Irritable bowel syndrome with constipation: a European-focused systematic literature review of disease burden

Abstract

Objective:

To conduct a systematic literature review to assess burden of disease and unmet medical needs in patients with irritable bowel syndrome (IBS) with constipation (IBS-C), with a focus on five European countries (France, Germany, Italy, Spain, UK).

Methods:

MEDLINE, EMBASE, and grey literature searches were carried out using terms for IBS and constipation, to identify studies reporting epidemiological, clinical, humanistic, or economic outcomes for IBS-C, published between 2000 and 2010.

Results:

Searches identified 885 unique abstracts and 33 supplementary articles, of which 100 publications and six grey literature sources met the inclusion criteria. Among patients with IBS, the prevalence estimates of IBS-C ranged from 1 to 44%. Co-morbid conditions, such as personality traits, psychological distress, and stress, were common. Patients with IBS-C had lower health-related quality-of-life (HRQoL) compared with the general population, and clinical trials suggested that effectively treating IBS-C improves HRQoL. The European societal cost of IBS-C is largely unknown, as no IBS-C-specific European cost-of-illness studies were identified. Two cost analyses demonstrated the substantial societal impact of IBS-C, including reduced productivity at work and work absenteeism. Guidelines offered similar recommendations for the diagnosis and management of IBS; however, recommendations specifically for IBS-C varied by country. Current IBS-C treatment options have limited efficacy and the risk:benefit profile of early 5-HT₄ agonists restricts clinical use.

Conclusions:

This systematic review indicates a clear need for European-focused IBS-C burden-of-disease and cost-of-illness studies to address identified evidence gaps. There is a need for new therapies for IBS-C that are effective, well tolerated, and have a positive impact on HRQoL.

• Irritable bowel syndrome
• Constipation
• Epidemiology
• Clinical
• Economic
• Disease burden
• Systematic review

Transparency

Declaration of funding

This study was sponsored by Almirall.

Declaration of financial relationships

Josep Fortea and Mercedes Prior are employees of Almirall. JME Peer Reviewers on this manuscript have no relevant financial relationships to disclose.

Acknowledgements

The authors would like to thank Ingela Wiklund, Talia Foster, and Karin Travers, who are employees of United Biosource Corporation, for their contribution to conducting this study. (Talia Foster was the Principal Investigator of the systematic literature search and Karin Travers was the Project Manager.) The authors would also like to thank Claire Chadwick, PhD, of Complete Clarity, who provided medical writing support funded by Almirall.