The Spectrum of Constipation-Predominant Irritable Bowel Syndrome and Chronic Idiopathic Constipation: US Survey Assessing Symptoms, Care Seeking, and Disease Burden

Heidelbaugh JJ1, Stelwagon M2, Miller SA3, Shea EP2, Chey WD4. Am J Gastroenterol. 2015 Apr;110(4):580-7. doi: 10.1038/ajg.2015.67. Epub 2015 Mar 17.
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1Departments of Family Medicine and Urology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA. 2Ironwood Pharmaceuticals, Inc., Cambridge, Massachusetts, USA. 3Lieberman Inc., Great Neck, New York, USA. 4Division of Gastroenterology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.


INTRODUCTION: The irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) are associated with substantial symptom and disease burden. Although typically classified as distinct diseases, symptoms frequently overlap.

AIM: The objective of this study was to characterize symptom and disease burden in IBS-C and CIC sufferers and examine a subset of CIC sufferers with abdominal symptoms.

METHODS: In a US population-based survey, respondents meeting the Rome III criteria for IBS-C or CIC rated symptom frequency and bothersomeness, missed work and disrupted productivity, and degree of obtaining and satisfaction with physician care. CIC respondents were analyzed in two subgroups: those with abdominal symptoms ≥once weekly (CIC-A) and those without (CIC-NA).

RESULTS: Of the 10,030 respondents, 328 met the criteria for IBS-C and 552 for CIC (363 CIC-A; 189 CIC-NA). All symptoms were significantly more frequent in IBS-C vs. CIC respondents (P<0.0001). Constipation was extremely/very bothersome in 72% of IBS-C respondents, 62% of CIC-A, and 40% of CIC-NA (P<0.01 all pairs). All 11 other measured symptoms were significantly more bothersome in IBS-C and CIC-A vs. CIC-NA respondents. In IBS-C vs. CIC-A, abdominal discomfort, bloating, straining, and pellet-like stools were also significantly more bothersome, with other remaining symptoms similar. Gastrointestinal symptoms disrupted productivity a mean of 4.9 days per month in IBS-C respondents, 3.2 in CIC-A, and 1.2 in CIC-NA (P<0.001 all pairs); missed days were similar in IBS-C and CIC-A respondents.

CONCLUSION: CIC respondents with abdominal symptoms experience greater disease burden compared with CIC respondents without frequent abdominal symptoms and have a disease burden profile that is similar to IBS-C respondents.

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