The burden of irritable bowel syndrome and chronic constipation on health-related quality of life in black Africans: a comparison with healthy control subjects in Côte d'Ivoire, West Africa

Abstract

Background: Although patients with irritable bowel syndrome (IBS) and chronic constipation (CC) have an impaired health-related quality of life (HRQoL), little is known in black African patients compared with control subjects. This study provided the magnitude and the influencing factors of HRQoL impairment in black African outpatients with IBS or CC compared with control subjects using the generic SF-36 questionnaire. Materials and methods: One hundred and four consecutive black African outpatients complaining with IBS (n=72, mean age=38.9 years, female=62.5%) and CC (n=32, mean age=37.4 years, female=75%) met Rome 3 criteria were compared with 210 control subjects (mean age=37.4 years, 63.8% male). The SF-36 scores in all domains of HRQoL with the corresponding physical (PCS) and mental (MCS) composite scores between groups were compared with post hoc analysis and multivariate linear regression analysis for the assessment of the influencing factors. Results: Overall, IBS and CC patients exhibited low SF-36 scores in the 8 domains of HRQoL in comparison with control subjects. IBS patients scored less in mental health (mean difference=-10.3, p=0.001), bodily pain (mean difference=-23.5, p≤0.0001), and social functioning domains (mean difference =-15.1, p=0.01) in comparison with CC patients. Post hoc analysis demonstrated a trend down of PCS (mean difference=-12.9, p<0.0001) and MCS (mean difference=-11.2, p=0.01) disfavoring IBS patients than those with CC in comparison with control subjects. In multivariate linear regression analysis, besides the negative impact of IBS and CC, factors influencing PCS were BMI (β=0.4; p=0.01) and comorbidities (β=-5.9; p=0.002). Those influencing MCS were the presence of remunerated activity (β=2.7, p=0.02), and patient living alone (β=9.4; p=0.04). Conclusion: IBS and CC impact negatively on the HRQoL in black African subjects and more importantly in those with IBS than CC.

Keywords: SF-36 questionnaire; black Africans; chronic constipation; irritable bowel syndrome; quality of life.

Figure 1

Distribution and trend of means scores of SF-36questionnaire items adjusted to age within all subgroups. Lines were smoothed because of the presence of one subject in the belonging age class. Abbreviations: IBS, irritable bowel syndrome; CC, chronic constipation; Ct, controls; PF, physical functioning; RP, role of physical; RE, role of emotional; BP, bodily pain; SF, social functioning; GH, general health; VT, vitality; MH, mental health; PCS, physical composite score; MCS, mental composite score.

Figure 2

Box plots depicting the distribution and trends of physical (A) and mental (B) composite scores between patients with irritable bowel syndrome, chronic constipation, and control subjects. The box represents the interquartile range; the top and the bottom of the box are, respectively, the 25^th and 75^th percentile. The line across the box is the median. The lower and upper values are indicated by the whiskers. Stars and circles represent the outliers and extreme values. Abbreviations: IBS, irritable bowel syndrome; CC, chronic constipation.

Figure 3

Box plots depicting the distribution, comparison, and trends of physical (A) and mental (B) composite summaries between subjects with no painful chronic constipation (0), painful chronic constipation (1) and irritable bowel syndrome (2). The box represents the interquartile range; the top and the bottom of the box are, respectively, the 25^th and 75^th percentile. The line across the box is the median. The lower and upper values are indicated by the whiskers. Stars and circles represent outliers and extreme values. SE: standard error, Q = calculated statistic, Q(0.05): the critical value of tabled Q statistic =2.39. KW = Kruskal Wallis test. Abbreviations: IBS, irritable bowel syndrome; CC, chronic constipation.