The impact of functional constipation on quality of life of middle-aged Black Americans: a prospective case-control study

Cost of Constipation: A New Look With a Focus on New Medications

GOAL

The study was designed to assess drug costs for constipation therapy and to relate costs to markers of functional status.

BACKGROUND

Secretagogues have been introduced as new agents for the treatment of constipation. Previously published modeling studies suggested that improved productivity lowers the indirect disease burden and balances the higher drug costs.

STUDY

Data were abstracted from the publicly available Medical Expenditure Panel Survey to identify adults with a functional gastrointestinal disorder who received a prescription for laxatives or secretagogues covering >2 days. Demographic data, recorded health care utilization and cost, and markers of functional status were extracted for the years from 2005 to 2017 to determine differences between participants treated with secretagogues or laxatives.

RESULTS

The cohort of 2006 persons was female predominant [67.8%; age: 56.9 (55.8-57.9) years] and spent $92.89 (75.68-110.10) for medications treating constipation. The use of secretagogues (10.3% of the cohort) was the best independent predictor of constipation treatment costs. Using quality of life measures, perceived limitations in activities or work, and absenteeism, there was no difference between participants receiving laxatives and those taking secretagogues.

CONCLUSION

Using survey data designed to be representative of the United States population, the study identified secretagogues as a key cost factor in drug treatment of constipation. The results do not support models suggesting improved role functioning offsets these higher direct expenditures. While prospective comparative studies are needed to more definitively correlate costs with direct or indirect benefits of different agents, limiting the use of more expensive medications to otherwise refractory cases may help to reign in the spiraling health care costs in this country.

The Humanistic and Economic Burden of Chronic Idiopathic Constipation in the USA: A Systematic Literature Review

Background

Chronic idiopathic constipation (CIC) is a functional gastrointestinal disorder with an estimated prevalence of 16% in the USA; however, the humanistic and economic burden of CIC is poorly characterized.

Aim

This systematic literature review aimed to assess the humanistic and economic burden of CIC in adults in the USA.

Methods

Two systematic literature searches of English-language publications on the humanistic and economic burden of CIC in adults in the USA were conducted using electronic databases and other resources. Both searches included the terms "chronic idiopathic constipation" and "functional constipation". Specific terms used in the search on humanistic burden included "quality of life", "SF-36", "SF-12", and "PAC-QOL"; search terms for economic burden included "cost", "resource use", "absenteeism", and "productivity".

Results

Overall, 16 relevant articles were identified. Health-related quality of life (HRQoL) appeared to be reduced in patients with CIC compared with controls and the general US population. Abdominal (r=0.33-0.49), stool (r=0.23-0.33), and rectal symptoms (r=0.53) appeared to be associated with reduced HRQoL. Younger age and female sex were associated with reduced overall HRQoL and greater symptom severity. Direct outpatient costs were higher in patients with CIC than those without CIC (US$6284 vs US$5254). Patients with CIC and abdominal symptoms reported more days of disrupted productivity per month than those without abdominal symptoms (3.2 days vs 1.2 days). The overall prevalence of complementary and alternative medicine use by patients with CIC was similar to that in the general US population.

Conclusion

The reduced HRQoL and increased costs associated with CIC indicate unmet therapeutic need in this disorder. Further research is required to better understand the humanistic and economic burden of CIC in the USA.

Effective of education on quality of life and constipation severity in patients with primary constipation

OBJECTIVE

This study was conducted to examine the effect of education on quality of life and constipation severity in patients with primary constipation.

METHODS

This randomised controlled study was conducted with 80 patients who applied at the gastroenterology outpatient clinic of a university hospital. In the study, the Constipation Questionnaire, Constipation Quality-of-Life Questionnaire (PAC-QOL), and Constipation Severity Instrument (CSI) were used.

RESULTS

It was that found after 4 weeks of education, the total PAC-QOL mean score decreased to 60.85 ± 5.65 and total CSI mean score decreased to 20.17 ± 4.05 in the intervention group (p < 0.001). No change was observed in the patients in the control group (p > 0.05). After 4 weeks, a statistical difference was found between the two groups in PAC-QOL mean score and CSI mean score (p < 0.05).

CONCLUSION

It was determined that the education given to individuals with primary constipation decreased the constipation severity and increased the quality of life.

PRACTICE IMPLICATIONS

Constipation education will make a contribution to the active use of follow-up forms by nurses in the clinic for the diagnosis of constipation, individual assessment of each patient, and their active role in constipation management.

Acupuncture for patients with chronic functional constipation: A randomized controlled trial

BACKGROUND

Acupuncture is used to treat chronic functional constipation (CFC) in China, despite limited evidence. We aim to assess the effectiveness and safety of acupuncture in managing CFC.

METHODS

A multicenter randomized controlled trial was performed involving 684 patients with CFC; the patients were randomly allocated to receive He acupuncture (n = 172), Shu-mu acupuncture (n = 171), He-shu-mu acupuncture (n = 171), or oral administration of mosapride (n = 170). Sixteen sessions of acupuncture were given in the treatment duration of 4 weeks. The primary outcome was the change in spontaneous bowel movements (SBMs) at week 4 (at the end of treatment) compared to baseline. The secondary outcomes included stool consistency (Bristol scale), the degree of straining during defecation, and adverse events.

KEY RESULTS

The SBMs increased in all the four groups at week 4, and the magnitude of increase was equivalent in the four groups (He acupuncture, 2.7 [95% CI, 2.3-3.1]; Shu-mu acupuncture, 2.7 [95% CI, 2.3-3.0]; He-shu-mu acupuncture, 2.2 [95% CI, 1.9-2.5]; and mosapride, 2.4 [95% CI, 2.0-2.9]; P = .226). However, the change in SBMs at week 8 was significantly smaller in mosapride group (1.4 [95% CI, 1.0-1.8]) than the three acupuncture groups (2.4 [95% CI, 2.1-2.7], 2.3 [95% CI, 1.9-2.7], 2.1 [95% CI, 1.7-2.5] in He, Shu-mu, and He-shu-mu group, respectively, P = .005).

CONCLUSIONS & INTERFERENCES

The three acupuncture treatments were as effective as mosapride in improving stool frequency and stool consistency in CFC, but the magnitude of the treatment effect is unknown due to the lack of sham acupuncture control.

Efficacy of Cranial Electrotherapy Stimulation Combined with Biofeedback Therapy in Patients with Functional Constipation

Background/Aims

A large number of studies have shown that function constipation (FC) has an extremely high incidence of mental and psychological disorders. Cranial electrotherapy stimulation (CES) was applied to the treatment of psychological disorders such as anxiety and depression. We explored the effects of CES combined with biofeedback therapy (BFT) on the psychological state, clinical symptoms, and anorectal function in patients with FC.

Methods

A total of 74 patients with FC were randomly divided into 2 groups. The control group received BFT. CES combined with BFT was carried out in the experiment group. All patients were assessed using the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Wexner constipation score at baseline and the end of each course. Anorectal manometry and balloon expulsion tests were performed before and after treatment.

Results

After treatment, the participants in the experiment group had significantly lower score SAS, SDS, and Wexner constipation scores than the control group (all P < 0.05). The number of successful expulsion in the experiment group was larger than the control group (P = 0.016).

Conclusions

CES combined with BFT was effective in improving the psychological status of anxiety, depression, and bowel symptoms in patients with FC.

Gastrointestinal problems in modern wars: clinical features and possible mechanisms

Gastrointestinal problems are common during wars, and they have exerted significant adverse effects on the health of service members involved in warfare. The spectrum of digestive diseases has varied during wars of different eras. At the end of the 20th century, new frontiers of military medical research emerged due to the occurrence of high-tech wars such as the Gulf War and the Kosovo War, in which ground combat was no longer the primary method of field operations. The risk to the military personnel who face trauma has been greatly reduced, but disease and non-battle injuries (DNBIs) such as neuropsychological disorders and digestive diseases seemed to be increased. Data revealed that gastrointestinal symptoms such as constipation, diarrhea, dyspepsia, and noncardiac chest pain are common among military personnel during modern wars. In addition, a large number of deployed soldiers and veterans who participated in recent wars presented with chronic gastrointestinal complaints, which fulfilled with the Rome III criteria for functional gastrointestinal disorders (FGIDs). It was also noted that many veterans who returned from the Gulf War suffered not only from chronic digestive symptoms but also from neuropsychological dysfunction; however, they also showed symptoms of other systems. Presently, this broad range of unexplained symptoms is known as "Gulf War syndrome". The mechanism that underlies Gulf War syndrome remains unclear, but many factors have been associated with this syndrome such as war trauma, stress, infections, immune dysfunction, radiological factors, anthrax vaccination and so on. Some have questioned if the diagnosis of FGIDs can be reached given the complexity of the military situation. As a result, further studies are needed to elucidate the pathogenesis of gastrointestinal disease among military personnel.

Comparison of psychological characteristics between patients with irritable bowel syndrome with constipation and those with functional constipation

AIM: To explore the difference in psychological characteristics between patients with irritable bowel syndrome with constipation (IBS-C) and those with functional constipation (FC), to seek the role of psychological factors in the pathogenesis of the two diseases, and to provide a theoretical basis for the development of individualized treatments for them.

METHODS: We retrospectively compared the psychological characteristics (depression, anxiety profiles and score for life quality) between patients with IBS-C vs those with FC using validated questionnaires. Subjects rated the intensity of digestive symptoms experienced using visual analogue scales and questionnaires. Colonic transit time measurements and anorectal manometry were performed.

RESULTS: Of the 208 consecutive constipated patients included, 102 suffered from IBS-C and 106 from FC. Demographic and physiological traits were similar between the two groups. Levels of the common symptoms such as constipation, bloating, abdominal pain and diarrhea in patients with IBS-C were higher than those in patients with FC (P < 0.05), although there was no significant difference in Bristol stool form scale or constipation symptom score (P > 0.05). Patients with FC had higher transit time in the recto-sigmoid area than IBS-C patients, although transit time in other regions was similar between the two groups. There was no significant difference in anorectal manometry measures between the two groups. Patients suffering from IBS-C reported significantly higher depression score (18.156 ± 1.476 vs 11.902 ± 1.351, P < 0.01), and high depression scores were found more frequently in the IBS-C group as compared to the FC group, although trait anxiety and state anxiety were similar between the two groups (P > 0.05). Multiple linear regression showed a positive correlation between symptom intensity and depression and anxiety scores only for FC patients.

CONCLUSION: IBS-C and FC have some differences in the psychological aspects. IBS-C patients are more depressed than patients with FC. There is a correlation between depression, anxiety and levels of symptoms in FC patients.

Diagnosis of functional constipation: agreement between Rome III and Rome II criteria and evaluation for the practicality

OBJECTIVE

To investigate the agreement between Rome III and Rome II criteria for diagnosing functional constipation (FC) and to evaluate the accuracy of each constipation symptom for FC diagnosis.

METHODS

Patients with chronic constipation underwent rigorous biochemical and endoscopic/imaging tests to exclude organic and metabolic diseases. The questionnaires including general information, constipation symptoms, and the most troublesome constipation symptoms were completed in a face-to-face survey. The accuracy of constipation symptoms for FC diagnosis was examined using the likelihood ratio.

RESULTS

Among 184 patients (43 males and 141 females) with chronic constipation, 166 (90.2%) met Rome II criteria and 174 (94.6%) met Rome III criteria for FC, while 166 met both criteria. There was a good diagnostic agreement between the two sets of criteria, with a kappa value of 0.69 and the overall agreement rate was 95.7% (P < 0.001). Based on Rome III criteria, the most accurate symptom for FC diagnosis was sensation of anorectal blockage, followed by straining during defecation and infrequent bowel movements. The most troublesome symptoms reported by patients were lumpy or hard stools, straining during defecation, sensation of incomplete evacuation. More patients indicated that 'the symptoms in the past 3 months' was better than 'those within the past one year' to reflect their constipation (36.7% vs 6.0%, P < 0.001).

CONCLUSIONS

There is good agreement between Rome III and Rome II criteria for FC diagnosis. Rome III criteria are more practical than Rome II criteria for Chinese patients.