Introduction

Functional Constipation (FC) and Constipation-predominant Irritable Bowel Syndrome (IBS-C) are two common disorders of gut-brain interaction (DGBI) which can often present overlapping symptoms, thus making difficult to distinguish them. ​

Aims & Methods

This study aims to determine whether the demographic and clinical profiles of consecutive patients diagnosed with FC and IBS-C differ in real-world clinical practice.
Demography and clinical information from the first clinical consultation where the diagnosis was made by a single consultant using a standardized clinical letter were retrospectively collected from January 2016 to March 2025 at a single tertiary care neurogastroenterology clinic in the UK Data were collected using a standardised template and were reported as median [interquartile range (IQR)] or frequency (%), and compared using the Chi-square test or Mann-Whitney U test.

Results

	FC (n= 88)	IBS - C (n=257)	p-value
Demography and general characteristics
Male, n (%) Age (years), median (IQR) Duration of symptoms (year),median (IQR)	24 (27%) 47 (25) 12,5 (17)	42 (16%) 32 (26) 5 (10)	0.036 0.0001 0.0001
Total number of concomitant medical condition, median (IQR) Chronic pain, n (%) Abdominal surgeries, n (%)	1 (2) 12 (14%) 24 (27%)	4 (4,5) 66 (26%) 112 (44%)	0.001 0.02 0.01
Total number of hospital admissions, median (IQR)	1 (2)	1 (5)	1.0
Total number of previous diagnostic investigation at first consultation, median (IQR)	1 (2)	1 (2)	1.0
Concomitant medications
Total number of concomitant medications, median (IQR) Tricyclic antidepressant, n (%) Selective Serotonin Reuptake Inhibitor, n (%) Serotonin-norepinephrinereuptake inhibitors, n (%) Opioids n, (%) Laxatives n, (%) Antispasmodics n, (%)	3 (4,5) 12 (14%) 12 (14%) 8 (9%) 13 (15%) 61 (70%) 3 (3%)	4 (4,5) 44 (18%) 39 (15%) 13 (5%) 82 (31%) 116 (45%) 42 (16%)	0.001 0.550 0.859 0.268 0.003 0.0001 0.003
Gi symptoms
Nausea, n (%) Early satiety n, (%) Vomiting, n (%) Post pandrial fulness, n (%) Heartburn, n (%) Abdominal pain, n (%)	16 (19%) 6 (7%) 7 (8%) 8 (9%) 13 (15%) 9 (10%)	93 (37%) 56 (21%) 45 (17%) 53 (20%) 52 (19%) 234 (91%)	0.002 0.002 0.04 0.02 0.330 0.0001

A total of 88 FC and 257 IBS-C consecutive patients were diagnosed according to Rome IV criteria. FC patients were older and most frequently males, with a longer duration of symptoms. Abdominal pain was largely absent in FC patients and when present this was not related to defecation but reported as result of long-lasting lack of bowel movement. Upper gastrointestinal symptoms were more frequent in IBS-C compared to FC. Comorbidities, particularly chronic pain syndromes, and abdominal surgeries were more frequently reported by IBS-C patients. in addition, IBS-C patients were more frequently on pain medications, while FC on laxatives. Table 1 summarizes the data collected in both groups.

Conclusion

This real-world study suggests that FC and IBS-C patients differ in demographic, clinical profile and comorbidities. IBS-C patients report a more severe clinical picture despite FC patients and had a longer duration of symptoms.

References

Bharucha AE, Sharma M. Painful and Painless Constipation: All Roads Lead to (A Change in) Rome. Dig Dis Sci. 2018 Jul;63(7):1671-1674. doi: 10.1007/s10620-018-5027-2. PMID: 29564675; PMCID: PMC6293467.
Bouchoucha M, Devroede G, Mary F, Bon C, Bejou B, Benamouzig R. Painful or Mild-Pain Constipation? A Clinically Useful Alternative to Classification as Irritable Bowel Syndrome with Constipation Versus Functional Constipation. Dig Dis Sci. 2018 Jul;63(7):1763-1773. doi: 10.1007/s10620-018-4995-6. Epub 2018 Feb 28. PMID: 29492744.

Introduction

Gastric cancer ranks as the fifth most common cancer and the second leading cause of cancer-related deaths. Multifocal atrophic gastritis and gastric intestinal metaplasia (GIM) often coexist and are both associated with the risk of developing gastric cancer, with GIM being the first irreversible mucosal transformation to cancer. Endoscopic surveillance was associated with earlier cancer detection and improved survival. This study aims to evaluate the prevalence, epidemiological characteristics, and clinical features of patients with GIM.

Aims & Methods

This is a single-center, retrospective study from January 1, 2022 to December 31, 2023. Including patients aged ≥18 years who underwent esophagogastroduodenoscopy (EGD) with gastric biopsies confirming GIM, All identified cases of GIM were reviewed by gastrointestinal pathologists to confirm the diagnosis. Th primary outcome was to assess the prevalence, epidemiological characteristic, and clinical features of GIM. The secondary outcome was to evaluate adherence to recommended surveillance protocols for GIM.

Results

Among 3,663 patients who underwent EGD, GIM was identified in (4.17%, n=153). The mean age of patients with GIM was 60 years, Males represented more than half of patients (54.2%), the majority were classified as overweight (Body mass index (BMI) 25–29.9; 64%, n=97) or obese (BMI ≥30; 24.3%, n=37).Smoking was reported in (17.6%, n=27), while (5.2%, n=8) reported alcohol consumption. Moreover, (7.2%, n=11) had a history of prior gastric surgeries. Dyspepsia (33.3%) was the most common indication for EGD. Gastritis was the predominant endoscopic finding and the primary reason for performing gastric biopsies (73%, n=112 ).The most common GIM subtype was complete (52%), followed by incomplete (37%) and mixed (11%). In terms of GIM location, extensive GIM was observed in (28.7%), localized GIM in (17.6%), while the location remained unknown in (53.6%) due to the lack of a follow-up EGD for mapping. Coexisting autoimmune atrophic gastritis was observed in (12.4%, n=19), Helicobacter pylori infection was detected in (16.3%, n=25). Furthermore, Dysplasia was identified in (2.6%, n=4), with low-grade dysplasia and high-grade dysplasia each accounting for (1.3%, n=2) (Table 1). Three patients developed.gastric cancer (2%) , while (4.6%, n=7) were found to have neuroendocrine tumors (NET). First degree family history of gastric cancer was reported in (12.4%, n=19).

Gastric Intestinal Metaplasia characteristic	Percentage
Location Localized Extensive. Unknown	27 (17.6%) 44 (28.7%) 82 (53.6%)
Type of GIM Incomplete Complete Mixed	51 (37%) 71 (52%) 15 (11%)
Autoimmune Atrophic Gastritis Absent Present	134 (87.6%) 19 (12.4%)
Helicobacter Pylori (H. pylori) Absent Present	128 (83.7%) 25 (16.3%)
Dysplasia Absent Low Grade High Grade	149 (97.4%) 2 (1.3%) 2 (1.3%)

Conclusion

This study highlights a 4.17% prevalence of GIM among patients who underwent EGD. High BMI and male sex were observed in more than half of the patients. Dysplasia was detected in 2.6%, gastric cancer in 2%, and NET in 4.6% of cases. Many patients lacked follow-up EGD surveillance, limiting effective monitoring. Larger studies with extended follow-up are required to further investigate these associations and their clinical implications.