In the Journals

Chronic idiopathic constipation, IBS-C exist on a 'spectrum' of disease

Constipation-predominant irritable bowel syndrome, or IBS-C, and chronic idiopathic constipation, or CIC, are not distinct diseases but rather exist on a spectrum where abdominal symptoms affect the most severe patients, according to recent study data.

Although IBS-C and CIC are “classified by the Rome criteria as distinct diseases, symptoms frequently overlap,” William D. Chey, MD, from University of Michigan School of Medicine, told Healio Gastroenterology. “The objective of our study was to characterize symptom and disease burden in IBS-C and CIC sufferers and gain insights into whether these really are separate and distinct disorders or conversely represent the two ends of a disease spectrum defined by the presence or absence of abdominal symptoms including pain, discomfort and bloating.”

William D. Chey

Chey and colleagues conducted a U.S. population-based survey study that included respondents who met Rome III criteria for IBS-C or CIC based on an initial screening survey distributed in January 2010. The study survey assessed overall symptom severity, frequency, bothersomeness, whether they had seen a physician, satisfaction with physician care, missed work and disrupted productivity. CIC respondents were analyzed in two subgroups: those with abdominal symptoms at least once per week (CIC-A) and those without abdominal symptoms (CIC-NA).

Of 10,030 respondents, 328 met the criteria for IBS-C, 363 for CIC-A and 189 for CIC-NA. Both groups were predominantly female and white.

All of the abdominal and bowel symptoms assessed were more frequent in IBS-C respondents vs. those with CIC (P < .0001). Constipation was extremely or very bothersome in 72% of the IBS-C group compared with 62% of the CIC-A group and 40% of the CIC-NA group (all P < .01). Of the 11 other symptoms assessed, all were significantly more bothersome to respondents with IBS-C and CIC-A compared with those who had CIC-NA. Disrupted productivity was highest in IBS-C respondents, with a mean of 4.9 days per month compared with 3.2 in CIC-A respondents and 1.2 in CIC-NA respondents (all P < .001). CIC-NA patients who sought physician care also were more likely to be very or extremely satisfied with that care compared with the other groups (P < .01).

“We concluded that IBS-C and CIC patients with abdominal symptoms have a similar disease burden and both groups experience greater disease burden than CIC patients without abdominal symptoms,” Chey said. “Our results argue that for many patients, CIC and IBS-C are not separate and distinct entities but more likely reside on a ‘spectrum’ of disease with abdominal symptoms identifying more severely affected constipation patients.” – by Adam Leitenberger

Disclosure: Chey reports he has served as an adviser or consultant for Actavis, AstraZeneca, Astellas, Asubio, Ferring, Furiex, Ironwood, Nestle, Proctor & Gamble, Prometheus, Salix, SK, Sucampo and Takeda. He also reports he has served as a speaker and received travel expenses from the GI Health Foundation, and has received grant support from Ironwood, Perrigo and Prometheus. Please see the study for a full list of all other authors’ relevant financial disclosures.