The burden of irritable bowel syndrome and chronic constipation on health-related quality of life in black Africans: a comparison with healthy control subjects in Côte d’Ivoire, West Africa

Figures & data

Box 1 Survey questionnaire

i-Do you suffer from chronic constipation. Yes or no?

ii-Do you suffer from irritable bowel syndrome. Yes or no?

iii-How many times did you suffer from chronic constipation or irritable bowel syndrome? Less than 3 years, between 3 and 5 years, more than 5 years

iv-Do you have a regular bowel movement. Yes or no?

v-In these past 4 weeks, do you have difficulties to evacuate stools. Yes or no?

vi-How many times per week do you have a bowel movement: less than 3 times a week, between 2 and 3 times a week or more than 3 times a week?

vii-Do you complain abdominal pain or discomfort. Yes or no?

viii-If so, during these past 4 weeks, how many times have you complain with abdominal pain or discomfort: less than 3 times a week, between 2 and 3 times a week, more than 3 times a week?

ix-Do you have complaints with abdominal pain or discomfort during these past 3 months, 4 months, 6 months?

x-Do you have difficulties to evacuate stools during these past 3 months, 4 months, 6 months?

xi-Please chose on the figure below, the corresponding box (only one choice to be done) depicting the stool pattern that you usually have.

Type 1: Separate hard lumps

Type 2: Lumpy and sausage like

Type 3: A sausage, sharp with cracks in the surface

Type 4: Like a smooth, soft sausage or snake

Type 5: Soft blobs with a clear-cut edge

Type 6: Mushy consistency with ragged edges

Type 7: Liquid consistency with no solid pieces

Note: © 2000 Rome Foundation, Inc. All Rights Reserved.

Table 1 Baseline characteristics at inclusion

Sociodemographic and clinic parameters	IBS (n=72)	CC (n=32)	Controls (n=210)
Demographic parameters				P-value
Age (years) [mean(SD)]	38.9(10.5)	37.4(9.3)	37.8(9)	0.6
Age in class (years)[n(%)]
15–30	14(19.4)	6(19)	45(21.4)
31–40	29(40.3)	18(56.2)	93(44.3)
41–50	20(28)	6(19)	55(26.2)
51–60	6(8.3)	1(3.1)	12(5.7)
≥61	3(4.2)	1(3.1)	5(2.4)
Gender (Female)[n(%)]	45(62.5)	24(75)	76(36.2)	<0.0001
BMI	25.1(5.6)	25.9(5.9)	25.4(5)	0.8
Marital status (yes) [no(%)]				<0.0001
Married	33(45.8)	13(40.6)	91(43.3)
Living with a partner	11(15.3)	2(6.2)	49(23.3)
Widowed	1(1.4)	0(0)	17(8.1)
Single	23(31.9)	17(53.1)	38(18.1)
Living alone	3(4.2)	0(0)	15(7.1)
Remunerated activity (yes)[no(%)]	46(63.9)	23(71.9)	141(67.1)	0.7
Medical history				0.1
Arterial hypertension	3(4.2)	3(9.4)	18(8.6)
Diabetes	1(1.4)	1(3.1)	4(1.9)
Epigastralgia	16(22.2)	7(21.9)	23(11)
None	51(70.8)	19(59.4)	147(70)
Comorbidities (yes)[n(%)]	21(28.2)	13(40.6)	63(30)
Functional symptoms
Abdominal pain or discomfort	72(100)	21(65.6)	34(16.2)	NA
Regularity of bowel movement (yes)[n(%)]	18(25)	7(21.9)	202(96.2)	<0.0001
Number of bowel movement per week [n (%)]
<2	25(34.7)	14(43.8)	0(0)
2–3	27(37.5)	12(37.5)	1(0.5)
>3	20(27.8)	6(18.8)	208(99)
Duration of symptoms (years)[n(%)]
<5	25(34.7)	14(43.8)	0	NA
5–10	19(26.4)	10(31.2)	0
10–15	15(20.8)	4(12.5)	0
>15	13(18.1)	4(12.5)	0
Bristol stool scale [n (%)]				<0.0001
Type 1	26(36.1)	15(46.9)	0(0)
Type 2	16(22.2)	5(15.6)	6(2.9)
Type 3	13(18.1)	7(21.9)	13(6.2)
Type 4	14(19.4)	5(15.6)	97(46.2)
Type 5	2(2.8)	0(0)	55(26.2)
Type 6	1(14.4)	0(0)	29(13.8)
Type 7	0(0)	0(0)	10(4.8)

Notes: The comparison was computed between irritable bowel syndrome and chronic constipation versus controls. NA, non-applicable between the two groups because variables entered in the definition of irritable bowel syndrome or painful chronic constipation (Abdominal pain or discomfort) or not assessed in the control group (duration of symptoms).

Abbreviations: IBS, irritable bowel syndrome; CC, chronic constipation; SD, standard deviation.

Box 2 Rome 3 criteria

i- a stool frequency less than 3 times a week

ii- a strain during bowel movement occurring more than 25% of defecation

iii- a sensation of an incomplete evacuation occurring more than 25% of defecation

iv-a sensation of anal obstruction occurring more than 25% of defecation

v- using digital maneuvers for stools evacuation more than 25% of defecation

vi- the onset of these symptoms above lasting more than 6 months and which have occurred non-consecutively 3 months before the study.

Table 2 Mean scores of SF-36 questionnaire items and differences comparison between groups

	Mean values (standard deviation)			Mean differences (standard error of difference) between groups
	IBS	CC	Ct	IBS vs CC	p	IBS vs Ct	p	CC vs Ct	p
PF	83.3(10.8)	85.5(15.4)	95.7(8.6)	−2.1(2.6)	0.4	−12.4(1.4)	0.0001	−10.3(2.8)	0.001
RP	41.3(42.4)	58.6(39.5)	78(28.2)	−17.2(8.8)	0.05	−36.7(5.4)	0.0001	−19.4(5.7)	0.01
RE	41.2(42.8)	60.4(42.7)	77.5(31.2)	−19.2(9.1)	0.04	−36.7(5.4)	0.0001	−17.1(7.9)	0.04
BP	50.5(31)	74(25)	96.3(11.3)	−23.5(6.2)	0.0001	−45.8(3.7)	0.0001	−22.3(4.5)	0.0001
SF	58.1(29)	73.2(26.4)	84.6(22.4)	−15.1(6)	0.01	−26.4(3.8)	0.0001	−11.3(4.9)	0.01
VT	35.8(15.4)	36.3(14.3)	52.7(15.7)	−0.4(3.2)	0.8	−16.9(3.7)	0.0001	−16.5(2.9)	0.0001
MH	44(13.7)	54.3(12)	58.7(12.8)	−10.3(2.8)	0.0001	−14.7(1.8)	0.0001	−4.4(2.4)	0.1
GH	45.8(21.2)	54.4(17.9)	74.5(13.5)	−8.6(4.3)	0.05	−28.7(2.7)	0.0001	−20.1(3.3)	0.0001
PCS	55.2(21.6)	68.1(19.6)	86.1(10.7)	−12.9(4.5)	0.01	−30.9(1.9)	0.0001	−18(3.5)	0.0001
MCS	44.8(20.4)	56(19.1)	68.4(15.3)	−11.2(4.2)	0.01	−23.6(2.6)	0.0001	−12.4(3)	0.0001

Abbreviations: IBS, irritable bowel syndrome; CC, chronic constipation; Ct, controls; PF, physical functioning; RP, role of physical; RE, role of emotional; BP, bodily pain; SF, social functioning; GH, general health; VT, vitality; MH, mental health; PCS, physical composite score; MCS, mental composite score.

Figure 1 Distribution and trend of means scores of SF-36questionnaire items adjusted to age within all subgroups. Lines were smoothed because of the presence of one subject in the belonging age class.

Abbreviations: IBS, irritable bowel syndrome; CC, chronic constipation; Ct, controls; PF, physical functioning; RP, role of physical; RE, role of emotional; BP, bodily pain; SF, social functioning; GH, general health; VT, vitality; MH, mental health; PCS, physical composite score; MCS, mental composite score.

Table 3 Distribution of the scores of SF-36 questionnaire according to the gender within the subgroup of subjects with irritable bowel syndrome, chronic constipation, or control subjects

	Median values (range) of SF-36 scores
	IBS			CC			Control subjects
	Female	Male	p-value	Female	Male	p-value	Female	Male	p-value
PF	80(35)	85(45)	0.4	85(65)	95(15)	0.1	100(50)	100(45)	0.8
RP	25(100)	25(100)	0.2	63(100)	88(100)	0.7	100(100)	100(100)	0.6
RE	33(100)	100(100)	0.7	67(100)	83(100)	0.9	100(100)	100(100)	0.3
BP	50(100)	67(100)	0.4	75(83)	83(100)	0.6	100(43)	100(86)	0.3
SF	57(100)	57(100)	0.5	71(86)	79(71)	0.6	100(57)	100(71)	0.2
VT	35(80)	35(60)	0.8	40(50)	28(45)	0.4	50(55)	50(60)	0.7
MH	44(56)	40(72)	0.7	54(36)	52(44)	0.5	60(44)	60(60)	0.4
GH	45(80)	50(85)	0.4	55(70)	60(50)	0.9	75(65)	70(50)	0.7
PCS	54(71)	51(70)	0.8	71(63)	83(53)	0.4	88(48)	88(53)	0.5
MCS	37(75)	40(75)	0.9	60(60)	64(59)	0.8	71(54)	69(55)	0.7

Abbreviations: IBS, irritable bowel syndrome; CC, chronic constipation; PF, physical functioning; RP, role of physical; RE, role of emotional; BP, bodily pain; SF, social functioning; GH,general health; VT, vitality; MH, mental health; PCS, physical composite score; MCS, mental composite score.

Figure 2 Box plots depicting the distribution and trends of physical (A) and mental (B) composite scores between patients with irritable bowel syndrome, chronic constipation, and control subjects. The box represents the interquartile range; the top and the bottom of the box are, respectively, the 25^th and 75^th percentile. The line across the box is the median. The lower and upper values are indicated by the whiskers. Stars and circles represent the outliers and extreme values.

Abbreviations: IBS, irritable bowel syndrome; CC, chronic constipation.

Figure 3 Box plots depicting the distribution, comparison, and trends of physical (A) and mental (B) composite summaries between subjects with no painful chronic constipation (0), painful chronic constipation (1) and irritable bowel syndrome (2). The box represents the interquartile range; the top and the bottom of the box are, respectively, the 25^th and 75^th percentile. The line across the box is the median. The lower and upper values are indicated by the whiskers. Stars and circles represent outliers and extreme values. SE: standard error, Q = calculated statistic, Q(0.05): the critical value of tabled Q statistic =2.39. KW = Kruskal Wallis test.

Abbreviations: IBS, irritable bowel syndrome; CC, chronic constipation.

Table 4 Predictive factors affecting physical and mental composite summaries of the SF-36 scores in subjects with irritable bowel syndrome compared with those with chronic constipation: multivariate regression analysis

	PCS		p	MCS		p
	β	95%CI		β	95%CI
BMI	1.2	0.5, 1.9	0.001	0.91	0.2, 1.6	0.01
Remunerated activity (yes)	8.2	0.1, 16.2	0.05		-	-
Duration of symptoms (years)					-	-
<5 years	1	-	-		-	-
5–10	0.8	−8.8, 10.3	0.9		-	-
10–15	−9.9	−20.7, 0.9	0.07		-	-
>15	−1.2	−12.4, 10.0	0.8		-	-
IBS vs CC	−10.3	−18.5, −2.03	0.02	−9.9	−18.1, −1.9	0.02

Notes: Adjusted R for PCS=0.21, Adjusted R for MCS=0.13. Bristol stool scale was not included in the analysis.

Abbreviations: PCS, physical composite summary; MCS, mental composite summary, β=regression coefficient; CI, confidence interval; BMI, body mass index; IBS, irritable bowel syndrome; CC, chronic constipation.