IS DYSPEPSIA MORE PREVALENT IN FUNCTIONAL CONSTIPATION THAN FUNCTIONAL DIARRHEA? A POPULATION-BASED STUDY

Abstract

Purpose: In chronic constipation, disturbed gastric and small bowel transit as well as abnormal esophageal motility has been demonstrated. The aim of this study was to determine if the prevalence of dyspepsia is higher in subjects with functional constipation than diarrhea. We conducted a cross-sectional study to examine the prevalence of upper gastrointestinal symptoms in subjects with chronic colonic symptoms. Methods: 1069 employees of an integrated healthcare system were mailed a validated questionnaires inquiring about their upper and lower gastrointestinal symptoms (validated Bowel Disease Questionnaire). Definitions of dyspepsia subgroups (including dysmotility, reflux and ulcer-like), functional constipation and diarrhea were based on the Rome I criteria. Reflux-like dyspepsia was defined as having dyspepsia according to the Rome criteria with heartburn and/or reflux once a week or more. Results: 723 subjects (response rate 72%) returned the survey (age range 24–77). One hundred and forty (19.4%) subjects reported constipation and 10.9% reported diarrhea. Symptoms of dyspepsia were reported by 14.7% of subjects (6.2% ulcer-like, 6.1% dysmotility-like, and 9.4% reflux-like dyspepsia). Controlling for age, constipation was more common in females (OR 1.95, 95% CI 1.29-2.95, p < 0.01), whereas diarrhea and dyspepsia (including its subgroups) were not associated with gender (all p>41). Dyspepsia (including ulcer-like and reflux-like) was slightly more common in subjects with constipation than diarrhea but the differences were not significant (all p>0.25) (Table). On individual symptom analysis, heartburn (7% vs. 3%) and acid regurgitation (4% vs. 2%) were more common in subjects with constipation than diarrhea, but these differences were not significant (all p >0.23)Table: Prevalence and 95% CI of dyspepsia and dyspepsia subtypes in subjects with constipation and diarrheaConclusions: There is considerable overlap of upper gastrointestinal symptoms in both functional constipation and diarrhea. The prevalence of symptoms of dyspepsia and its subgroups are not significantly higher in subjects with constipation than diarrhea.