Constipation is a common condition that affects people of all ages worldwide. It's more prevalent in women and increases with age. The causes are multiple, and there are various diagnostic and treatment options available. However, due to its high frequency and chronic nature, managing constipation can lead to common mistakes. This article highlights ten common mistakes in managing constipation and how to avoid them based on recent studies and clinical guidelines.

Around 11% of the worldwide population experience irritable bowel syndrome (IBS), making it one of the most frequent gastroenterological diagnoses.1 The symptoms of IBS include abdominal pain associated with unpredictable bowel habits and variable changes in the form and frequency of stool.2 While all patients with IBS suffer from recurrent bouts of abdominal pain, their bowel habits are varied: around one-third suffer predominantly with diarrhoea (IBS-D), one-fifth experience predominantly constipation (IBS-C) and half have an erratic mixed pattern of both diarrhoea and constipation (IBS-M).3 This very heterogeneous condition undoubtedly has multiple causes and an individualized approach to management and treatment is required. Here I discuss the mistakes most frequently made when diagnosing and managing IBS. The mistakes and discussion that follow are based, where possible, on published data and failing that on many years of my own clinical experience.

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a subclassification of steatotic liver disease (SLD), defined as the presence of excess triglyceride storage in the liver in conjunction with at least one cardiometabolic risk factor and no other discernible cause.1 Cirrhosis secondary to MASH is the most common cause of liver disease in the world and is the fastest-growing indication for liver transplantation, but it also has a >50% recurrence rate post-transplantation.

People with irritable bowel syndrome (IBS) experience chronic intermittent symptoms, such as abdominal pain, bloating and/or altered bowel movements. These symptoms may negatively impact their daily life, prohibiting participation in social activities or leading to work absenteeism, and they are associated with increased healthcare utilisation.More than 85% of people with IBS indicate that food is one of the triggers for their gastrointestinal symptoms. Many of them have also tried diets, eliminated certain foods, taken supplements or used over-the-counter remedies before consulting a doctor or dietitian.4 Somewhat contradictorily, according to surveys of patients’ expectations in primary care, patients with IBS expect their general practitioner to provide reassurance or drug treatments, but less than 10% value dietary intervention. This is despite the fact that almost 95% of general practitioners report that they start the treatment of IBS by giving nutritional advice.5 Dietary interventions are also given a prominent place in the guidelines as both first- and second-line treatments for IBS.

2024 update: Mark Fox
2016 version: Mark Fox

Dyspepsia refers to upper abdominal discomfort that can arise from the upper gastrointestinal tract, with symptoms including epigastric pain, bloating, early satiety, belching, nausea, and heartburn. It is commonly caused by functional dyspepsia, gastro-oesophageal reflux disease (GORD), peptic ulcer disease, or malignancy. Endoscopy is not always necessary for diagnosis, and clinical guidelines recommend considering clinical presentation without alarm symptoms. The management of dyspepsia is challenging due to its broad definition, lack of specific treatments, and psychosocial issues. Here, I discuss 10 common mistakes in diagnosis and treatment.