowel syndrome and functional constipation. Both conditions are located within intestinal functional disorders and have a significant personal, health and social repercussion, affecting quality of life of the patients who suffer them. The former is the subtype of irritable bowel syndrome in which constipation is the predominant bowel movement alteration together with recurrent abdominal pain, swelling and frequent abdominal distension. The constipation is characterized by difficulty or scarce frequency in relation with bowel movements, often accompanied by excessive effort during defecation or sensation of incomplete evaluation. There is no underlying organic cause in most of the cases, it being considered a functional intestinal disorder. There are many clinical and physiopathological clinical similarities between both disorders, with similar response of the constipation to common drugs, the fundamental difference being the presence or absence of pain, but not in an “all or nothing” evaluable way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, grade of impairment, forms of perception and behavior. Using the Rome criteria, the functional gastrointestinal disorders are diagnosed. The Clinical Practice Guide is adapted to the Rome IV criteria dissiminated at the end of May 2016. In a first part, the conceptual and pathophysio aspects, alarm criteria, diagnostic tests and referral criteria between Primary Care and Digestive Tract Department were analyzed. In this second part, all the available therapeutic alternatives (exercise, fluid intake, diet with soluble fiber rich foods, fiber supplements, other components of the diet, osmotic or stimulants laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychotherapy, acupuncture, enemas, sacral nerve stimulation or surgery) are reviewed, making practical recommendations for each one of them.