G. De Roberto

Colonic motility studies in severe chronic constipation: an organic approach to a functional problem.

Abstract Chronic constipation is one of the more frequent functional gastrointestinal symptoms. The more severe cases not infrequently undergo a major surgical approach. However, there is still a need for a better diagnostic and therapeutic approach, since the results are still unpredictable, probably due to a poor selection of candidates. This article focuses on the current diagnostic approach to chronic constipation, with an emphasis on the possible role of colonic manometry to help better choose those patients that may benefit from surgery.

Pharmacological treatment of irritable bowel syndrome: a critical assessment

Irritable bowel syndrome (IBS) is currently defined as a chronic painful abdominal symptom complex arising from altered intestinal function and without discernible underlying structural changes in the gut (1). Since IBS is one of the most frequent complaints related to the gastrointestinal tract in subjects both seeking and not seeking medical attention (2), in recent years there has been considerable interest in developing diagnostic criteria, the most recent being the socalled Rome II criteria (3). Classically, patients with IBS may be subdivided into three groups, each representing about onethird of the overall population: patients with predominance of constipation, patients with predominance of diarrhoea, and patients with alternating bowel habits (4): unfortunately, in most therapeutic trials described in the literature IBS patients have not been subdivided into types, so potential benefits for subgroups may have been lost. Although IBS is frequent in clinical practice, it is worth noting that to date there are only a few studies offering convincing evidence of drug effectiveness in treating the symptom complex of this syndrome (5), as also shown by the variety of compounds employed. Moreover, most of the available literature trials suffer from methodological problems (see below) (6). This review assesses the current pharmacological options for treating IBS, with emphasis on the (few) solid data showing efficacy.