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. 2016 Jun;4(3):413-22.
doi: 10.1177/2050640615600114. Epub 2015 Aug 6.

Symptom burden and consulting behavior in patients with overlapping functional disorders in the US population

Nimish Vakil  1 , Margie Stelwagon  2 , Elizabeth P Shea  2 , Steve Miller  3
Affiliations

Symptom burden and consulting behavior in patients with overlapping functional disorders in the US population

Nimish Vakil et al. United European Gastroenterol J. 2016 Jun.

Abstract

Background: Regulatory and treatment guidelines focus on individual conditions, yet clinicians often see patients with overlapping conditions.

Objective: This cross-sectional survey study assesses the impact of overlapping functional dyspepsia (FD), gastroesophageal reflux disease (GERD), irritable bowel syndrome with constipation (IBS-C), and chronic idiopathic constipation (CIC) on symptom burden and consulting behavior.

Methods: Survey participants met Rome III criteria for FD, IBS-C, and/or CIC, and/or reported GERD; participants answered questions about symptom frequency and bothersomeness, work and productivity, and consulting behavior.

Results: Of 2641 respondents, 1592 (60.3%) had one condition; 832 (31.5%) had two; and 217 (8.2%) had three; 57.3% of 1690 FD, 54.6% of 1337 GERD, 82.6% of 328 IBS-C, and 62.5% of 552 CIC respondents had condition overlap. Overall GI symptoms were very/extremely bothersome in 28.6% of single-condition respondents, 50.7% of two-condition, and 69.6% of three-condition respondents (p < 0.001, chi square). Symptom frequency and productivity losses both increased with condition overlap. Over 12 months, 43.7% of single-condition, 49.9% of two-condition, and 66.5% of three-condition respondents consulted a physician about GI symptoms (p < 0.001, chi square).

Conclusion: Functional GI disorders frequently overlap with each other and with GERD. Condition overlap is associated with greater symptom burden and increased physician consultations.

Keywords: FD; GERD; IBS; IBS-C; Irritable bowel syndrome with constipation; chronic idiopathic constipation; functional dyspepsia; gastroesophageal reflux disease.

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Figures

Figure 1.
Figure 1.
Overlap among common symptomatic gastrointestinal disorders. Figure not to scale. CIC: chronic idiopathic constipation; IBS-C: constipation-predominant irritable bowel syndrome; FD: functional dyspepsia; GERD: gastroesophageal reflux disease.
Figure 2.
Figure 2.
(a) Frequency of symptoms experienced by IBS-C respondents, with and without overlapping condition. *vs. IBS-C only, p < 0.05. **vs. IBS-C only and vs. IBS-C-FD overlap, p < 0.05. ***vs. IBS-C only, vs. IBS-C-FD overlap, and vs. IBS-C-GERD overlap, p < 0.05. (b) Frequency of symptoms experienced by CIC respondents, with and without overlapping conditions. *vs. CIC only, p < 0.05. **vs. CIC only and vs. CIC-FD overlap, p < 0.05. ***vs. CIC only, vs. CIC-FD overlap, and vs. CIC-GERD, p < 0.05. (c) Frequency of postprandial distress experienced by FD respondents, with and without overlapping conditions. *vs. FD only, p < 0.05. **vs. FD only and vs. CIC-FD overlap, p < 0.05. CIC: chronic idiopathic constipation; IBS-C: constipation-predominant irritable bowel syndrome; FD: functional dyspepsia; GERD: gastroesophageal reflux disease.
Figure 3.
Figure 3.
Overall symptom bothersomeness: percentage of respondents reporting very or extremely bothersome symptoms, by condition in rank order. P < 0.001, chi square test. CIC: chronic idiopathic constipation; IBS-C: constipation-predominant irritable bowel syndrome; FD: functional dyspepsia; GERD: gastroesophageal reflux disease.
Figure 4.
Figure 4.
Percentage of respondents who sought physician care for GI symptoms in past 12 months, in rank order by condition. GI: gastrointestinal; CIC: chronic idiopathic constipation; IBS-C: constipation-predominant irritable bowel syndrome; FD: functional dyspepsia; GERD: gastroesophageal reflux disease.
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