Clinical Practice Guideline: irritable bowel syndrome with constipation and functional constipation in the adult

espanolEn esta Guia de Practica Clinica analizamos el manejo diagnostico y terapeutico de pacientes adultos con estrenimiento y molestias abdominales, bajo la confluencia del espectro del sindrome del intestino irritable y el estrenimiento funcional. Ambas patologias estan encuadradas en los trastornos funcionales intestinales y tienen una importante repercusion personal, sanitaria y social, afectando a la calidad de vida de los pacientes que las padecen. La primera es el subtipo de sindrome del intestino irritable en el que el estre- nimiento es la alteracion deposicional predominante junto con dolor abdominal recurrente, hinchazon y distension abdominal frecuente. El estrenimiento se caracteriza por la dificultad o la escasa frecuencia en relacion con las deposiciones, a menudo acompanado por esfuerzo excesivo durante la defecacion o sensacion de evacuacion incompleta. En la mayoria de los casos no tiene una causa organica subyacente, siendo considerado un trastorno funcional intestinal. Son muchas las similitudes clinicas y fisiopatologicas entre ambos trastornos, con respuesta similar del estrenimiento a farmacos comunes, siendo la diferencia fundamental la presencia o ausencia de dolor, pero no de un modo evaluable como “todo o nada”. La gravedad de estos trastornos depende no solo de la intensidad de los sintomas intestinales sino tambien de otros factores biopsicosociales: asociacion de sintomas gastrointestinales y extraintestinales, grado de afectacion, y formas de percepcion y comportamiento. Mediante los criterios de Roma, se diagnostican los trastornos funcionales intestinales. Esta Guia de Practica Clinica esta adaptada a los criterios de Roma IV difundidos a finales de mayo de 2016 y analiza los criterios de alarma, las pruebas diagnosticas y los criterios de derivacion entre Atencion Primaria y Aparato Digestivo. Asimismo, se revisan todas las alternativas terapeuticas disponibles (ejercicio, ingesta de liquidos, dieta con alimentos ricos en fibra soluble, suplementos de fibra, otros componentes de la dieta, laxantes osmoticos o estimulantes, probioticos, antibioticos, espasmoliticos, esencia de menta, prucaloprida, linaclotida, lubiprostona, biofeedback, antidepresivos, tratamiento psicologico, acupuntura, enemas, neuroestimulacion de raices sacras o cirugia), efectuando recomendaciones practicas para cada una de ellas. EnglishIn this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an “all or nothing” manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.