Authors of a scoping review of 27 clinical practice guidelines (CPGs) from 2012 to 2024 found considerable inconsistency in diagnostic criteria for constipation-predominant IBS (IBS-C) and functional constipation (FC). Rome IV was most commonly used (59.3%), followed by Rome III (22.2%). IBS-C guidelines emphasized abdominal pain (71.4%), whereas FC guidelines prioritized spontaneous bowel movement frequency (88.9%). IBS-C CPGs often endorsed positive, symptom-based diagnosis (71.4%) versus far fewer FC CPGs (11.1%). Forty percent of CPGs acknowledged overlap between IBS-C and FC. One guideline proposed a pain threshold (Likert >4) to define “painful constipation.” Regional variation was notable: some Asian-based CPGs highlighted Bristol Stool Form Scale type 3 and abdominal bloating; most CPGs (81.5%) recommended colonoscopy only for alarm features or age criteria. These discrepancies likely skew prevalence estimates, payer policies, and clinical trial eligibility across regions.

Overall, the landscape is fragmented and region-dependent, complicating differential diagnosis and care pathways. The authors call for harmonized criteria that better integrate both pain and constipation domains across IBS-C and FC, and for progress toward objective biomarkers to reduce reliance on symptoms alone. As an interim step, standardized reporting of stool form, pain intensity scales, and symptom duration could improve comparability across settings while biomarker research matures.

Reference: Luo J, To WLW, Xu Q, et al. Clinical practice guidelines for the diagnosis of constipation-predominant irritable bowel syndrome and functional constipation in adults: a scoping review. BMC Gastroenterol. 2025;25(1):234. doi: 10.1186/s12876-025-03774-6.

Chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) produce overlapping symptoms—constipation, bloating/distension, and pain—likely along a spectrum where pain/hypersensitivity is more prominent in IBS-C. Both conditions carry heavy quality-of-life impacts and common comorbidities, though profiles differ (CIC: diabetes/obesity; IBS-C: anxiety/depression, functional dyspepsia, fibromyalgia, interstitial cystitis). BURDEN studies show a wide patient-clinician perception gap and low satisfaction with care: many patients rely on over-the-counter (OTC) medications, few feel in control, and stigma or uncertainty keeps many from seeking help or receiving a firm diagnosis—fueling unnecessary tests and anxiety.

The economic and treatment burdens are substantial: frequent outpatient visits, high use of imaging/colonoscopy despite limited diagnostic yield, and insurer hurdles. Most patients self-manage with OTCs. Prescription uptake is low, and treatment-emergent diarrhea is a frequent reason for discontinuation. Sex and cultural factors shape illness experience and care-seeking (eg, lower health-related quality of lfie and more bloating in women; variable healthcare use by sex and ethnicity). Because CIC and IBS-C often overlap and fluctuate, management should be individualized and patient-centric, which includes aligning on diagnosis and goals, addressing comorbidities and psychosocial drivers, tailoring therapy to the most bothersome symptoms, using prescriptions when indicated, avoiding low-value testing, and planning for adverse-event management to improve outcomes and reduce social/economic burden.

Reference: Harris LA, Chang CH. Burden of Constipation: Looking Beyond Bowel Movements. Am J Gastroenterol. 2022;117(4S):S2-S5. doi: 10.14309/ajg.0000000000001708.

Digital health is reshaping irritable bowel syndrome (IBS) care from diagnosis to day-to-day management. Noninvasive “smart” capsules and bacterial detection systems sample intestinal contents and physiology, while machine-learning models analyze microbiome, stool biomarkers, and patient-reported data to distinguish IBS subtypes and rule out organic disease. Wearables and apps (eg, watches, bands, patches) track heart rate variability, activity, stress, and symptoms, link triggers (diet, sleep, stress) to flares, and support adherence with tools like FODMAP guidance. mHealth platforms deliver cognitive behavioral therapy, mindfulness, and just-in-time adaptive interventions. Artificial intelligence (AI) agents (eg, emotion-aware chatbots) personalize prompts and integrate real-time data for remote care. These capabilities are increasingly integrated into telemedicine workflows, enabling longitudinal monitoring between visits and more timely, data-informed adjustments.

These tools are associated with fewer symptoms, better quality of life, higher adherence, and reduced unnecessary testing and visits, but face hurdles: variable data quality, privacy/security concerns, digital access gaps, and uneven reliability of non-validated AI advice. Looking ahead, AI may enable earlier diagnosis from microbiome signals, electronic medical record-integrated decision support that fuses wearable and patient-reported data, virtual reality-based therapies for gut–brain modulation, and reinforcement-learning protocols that adapt treatments over time—shifting IBS care toward proactive, precision-guided management.

Reference: De Silva AP, Prabagar K, Niriella MA, De Silva HJ. Management of Irritable Bowel Syndrome: The Role of Digital Health Technologies. J Gastrointestin Liver Dis. 2025;34(3):275-278. doi: 10.15403/jgld-6189.