Many patients with chronic constipation or constipation-predominant irritable bowel syndrome are dissatisfied with their current medications, according to study results.
Guido Basilisco, MD, of the gastroenterology and endoscopy unit at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, and colleagues wrote that previous surveys of patients with chronic constipation (CC) have shown that they can become dissatisfied with their treatment despite normalized bowel habits.
“Defining ‘satisfaction with therapy’ or ‘adequate relief of symptoms’ for patients with CC is extremely important in clinical practice for several reasons,” they wrote. “New and more expensive medication can be initiated when the older/cheaper treatments have failed, diagnostic algorithms suggest that functional diagnostic tests should be reserved to patients with inadequate response to laxatives, and — last but not least — more invasive therapeutic approaches have to be used in patients refractory to adequate therapies.”
Researchers conducted an aggregate analysis of 81 N-of-1 trials to evaluate patient satisfaction with therapy and determine if any factors predict favorable outcomes.
Patients with either CC or IBS-C underwent an at least 1-month cycle of effective treatment. To define satisfaction with therapy, investigators used three primary endpoints; satisfaction with therapy, improvement after treatment and extended satisfaction with therapy. They also assessed dyssynergia, resting anal pressure, colonic transit time and somatization.
Participating individuals completed the Patient Assessment of Constipation-Symptoms (PAC-SYM) questionnaire and its Modified version (M-PAC-SYM) and recorded straining at defecation, stool frequency and form every day.
Basilisco and colleagues found that 43% of patients did not achieve satisfaction with therapy. These patients had lower BMI and had more severe constipation at baseline.
Of the factors they explored, only the change in constipation severity on the M-PAC-SYM questionnaire was associated with satisfaction with therapy (OR = 4.3; 95% CI, P < .001).
“Satisfaction with therapy is not fully mapped by a single scale, test or questionnaire: this leads to caution in any clinical decisions affected by such uncertainty,” Basilisco and colleagues wrote. “The aggregate analysis of N-of-1 trials provides interesting clues on the role that clinical and physiological variables have on satisfaction with therapy for constipation in clinical practice.” – by Alex Young
Disclosure: The authors report no relevant financial disclosures.