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Summary   Background  Few clinical trials in chronic idiopathic constipation ( CIC ) patients have evaluated abdominal symptom severity and whether  CIC  patients with abdominal symptoms respond similarly to patients with limited abdominal symptoms.    Aims  To examine abdominal symptom severity and relationships between symptoms and global measures at baseline; compare linaclotide's effect on symptoms in subpopulations with more or less abdominal pain; and assess relationships between symptom improvement and global measures in these two subpopulations.    Methods  In two phase 3 trials, patients meeting modified Rome  II CIC  criteria were assigned to linaclotide 145 μg, 290 μg, or placebo once daily. Patients rated abdominal and bowel symptoms daily during 2‐week pre‐treatment and 12‐week treatment periods. Linaclotide's effect on symptoms and global measures [constipation severity, health‐related quality of life ( HRQOL ), treatment satisfaction] and their inter‐relationships were assessed in  post hoc  analyses of abdominal pain subpopulations.    Results  Of 1271  CIC  patients, 23%, 32%, and 43% reported moderate‐to‐severe abdominal pain, discomfort, and bloating, respectively, during baseline. In more‐severe abdominal pain patients, abdominal symptoms were more strongly correlated than bowel symptoms with global measures, but in less‐severe abdominal pain patients, abdominal and bowel symptoms were similarly correlated with global measures, at baseline and post‐treatment. Linaclotide significantly improved all symptoms and global measures in both subpopulations.    Conclusions  When abdominal pain is present in  CIC , abdominal and not bowel symptoms may drive patient assessments of constipation severity,  HRQOL , and treatment satisfaction. Linaclotide (145 μg and 290 μg) is an effective treatment for both abdominal and bowel symptoms, even in  CIC  patients with more severe abdominal pain at baseline. (Clinicaltrials.gov:  NCT 00765882,  NCT 00730015).

alimentary pharmacology and therapeutics

The impact of abdominal pain on global measures in patients with chronic idiopathic constipation, before and after treatment with linaclotide: a pooled analysis of two randomised, double‐blind, placebo‐controlled, phase 3 trials