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. 2015 Apr;110(4):580-7.
doi: 10.1038/ajg.2015.67. Epub 2015 Mar 17.

The spectrum of constipation-predominant irritable bowel syndrome and chronic idiopathic constipation: US survey assessing symptoms, care seeking, and disease burden

Joel J Heidelbaugh  1 , Margie Stelwagon  2 , Steve A Miller  3 , Elizabeth P Shea  2 , William D Chey  4
Affiliations

The spectrum of constipation-predominant irritable bowel syndrome and chronic idiopathic constipation: US survey assessing symptoms, care seeking, and disease burden

Joel J Heidelbaugh et al. Am J Gastroenterol. 2015 Apr.

Abstract

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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Figures

Figure 1
Figure 1
Frequency of symptoms among constipation-predominant irritable bowel syndrome (IBS-C) and chronic idiopathic constipation (CIC) respondents. BM, bowel movement. *IBS-C vs. CIC, P<0.0001.
Figure 2
Figure 2
Relative proportions of respondents meeting the criteria for chronic idiopathic constipation with abdominal symptoms (CIC-A), chronic idiopathic constipation without abdominal symptoms (CIC-NA), and constipation-predominant irritable bowel syndrome (IBS-C).
Figure 3
Figure 3
Symptoms rated as very or extremely bothersome among respondents with constipation-predominant irritable bowel syndrome (IBS-C), chronic idiopathic constipation with abdominal symptoms (CIC-A), and chronic idiopathic constipation without abdominal symptoms (CIC-NA). Abdominal symptoms: *IBS-C vs. CIC-NA and CIC-A vs. CIC-NA, P<0.0001; †IBS-C vs. CIC-A, P<0.03. Bowel symptoms: **IBS-C vs. CIC-NA, P<0.0001; ‡IBS-C vs. CIC-A, P<0.04; §CIC-A vs. CIC-NA, P<0.001.
Figure 4
Figure 4
Physician care. (a) Proportion of respondents who sought physician care in the past 12 months for gastrointestinal symptoms. CIC-A, chronic idiopathic constipation with abdominal symptoms; CIC-NA, chronic idiopathic constipation without abdominal symptoms; IBS-C, constipation-predominant irritable bowel syndrome. *IBS-C vs. CIC-NA and IBS-C vs. CIC-A, P<0.04; §CIC-A vs. CIC-NA, P<0.04. (b) Satisfaction with physician care. †IBS-C vs. CIC-NA and CIC-A vs. CIC-NA, P<0.01.
Figure 5
Figure 5
Symptoms addressed with a physician. Percentages are based on the number of respondents who visited physician and experienced the symptom within the past year. For constipation-predominant irritable bowel syndrome (IBS-C) respondents, N's ranged from 124 to 185; for chronic idiopathic constipation with abdominal symptoms (CIC-A), N's ranged from 104 to 159; for chronic idiopathic constipation without abdominal symptoms (CIC-NA), N's ranged from 17 to 62. *IBS-C vs. CIC-NA, P<0.03; **CIC-A vs. CIC-NA, P<0.04; †IBS-C vs. CIC-A, P<0.04.
Figure 6
Figure 6
Missed work and disrupted productivity due to gastrointestinal (GI) symptoms among working/school-going respondents. CIC-A, chronic idiopathic constipation with abdominal symptoms; CIC-NA, chronic idiopathic constipation without abdominal symptoms; IBS-C, constipation-predominant irritable bowel syndrome. *IBS-C vs. CIC-NA, P<0.01; §IBS-C vs. CIC-A and IBS-C vs. CIC-NA, P<0.001 †CIC-A vs. CIC-NA, P<0.001.
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