Sa2014 The Burden of Functional Disease

Abstract

Functional gastrointestinal (GI) disorders are common and are associated with a significant burden for affected individuals and society. Considering improvement in diagnostic and therapeutic options for patients with such diseases, we examined time trends in emergency department (ED) visits and hospitalization. METHODS: The Nationwide Inpatient Sample (NIS), the State Inpatient Database (SID) and Nationwide Emergency Department Sample (NEDS) were queried for annual encounters between 1997 and 2011 (2005-2011 for the NEDS), using diagnosis codes for constipation, irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), dyspepsia and gastroparesis. Total case loads, age and sex distribution, and significant comorbid conditions were abstracted. RESULTS: Constipation accounted for about half of all ED encounters for all functional GI diseases with a 25% increase to an annual rate of 189.2±5.7 per 100,000. In the same time frame ED visits for gastroparesis nearly doubled (annual rate of 9.6±0.5/100,000), while visits for dyspepsia and GERD decreased or remained stable. Admission rates from the ED remained stable and were highest for gastroparesis (53.1±2.0%) followed by IBS (32.7±0.5%), GERD (17.4±0.8%), dyspepsia (9.4±0.2) and constipation (4.1±0.1%). Nearly 40% (38.6±0.6%) of ED encounters for constipation involved children, while the fraction of pediatric patients was significantly lower in all other functional GI diseases. Admission rates for constipation more than doubled to 12.0±0.5/100,000, while those for IBS transiently increased by 50% around 2004 and then dropped to 4.0±0.2/100,000. This pattern was seen across all regions of the United States. Abdominal pain was listed as secondary diagnosis in nearly one fifth of the patients, which did not differ significantly from IBS (18.1±0.8% vs. 20.2±0.9%, respectively). Mood disorders commonly coexisted and correlated with higher likelihood of hospitalization. CONCLUSION: Despite the widespread availability of treatment options, constipation remains a common reason for ED visits and hospitalizations, accounting for more than 50% of the encounters with functional gastrointestinal illnesses as the primary diagnosis. The striking shifts in the apparent burden of constipation and IBS likely represent differences in diagnostic coding. The lack of geographic difference suggests that national campaigns rather than graduate and post-graduate training of practitioners caused this shift.