Irritable Bowel Syndrome Constipation Research Articles

Understanding Constipation: A Cross-Sectional Multicenter Study From A Developing Country Setting

Introduction: Constipation is a major public health issue worldwide and is associated with significant health care financial burden and reduced quality of life. About half of the patients are dissatisfied with the treatment prescribed. There is a lack of data on patients understanding of constipation; we therefore aimed to understand the nature of patient's defecatory disorders by using ROME III criteria. Methods: A cross-sectional study was carried out in outpatient gastroenterology clinics of two major hospitals of Karachi-Pakistan; one public and other was private tertiary care hospital. Purposive sampling was done and all patients complaining of constipation and consenting to participate in the study were included. Patients with alarm features (GI bleeding and weight loss) were excluded. Face to face interviews were conducted by trained doctors using a structured Rome III based pre-tested questionnaire and Bristol Stool Scale scoring system. Results: A total of 396 study participants were enrolled with mean (SD) age 38.8(14.7) years. Out of these 210(53%) participants were men. Irritable bowel syndrome-constipation (IBS-C) was present in 209(52.7%) and remaining 186(46.9%) had fulfilled the criteria of functional constipation (FC). Of all the participants, 214(54.0%) reported to have slow transit constipation based upon Bristol Stool Scale (Figure 1). Some accompanying symptoms reported by patients include sensation of incomplete evacuation (69.2%), feeling of abdominal distension (63.9%) and bloating (74.2%). Frequency of other symptoms reported by study participants and gender differences are given in Table 1. In our study FC was found to be more common amongst men (66.1% vs. 33.9%) whereas IBS-C was more common amongst women (57.9% vs. 42.1%, P < 0.001). A higher proportion of women reported more severe form of constipation as compared to men (83.3%, n=150 vs. 66%, n=138 P < 0.001). However, a higher percentage of men reported using medications to treat their symptoms (71.2%, n=151 vs. 57.1%, n=105, P=0.003). Various treatment modalities used by study participants are shown in Figure 2.FigureFigureTable: Table. Frequency of symptoms reported by study participants (n=396)Conclusion: Almost half of the patients were not suffering from slow transit constipation. A large number of patients had diverse accompanying defecatory symptoms. Proper understanding of patient's symptoms is essential for optimizing individual patient management.

Prevalence of functional constipation and constipation-predominant irritable bowel syndrome in Indian patients with constipation

Background: Evaluate prevalence of functional constipation (FC) and irritable bowel syndrome-constipation (IBS-C) in Indian constipated patients and assess their demographic/socio-economic/clinical characteristics.Methods: Patients (≥18 years) who visited their general physician with symptoms of constipation (Rome III criteria for FC or IBS-C as per physician assessment) and willing to participate were enrolled in this prospective, clinical-epidemiological study. Demographic, socioeconomic status, lifestyle and dietary habits, comorbid conditions, treatment history, concomitant medications, stool form (Bristol stool form scale), severity of constipation (constipation scoring system [CSS]), constipation-related symptoms (patient assessment of constipation symptoms [PAC-SYM]) and quality of life (patient assessment of constipation-quality of life questionnaire [PAC-QoL]) were recorded.Results: Out of 925 constipated patients, 75.6% were diagnosed with FC against 24.4% with IBS-C (P &lt; 0.0001). Patients of both subtypes had high average scores of PAC-SYM (FC: 27.1 ± 6; IBS-C: 30.1 ± 4.9) and CSS (FC: 8.4 ± 3.1; IBS-C: 11.2 ± 3), leading to high PAC-QoL score (FC: 38.1 ± 16.8; IBS-C: 42.2 ± 13.6). Hypertension (16%) and diabetes (10%) in patients with FC while acid peptic disorders (21.7%) amongst IBS-C patients were the most common comorbid conditions observed. Laxatives were the most common medication used; osmotic (32.6% versus 40.7%) and bulk laxatives (22.8% versus 37.4%) were the commonest laxatives. However, about 1/5th patients of FC were using home remedies.Conclusions: There was a higher prevalence of FC over IBS-C in Indian constipated patients; both subtypes had high frequency and severity of constipation-related symptoms and poor QoL.

Psychometry and Pescatori projective test in coloproctological patients.

BackgroundPsychological assessment is not commonly performed nor easily accepted by coloproctological patients. Our aim was to evaluate the psychological component of coloproctological disorders using uncommon tools.MethodsThe 21-Item Depression Anxiety and Stress Scale and the Pescatori projective test were applied to coloproctological outpatients of the Gastroenterology Department of our hospital as well as to healthy volunteers.ResultsSeventy patients (median age 47 years, 22 male) divided in 4 groups (functional constipation, constipated irritable bowel syndrome, benign anorectal disease and perianal Crohn’s disease) and 52 healthy volunteers (age 45 years, 18 male) completed the tests. Proctological patients showed higher scores of depression (P<0.001), anxiety (P<0.001), and stress (P<0.001) compared to healthy participants. Compared to the control group, patients with functional constipation, irritable bowel syndrome and perianal Crohn’s disease maintained the highest scores in all subscales (P<0.05), while patients with benign anorectal disease only had higher anxiety and stress (P<0.001) scores. The patients’ also showed lower scores in the Pescatori projective test (P=0.012). A weak association between the projective test and the depression subscale was found (P=0.05).ConclusionProctological patients had higher scores of depression, anxiety and stress and lower scores in the Pescatori projective test compared to healthy controls.

Expression and its significance of aquaporin 8 in patients with functional constipation or constipated irritable bowel syndrome

Objective To detect the expression level of aquaporin 8 (AQP8) in patients with functional constipation(FC) or constipated irritable bowel syndrome (IBS-C), and the correlation between the expression of AQP8 and clinical features. Methods From March to December 2014, a total of 16 patients with IBS-C and 19 patients with FC met Rome Ⅲ criteria were collected, and nine healthy individuals were assigned to control group at the same period. The ascending and decending colonic tissues mucosa of FC, IBS-C and control group were taken under endoscope. The expression of AQP8 at mRNA and protein level was detected by real-time polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC). The differences in AQP8 mRNA expression and AQP8 relative area were analyzed by Kruskal-Wallis test among groups, and Pearson correlation coefficient was performed for correlation analysis between the expression and clinical features. Results The relative expressions of AQP8 mRNA of ascending colon and descending colon of FC patients (1.38, 0.61 to 4.09; 2.65, 0.82 to 7.52) and IBS-C patients (2.23, 0.82 to 4.67; 1.35, 0.51 to 2.03) were higher than those of control group (0.56, 0.19 to 0.97; 0.38, 0.21 to 1.19), and the differences were statistically significant (ZFC=-2.435, -3.149, ZIBS-C=-2.690, -2.152; all P 0.05). Most of AQP8 of FC group was expressed in cytoplasm of colonic mucosa epithelial cells, while that of IBS-C group and control group was mostly expressed at apical membrane and basal membrane of epithelial cells. The results of semi-quantification demonstrated that AQP8 relative area of descending colon of FC and IBS-C group increased compared with that of control group (3.42%(1.24% to 5.61%), 2.45%(1.72% to 4.27%) vs 1.18%(0.35% to 2.81%); Z=-2.534, -2.151, both P<0.05). Meanwhile, AQP8 relative area of ascending colon of FC group increased compared with that of control group (2.46%(1.48% to 4.18%) vs 1.14%(1.29% to 2.15%) Z=-2.041, P<0.05). Conclusion There are differences in AQP8 expression quantity and location in cells of descending colon between patients with FC and patients with IBS-C, which is a way for differentiation these two diseases. Key words: Functional constipation; Irritable bowel syndrome; Aquaporin 8; Colonic mucosa; Clinical features

Treatment patterns, symptom reduction, quality of life, and resource use associated with lubiprostone in irritable bowel syndrome constipation subtype

Objectives Real-world patient outcomes data is scarce concerning the high disease burden of IBS-C. The aim of this study was to compare patient-reported symptom control, health-related quality of life (HRQoL), resource utilization, and treatment satisfaction of lubiprostone vs non-lubiprostone treatment for irritable bowel syndrome–constipation (IBS-C).Research design and methods An observational, retrospective US chart review and computer-assisted telephone patient survey was conducted March to August 2013 recruiting women over 18 years old with physician-confirmed IBS-C who had initiated new treatment from inadequate relief of previous treatments and who had been on the new treatment ≥3 months. Multiple IBS-C treatments were permitted. IBS-C severity, time since diagnosis, age, and race were controlled using inverse probability of treatment weighting. Weighted outcomes were compared using t-tests (continuous outcomes) and chi-squared tests (categorical outcomes).Main outcomes measures Instruments included Patient Assessment of Constipation Symptoms (PAC-SYM) and IBS quality of life (IBS-QoL). A single item assessed current treatment satisfaction.Results Of 162 patients (mean age 45.9 [SD 15.3] years old, 71% white, 61.1% with moderate IBS-C), 76 switched to lubiprostone and 86 to non-lubiprostone. Groups were similar in clinical and demographic characteristics and previous 30 day IBS-C treatment. After weighting, all PAC-SYM scores were lower for lubiprostone (P < 0.05). All IBS-QoL subscales were higher for lubiprostone including overall, dysphoria, social reaction, sexual, and relationship scores (P < 0.05.) More lubiprostone patients reported positive treatment satisfaction (92.3% vs 71.0%, P < 0.001).Conclusions In IBS-C patients with inadequate response to previous therapies, lubiprostone improved patient-reported symptom control, treatment satisfaction, and HRQoL. Key limitations include lack of measurement of patient-reported outcomes at treatment start and potential data gaps in chart documentation.

Frequency of subtypes of irritable bowel syndrome in positive and negative subtypes of schizophrenia

ObjectiveThe aim of the study was to determine the frequency of subtypes of irritable bowel syndrome in positive and negative subtypes of schizophrenia.MethodsSixty-two drug naïve hospitalized patients between 18 and 65 years (mean age: 33.6) with first episode of schizophrenia based on DSM IV-TR and 69 control subjects matched for age and sex completed this study. A semi-structured clinical interview was used to assess both groups. Clinical data were obtained and basic lab investigations and ultrasonography of abdomen were done in all subjects to exclude any related abdominal pathology. Axis-I disorders of DSM IV-TR were excluded in control subjects. Positive and Negative Syndrome Scale (PANSS) and Rome III Urdu language version scale (cross-validation obtained) for irritable bowel syndrome (IBS) were administered to assess the severity of positive and negative symptoms of schizophrenia and subtypes of irritable bowel syndrome, IBS constipation (IBS-C), IBS Diarrhoea (IBS-D) and IBS Mix (IBS-M) in case and control groups respectively.ResultsForty-seven patients (75.8%) and 15 patients (24.2%) had positive and negative schizophrenia respectively. Patients with positive and negative schizophrenia had higher rate of IBS-C 6.5% (n = 4), IBS-D 8.1% (n = 5), IBS-M 12.9% (n = 8), non-IBS 72.6% (n = 45) versus healthy subjects IBS-C 1.4% (n = 1), IBS-D 2.9% (n = 2), IBS-M 2.9% (n = 2), and non-IBS 92.8% (n = 64), OR = 4.8; 95% CI.ConclusionIrritable bowel syndrome is more frequent in patients with schizophrenia than in general population. This functional gastrointestinal disorder associated with psychotic symptoms requires attention and management while managing patients with subtypes of schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Breath methane in functional constipation: response to treatment with Ispaghula husk.

Colonic fermentation produces hydrogen (H2 ), and also produces methane (CH4 ) in subjects with methanogenic flora (M+). Methane production has been associated with chronic constipation (CC) and with changes in gut motility. To determine CH4 production in CC compared to controls, and to assess whether the therapeutic response to Ispaghula husk in CC differs between CH4 -producers and non-producers. Forty-eight patients with functional constipation or irritable bowel syndrome-constipation and 19 healthy age-and-sex-matched volunteers (HV) filled in a 1-week symptom diary and a dietary questionnaire. They then underwent a lactulose breath test (LBT) to measure H2 and CH4 production (peak and area under the time-concentration curve, AUC-) and a colonic transit time (CTT) assessment. In patients, measurements were repeated after a 4-week treatment with Ispaghula husk. Prevalence of M+ in patients was 60.5% vs 52.6% in HV (p = 0.37). Patients had significantly longer CTT and greater production of both H2 and CH4 during LBT. There was a significant correlation between CH4 production and CTT (r = 0.51; p = 0.07). Treatment response rate was similar for M+ and M- patients (58.3% vs 52.9%; p = 0.76) as were the increases in bowel movements and Bristol score, changes in abdominal discomfort and bloating. In M+, treatment reduced CTT (-10 ± 35 h; p = 0.029 vs baseline) and CH4 levels: peak CH4 (-13 ± 24 ppm; p = 0.014) and CH4 -AUC (-817 ± 3100 ppm/min; p = 0.04). Although CH4 production has been associated with CC pathophysiology, we found that CH4 status did not negatively affect the response to Ispaghula husk treatment. The measurement of CH4 levels as a biomarker tool for CC requires further appraisal.

Efficacy and Safety of High Specific Volume Polysaccharide-A New Type of Dietary Fiber for Treatment of Functional Constipation and IBS-C.

We investigated the efficacy and safety of a new type of dietary fiber (high specific volume polysaccharide) for use in treating constipation of different etiologies. Functional constipation patients and irritable bowel syndrome-constipation (IBS-C) patients were administrated high specific volume polysaccharide (HSVP) three times daily for a period of 2 wk to relieve their symptoms. Scores on a stool form scale, and patient reports of straining during a bowel movement, having sensations of an incomplete bowel movement or a blocked anorectum, and abnormal defecation intervals were recorded, graded, and scored by a functional constipation sample group. Similarly, a cohort of IBS-C patients reported their occurrence of abdominal discomfort or pain, abnormal stool formation, defecation frequency, and straining during a bowel movement. Additionally, both groups reported any adverse reactions associated with taking HSVP. All patients in both groups returned for follow-up visits, and no adverse reactions to treatment with HSVP were reported. In the functional constipation group, HSVP was effective for treating symptoms of constipation in 81.46% and 93.17% of patients after 7 and 14 d of dosing, respectively (both p<0.05). In the IBS-C group, symptoms of constipation were relieved in 71.67% and 88.34% of patients after 7 and 14 d of dosing, respectively (both p<0.05). High specific volume polysaccharide was shown be effective for treatment of functional constipation and IBS-C, without causing significant adverse events.

The Prevalence of Irritable Bowel Syndrome among Medical and Non-Medical Suez Canal University Students

Background: Irritable bowel syndrome (IBS) is one of the most frequently diagnosed gastrointestinal (GI) disorders in primary care and gastroenterology practices, despite the fact that many suffer symptoms without knowing their diagnosis or seek for medical consult, so this study aims to explore the prevalence of irritable bowel syndrome (IBS) among Suez Canal university students. Methods: A cross section. With multistage cluster probability sample. Using Rome criteria III IBS module, the questionnaire was administrated to Suez Canal university students; a population consisting of (86) students of the faculty of medicine & non-medical (84) students of the faculty of commerce English section with total (170) students of the third batch from both faculties (whose mean age is 20 ± 0.82) years old with total (109) females and (61) males. Results: The prevalence of IBS according to Rome III criteria in Suez Canal University was 22.9%. 23.8% were diseased in the faculty of commerce while 22.1% in faculty of medicine. Females in this study represent 64.1% of the sample, 30.3% of them were diseased, while males represent 35.9% about 9.8% of them were diseased. IBS constipation predominant type was 28.2%, diarrhea predominant type was 15.4%, mixed type was 46.2%, the unsubtyped cases represent 10.3%. Conclusion: Irritable bowel syndrome is a common disease among Suez Canal university students, more common in non medical students than medical ones, can be considered as a female predominant disease. And this requires a real medical concern.

Influence of a new 5-HT4 receptor partial agonist, YKP10811, on visceral hypersensitivity in rats triggered by stress and inflammation.

Adverse effects of previously developed 5-HT4 receptor agonists to treat functional constipation (FC) and constipation IBS (IBS-C) patients have limited their use but have given rise to new and more selective 5-HT4 receptor agonists. This work was aimed to evaluate the influence of YKP10811, a new potent 5-HT4 receptor partial agonist, on rat models of colorectal hypersensitivity to distension. Male and female rats were submitted to colorectal distension (CRD) before and after trinitrobenzene sulfonic acid (TNBS) infusion, acute (PRS) or chronic (water avoidance -10 days - WAS) stress. Electromyographic (EMG) response of abdominal muscles to CRD (15-60 mmHg) was used to measure pain. Changes of colonic tone were also evaluated. The influence of YKP10811 was compared to that of tegaserod with or without exposure of rats to a 5-HT4 receptor antagonist in TNBS treated rats and to both tegaserod and CP-154,526, a corticotropine releasing factor-R1 antagonist in WAS. We tested a possible pharmacological tachyphylaxis of YKP10811 in TNBS-induced hypersensitivity. YKP10811 (30 mg/kg) had no effect on basal sensitivity and tone in male and female rats but suppressed TNBS-induced hypersensitivity, an effect blocked by the 5-HT4 receptor antagonist GR113808 (10 mg/kg, SC). YKP10811 attenuated acute PRS-induced but not chronic WAS-induced colonic hypersensitivity. In addition, YKP10811 but not tegaserod reduced TNBS-induced colorectal hypersensitivity after 7 days of treatment. YKP10811exhibits antinociceptive activity in inflammation and acute stress-induced colonic hypersensitivity through 5-HT4 receptors but unlike tegaserod, YKP10811 maintains its activity after repeated administrations and may represent a new candidate to treat IBS-C patients.

Association Between SLC6A4 Serotonin Transporter Gene Lainked Polymorphic Region and ADRA2A -1291C>G and Irritable Bowel Syndrome in Korea.

Background/AimsDespite numerous studies on the relation of genetic polymorphisms with irritable bowel syndrome (IBS), the results still remain inconclusive. The aim of this study was to assess the possible association between SLC6A4 serotonin transporter gene linked polymorphic region (5-HTTLPR), ADRA2A −1291C>G, GNB3 825C>T, CCK1R intron 779T>C and TRPV1 945G>C polymorphisms and IBS based on Rome III criteria in Korea.MethodsStudy subjects were prospectively recruited from visitors to Seoul National University Bundang Hospital between July 2009 and January 2014. Ninety-nine IBS patients and 171 healthy controls were enrolled. Polymorphisms of above-mentioned 5 genes were genotyped. Serum serotonin from 101 participants was measured by ELISA and compared according to SLC6A4 5-HTTLPR polymorphisms and IBS subtypes.ResultsRegarding SLC6A4 5-HTTLPR polymorphism, L/L genotype was significantly associated with the total IBS, constipation predominant IBS (IBS-C) and mixture of diarrhea and constipation IBS (IBS-M) (adjusted OR: 4.35, 95% CI: 1.04–16.67; adjusted OR: 11.11, 95% CI: 1.69–50.00 and adjusted OR: 5.56, 95% CI: 1.05–33.33, respectively). Carrying ADRA2A −1291G allele was significantly associated with total IBS and diarrhea predominant IBS (adjusted OR: 3.37, 95% CI: 1.16–9.77 and adjusted OR: 5.64, 95% CI: 1.18–27.01, respectively). IBS-C patients showed reduced level of serum serotonin compared to controls and patients with diarrhea predominant IBS (50.2 ng/mL vs. 69.0 ng/mL and 92.9 ng/mL, P = 0.017 and P = 0.001, respectively).ConclusionsGenetic polymorphisms of SLC6A4 5-HTTLPR and ADRA2A −1291C>G could be one of the pathophysiological factors of IBS in Korea. Reduced serum serotonin shown in the IBS-C group suggested a role of serotonin in IBS, but large study is needed for confirming genotypic difference in serum serotonin level.

Sa1072 Symptom Control, Quality of Life, and Treatment Satisfaction in Patients Treated With Lubiprostone vs. Other Treatments for Irritable Bowel Syndrome-Constipation (IBS-C)

Sa1072 Symptom Control, Quality of Life, and Treatment Satisfaction in Patients Treated With Lubiprostone vs. Other Treatments for Irritable Bowel Syndrome-Constipation (IBS-C)

Sa2010 Differentiation of Functional Constipation (FC) and Irritable Bowel Syndrome-Constipation Predominant (IBS-C) Based on ROME III Criteria. A Population Based Study

Sa2010 Differentiation of Functional Constipation (FC) and Irritable Bowel Syndrome-Constipation Predominant (IBS-C) Based on ROME III Criteria. A Population Based Study

Faecal incontinence—the hidden scourge of irritable bowel syndrome: a cross-sectional study

ObjectiveFaecal incontinence (FI) is a devastating condition which is well recognised in the elderly and those with certain conditions such as inflammatory bowel disease. However, there is surprisingly little information...

Management of chronic constipation in general practice

Chronic constipation is often diagnosed and treated by general practitioners (GPs). The aim of the study was to evaluate the management of constipation by a cohort of Italian GPs. Over the course of 1month, 41 GPs recorded tests and therapies suggested to patients complaining of chronic constipation. They were classified according to the Rome III criteria as constipated irritable bowel syndrome (C-IBS), functional constipation (FC), or "self-perceived constipation" (SPC) (not consistent with the Rome criteria). The most frequently prescribed tests for the 229 patients (147 FC, 50 C-IBS, 32 SPC) were routine blood tests (59.3%), abdominal ultrasounds (37.2%), thyroid function (36.7%), fecal occult blood tests (36.7%), and tumor markers (35%). Patient sex and age, GP age, and whether the diagnosis was new influenced the GP's request, but FC, C-IBS, or SPC status did not. Dietary suggestions (81.9%), fiber supplements (59.7%), reassurance (50.9%), and laxatives (30.5%) were the most frequently prescribed treatments. Antispasmodics were more frequently suggested for C-IBS patients; dietary suggestions, fiber, and enemas were more frequently prescribed in SPC patients. Patient and GP age and whether the diagnosis was new influenced the GP's choice of treatment. The Rome III criteria do not influence diagnostic strategies and only slightly influence therapeutic strategies of GPs. Other factors (age, gender, new or old diagnosis) have more influence on GPs choice of investigations and treatment.

Rifaximin and Neomycin in the Treatment of Constipation IBS with Methane as a Biomarker on Breath Testing: Presidential Poster

Purpose: Several investigators have determined that methane on breath testing is associated with constipation IBS (C-IBS). Whether reduction of methane production and/or altering methanogenic flora improves IBS-C is not known. Rifaximin has been proven effective in the treatment of non-C-IBS, but rifaximin alone has only a modest effect on methane eradication and improvement in constipation. In this double-blind placebo-controlled trial, we compared neomycin alone with rifaximin and neomycin in the treatment of methane-positive C-IBS. Methods: Consecutive C-IBS subjects (18-65 years of age) (Rome III criteria) were recruited after applying exclusion criteria. All subjects presented for a lactulose breath test after a 12-hour fast. Only subjects with methane level >3 ppm on at least one breath sample were enrolled. Subjects then completed a stool diary, questionnaire (100 point VAS scale for bloating, abdominal pain, constipation, diarrhea, and straining) and 2-week run-in phase. Subjects were then randomized to receive either neomycin 500 mg twice daily and placebo, or neomycin plus rifaximin 550 mg tid for 14 days in a double-blind fashion. Questionnaires were repeated weekly during treatment and for 4 weeks following completion of treatment. On the last week of follow-up, the stool diary was repeated. Results: Thirty two subjects were randomized/received drug (n=17 neomycin/placebo, n=15 neomycin/rifaximin). Baseline characteristics were not different between groups including baseline symptoms, gender, and age. By week two of treatment, the constipation VAS score was significantly less severe in neomycin/rifaximin (30.7±30.7) group vs neomycin/placebo (57.9±25.0) group (P=0.011). Similarly, bloating was significantly less severe in neomycin/rifaximin group compared to neomycin/placebo group, (45.1±33.3 vs 65.1±25.9; P=0.045). Constipation improvement had a durable response such that constipation remained significantly improved even 3 weeks following cessation of therapy (P<0.05). In addition, bloating and straining had durable improvement. In the neomycin/rifaximin group, the eradication of breath methane (≤3 ppm) was associated with a lower severity for constipation (26.6±19.0) compared to subjects with methane still present (67.2±32.1; P=0.041). Conclusion: Rifaximin combined with neomycin appears to be superior to neomycin alone in the treatment of C-IBS subjects with methane. The best determinant of improvement was the eradication of methane after treatment in the neomycin/rifaximin group. Disclosure - Dr. Mark Pimentel - Consultant: Salix Pharmaceuticals, Grant/Research Support: Salix Pharmaceuticals Dr. Christopher Chang - Grant/Research Support: Salix Pharmaceuticals Dr. John Dibaise - Grant/Research Support: Salix Pharmaceuticals Dr. Satish Rao - Grant/Research Support: Salix Pharmaceuticals, Advisory Committee/Board: Salix Pharmaceuticals, Other - Honorarium: Salix Pharmaceuticals. This research was supported by an industry grant from Salix Pharmaceuticals, inc.

Su1040 Longitudinal Direct Medical Costs Associated With Irritable Bowel Syndrome-Constipation and Chronic Idiopathic Constipation in a Population-Based Sample Over a 10-Year Period

Purpose: : It is estimated that ~ 10-15% of adults have irritable bowel syndrome with approximately 30% of those having irritable bowel syndrome with constipation (IBS-C). Chronic idiopathic constipation (CIC) affects up to 10-15 % of adults in the general population. Constipation has been shown to be the second most common ambulatory digestive disease diagnosis accounting for over 6.5 million visits per year in the United States. Little is known about economic burden of these disorders in terms of numbers of medical visits and diagnostic procedures compared to the general population. The purpose of this study was to compare direct medical costs of population-based cohorts with and without IBS-C and CIC over a 10-year period. Methods: A nested case-control sample was identified through a population-based survey in Olmsted County, MN. The study cohort was comprised of adult respondents to a mailed survey of gastrointestinal symptoms, many specifically related to constipation, and who had given prior research authorization (n= 3831). Cases consisted of 115 adults identified as having IBS-C and 365 identified as having CIC based on survey responses (modified Rome criteria II). Controls were matched 2:1 to cases on gender, age (+ 5 years), and registration date, a proxy for time in the community (+ 5 years). Patient level administrative data on health care utilization and associated costs were accessed for a ten-year period (1999-2008) prior to the survey. Utilization and costs were compared using the Chi-square statistic, Fisher's exact test, and the Wilcoxon Rank Sum statistic. Results: IBS-C cases reported more bloating (p,0.0001) and functional dyspepsia symptoms (p,0.0001), while there were no differences in the CIC cases to controls. There were no differences in Charlson comorbidities in the IBS-C group; there were significantly more multiple sclerosis cases in the CIC cases than controls. Among GI-specific comorbidities, IBS-C cases had a higher prevalence of pancreatitis (p=0.02) than controls. Hospital and ER visits were not greater in IBS-C cases. However, IBS-C cases were found to have higher costs in imaging (p=0.02) (Table 1). Unadjusted resource utilization did not demonstrate differences for CIC compared to controls. CIC cases had higher costs in the area of procedural costs (p=0.04) and trended higher in total costs, and diagnostic tests (Table 2). Conclusions: Over 10 years, costs related to imaging and related to procedures and diagnostic tests were significantly higher for those with IBS-C and CIC, respectively. Although acute care-related utilization and other health care costs were consistently higher in the IBS-C and CIC groups, results were not significantly different in this modest sample. This suggests increased economic burden related to outpatient diagnostic testing for IBS-C and CIC even among community-based individuals. Table 1. Unadjusted All-Cause Resource Utilization and Costs by IBS-C Group

Lactase persistence/non‐persistence genetic variants in irritable bowel syndrome in an endemic area for lactose malabsorption

Lactase non-persistence is common in India. We evaluated: (i) frequency of lactase gene (C/T-13910 and G/A-22018) polymorphisms in irritable bowel syndrome (IBS) and healthy controls (HC), (ii) association between these polymorphisms and IBS-subtypes and symptoms. A total of 150 IBS patients (Rome-III criteria) and 252 age and gender-matched HC were evaluated for C/T-13910 and G/A-22018 genotypes using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Totals of 79 (52%), 52 (35%) and 19 (13%) patients had diarrhea-predominant IBS (D-IBS), constipation predominant IBS (C-IBS) and alternating diarrhea and constipation IBS (A-IBS), respectively (Rome-III). Frequency of C/T-13910 [genotypes: CC 102 (68%), CT 43 (29%), TT 5 (3%) vs CC 155 (61%), CT 83 (33%), TT 14 (6%), P > 0.05] and G/A-22018 [GG 97 (65%), GA 41 (27%), AA 12 (8%) vs GG 154 (61%), GA 78 (31%), AA 20 (8%), P > 0.05] were similar among IBS and HC. Patients with D-IBS more often had C/T-13910 and G/A-22018 genotypes than C-IBS (CC 71 [90%], CT 6 [8%], TT 2 [2%]) versus (24 [46%], 25 [48%], 3 [6%]), A-IBS (7 [39%], 12 [63%], 0, [0%]) and HC (155 [61%], 83 [33%], 14 [6%]), P < 0.0001 and (GG 69 [87%], GA 6 [8%], AA 4 [5%]) vs (22 [42%], 24 [46%], 6 [12%]) vs (6 [32%], 11 [58%], 2 [10%]), P < 0.0001. IBS with CC and GG genotypes more often had abdominal pain (P = 0.005), distension (P = 0.031) and higher stool frequency (P = 0.003) and reported symptoms following dairy products than non-CC (P < 0.0001). Though C/T-13910 and G/A-22018 polymorphisms were comparable among IBS and HC, these were more common among D-IBS and reported some symptoms like abdominal pain, bloating and exacerbation by dairy products.

Correlation between the expression of serotonin transporter and somatic and psychological symptoms of irritable bowel syndrome

Objective To explore the correlation of the expression of serotonin transporter (SERT) at mRNA and protein level with psychological and somatic symptoms of irritable bowel syndrome (IBS).Methods A total of 254 out-patients of the Department of Gastroenterology were selected as case group,and 120 healthy persons and volunteers were set as control group. The expression of SERT at mRNA level was tested by real-time polymerase chain reaction (PCR) and the expression of SERT at protein level was detected with Western blotting. The study objects were evaluated by psychological and somatic symptom self-rating scale (SLC-90) and the correlation between the expression of SERT at protein level and psychological symptoms was explored.Results There were constipation irritable bowel syndrome (C-IBS),diarrhea irritable bowel syndrome (D-IBS)and alternating diarrhea and constipation irritable bowel syndrome (A-IBS).The expressions of SERT at mRNA and protein level in C-IBS (0.58±0.24;0.99±0.51) were significantly higher than those in A-IBS group (0.37±0.22;0.67±0.34),D-IBS group (0.41 ±0.26 ;0.71±0.41) and control group (0.42±0.29;0.78±0.47) (P＜0.05),there was no significant difference between A-IBS and D-IBS (P ＞ 0.05). There was negative correlation between SERT expression at protein level and psychological symptoms (r=-0.67,P＜0.01),depression factor (r=-0.81,P＜0.01),anxiety factor (r=-0.72,P＜0.01) and hostility factor (r=-0.66,P＜0.01).There was no correlation between SERT expression and interpersonal sensitivity,obsessive-compulsive symptoms,terror,paranoia and psychological factors (P＞0.05).Conclusions The expressions of SERT at mRNA and protein level in colonic mucosa may affect psychological and somatic symptoms of IBS patients.The higher SERT expressions at mRNA and protein level,constipation may be more susceptible.However the lower SERT expression at protein level,more emotional performance of somatization,anxiety,depression and hostility may be shown. Key words: Irritable bowel syndrome; Membrance transport proteins; Constipation; Anxiety; Depression

Tu1388 Subjects With Irritable Bowel Syndrome-Constipation are “More Constipated” Than Those With Chronic Constipation: Spectrum From a Population Based Study

Tu1388 Subjects With Irritable Bowel Syndrome-Constipation are “More Constipated” Than Those With Chronic Constipation: Spectrum From a Population Based Study