Review for 10.1186/s12876-025-03774-6 (2025)

Title: Clinical Practice Guidelines for the Diagnosis of Constipation-predominant Irritable
Bowel Syndrome and Functional Constipation in Adults: A Scoping Review
Version: 2 Date: 24 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the focus of the study is on diagnostic criteria, the exclusion of treatment approaches
may limit the broader clinical utility of the findings. Treatment strategies are an important aspect
of managing these disorders, and a brief mention of how diagnostic criteria influence treatment
could have enriched the discussion.
-The review only includes national authorities and international academic associations. This
selection might exclude guidelines from other potentially relevant stakeholders, such as private
organizations or regional medical societies, which may have different perspectives or practical
insights into diagnosing IBS-C and FC.
-The reliance on the latest version of each guideline could also introduce a bias, as older versions
might provide insight into evolving practices or trends in diagnostic approaches.
-The study mentions the low diagnostic sensitivity of the Rome IV criteria for IBS-C and FC,
but the implications of this limitation are not fully explored. While it is acknowledged that this
impacts clinical decision-making, the study could delve further into the consequences of low
sensitivity on patient outcomes or treatment efficacy.
-The study primarily focuses on healthcare providers' perspectives and diagnostic criteria but
could benefit from exploring patient-centered aspects. For instance, how patients experience or
understand the diagnostic criteria, and how this impacts their treatment adherence or quality of
life, could add an important dimension to the review.
-While the review acknowledges the overlap between IBS-C and FC, it could go further in
discussing the specific challenges that this overlap presents for clinicians in practice. More
emphasis on the subjective nature of symptom reporting (e.g., abdominal pain) and how this can
lead to diagnostic uncertainty in real-world settings could offer more actionable insights.
-Although the article acknowledges the limitations of Rome's criteria, it could expand more on
the sensitivity and specificity of these diagnostic frameworks, especially in relation to IBS-C
and FC. The review could have provided more data on how misclassification between these
conditions directly impacts patient care and treatment outcomes, particularly for FC patients
who may experience pain, which is often overlooked.
-While the review mentions regional differences, it could be more explicit about how the
geographic variance in CPGs affects diagnostic accuracy. Some countries, such as Japan and
China, recommend colonoscopy regardless of the absence of alarm symptoms, yet the review
does not go deeply into why these variations occur or how they affect patient outcomes. A more
detailed exploration of healthcare infrastructure differences would provide clearer insights into
why these discrepancies persist.
-The review mainly focuses on diagnostic criteria but does not sufficiently address the long-
term management or treatment challenges faced by patients diagnosed with IBS-C and FC.
This aspect could have been more thoroughly discussed, especially considering how diagnostic
inaccuracies might impact treatment outcomes, adherence, and overall patient satisfaction.