Diagnosis of functional constipation: agreement between Rome III and Rome II criteria and evaluation for the practicality.

OBJECTIVE: To investigate the agreement between Rome III and Rome II criteria for diagnosing functional constipation (FC) and to evaluate the accuracy of each constipation symptom for FC diagnosis. METHODS: Patients with chronic constipation underwent rigorous biochemical and endoscopic/imaging tests to exclude organic and metabolic diseases. The questionnaires including general information, constipation symptoms, and the most troublesome constipation symptoms were completed in a face-to-face survey. The accuracy of constipation symptoms for FC diagnosis was examined using the likelihood ratio. RESULTS: Among 184 patients (43 males and 141 females) with chronic constipation, 166 (90.2%) met Rome II criteria and 174 (94.6%) met Rome III criteria for FC, while 166 met both criteria. There was a good diagnostic agreement between the two sets of criteria, with a kappa value of 0.69 and the overall agreement rate was 95.7% (P < 0.001). Based on Rome III criteria, the most accurate symptom for FC diagnosis was sensation of anorectal blockage, followed by straining during defecation and infrequent bowel movements. The most troublesome symptoms reported by patients were lumpy or hard stools, straining during defecation, sensation of incomplete evacuation. More patients indicated that 'the symptoms in the past 3 months' was better than 'those within the past one year' to reflect their constipation (36.7% vs 6.0%, P < 0.001). CONCLUSIONS: There is good agreement between Rome III and Rome II criteria for FC diagnosis. Rome III criteria are more practical than Rome II criteria for Chinese patients.

[Multi-centered stratified clinical studies for psychological and sleeping status in patients with chronic constipation in China].

OBJECTIVE: To survey the emotional and sleeping status of patients with chronic constipation (CC) and analyze the relationship between psychological status and constipated symptoms. METHODS: From January 2009 to April 2010, 5 centers and 25 stratified hospitals were selected as the representatives of different regions of mainland China. The CC questionnaires including constipated symptoms, emotional and sleeping status, previous treatments and self-reported impact of constipation on health status, etc. Questionnaires were completed by well-trained physicians or investigators during face-to-face interviews. CC was diagnosed in accordance with the Rome III criteria. RESULTS: A total of 909 valid questionnaires analyzed. There were 258 males and 651 females with a mean age of (49 ± 19) years. 41.5% (377 cases) reported "tense feelings" and 38.3% (348 cases) "felt downcast" over the past 3 months. The patients feeling tense and(or) downcast "frequently" and "most of time" were around 11.3% (103 cases) and 9.4% (85 cases). And 43.8% (398 cases) patients reported sleeping disorders over the past 3 months. Regional differences existed in the comorbidities of psychological and sleeping disorders in CC patients, especially in those from tertiary hospitals. And it was the highest in Beijing area for tense feelings and downcast. The sleeping disorders were the most common in the patients from secondary hospitals, of which 66.1% (37/56) and 65.0% (39/60) were from Wuhan and Xi'an respectively. They were higher than Beijing and Guangzhou (39.7% (23/58), 29.0% (9/31), all P = 0.001). The patients from rural primary clinics suffered more sleeping disorders than those from urban primary cares (P = 0.026). About 35.0% (318 cases) and 28.4% (258 cases) patients reported their constipation was related with emotional and sleeping disorders. The comorbidities of psychological and sleeping disorders were more common in severe constipated patients than mild and moderate counterparts and resulted in more hospital visits (both P = 0.000). CONCLUSIONS: The CC patients often have the comorbidities of psychological and sleeping disorders with regional differences. The patients from the hospitals at various levels may present different spectrums of comorbidities of psychological and sleeping disorders. And the severity of CC influences the moods, sleeps and hospital visits.