The Humanistic and Economic Burden of Chronic Idiopathic Constipation in the USA: A Systematic Literature Review

Figures & data

Table 1 Overview of Studies Included in the SLR on the Humanistic Burden of CIC

Study	Study Type	Objective	Diagnostic Criteria for CIC/FC	HRQoL Measure	Number of Patients with CIC/FC
Abel et al, 2017^Citation15	Longitudinal observational	To evaluate the differences in demographics, symptoms, and HRQoL among patients with CIC and IBS-C	Not specified; diagnosed by healthcare provider	PAC-QOL	496
Abbott et al, 2014^Citation25	Interventional (RCT)	To evaluate the effect of perineal self-acupressure on HRQoL and bowel function in patients with CIC	Rome III	PAC-QOL SF-12	100
Adragna et al, 2016^Citation26	Interventional	To assess the efficacy of OMT in patients with FC	Not specified	PAC-QOL SF-12	30
Baker et al, 2016^Citation27	Retrospective analysis	To compare PAC-QOL metrics in patients with CIC and dyssynergic defecation	Rome III	PAC-QOL	201
Body, 2016^Citation16	Retrospective analysis	To evaluate the relationship between PAC-QOL and CTT in patients with diabetes and CIC	Rome III	PAC-QOL	67
Chang et al, 2014^Citation13	Post hoc analysis of pooled RCTs	To compare the severity of abdominal and bowel symptoms in patients with CIC treated with linaclotide	Rome III	PAC-QOL	1271
Christie et al, 2017^Citation28	Interventional (RCT)	To assess the efficacy of lubiprostone in patients with diabetes and CIC	Rome III	PAC-QOL	76
Cudmore et al, 2017^Citation29	Interventional (RCT)	To assess the efficacy and safety of psyllium husk fiber supplement in patients with CIC	Rome III	PAC-QOL PAC-SYM	69
Friedenberg et al, 2012^Citation12	Prospective, case-controlled	To assess the impact of FC on HRQoL in black Americans	Rome III	SF-36	102
Iturrino et al, 2013^Citation30	Interventional (RCT)	To compare the effect of oral TU-100 (Tsumura & Co, Japan) on various aspects of bowel function in female patients with CIC	Rome III	PAC-QOL	45
Lewicky-Gaupp et al, 2008^Citation14	Prospective	To evaluate patient HRQoL before and after treatment for puborectalis dyssynergia	Rome II	PAC-QOL PAC-SYM	16
Nojkov et al, 2017^Citation17	Retrospective survey	To examine the effect of sex and age on CIC-related symptoms and HRQoL	Not specified	PAC-QOL PAC-SYM	726
Wong et al, 2010^Citation31	Secondary analysis of prospective study	To test the hypothesis that FC and IBS-C, as defined by the Rome III criteria, are not distinct entities	Rome III	PAC-QOL SF-12	231

Abbreviations: CIC, chronic idiopathic constipation; CTT, colonic transit time; FC, functional constipation; HRQoL, health-related quality of life; IBS-C, irritable bowel syndrome with constipation; OMT, osteopathic manipulative treatment; PAC-QOL, Patient Assessment of Constipation Quality of Life questionnaire; PAC-SYM, Patient Assessment of Constipation Symptoms questionnaire; RCT, randomized controlled trial; SF-12, 12-item Short-Form Health Survey; SF-36, 36-item Short-Form Health Survey; SLR, systematic literature review.

Figure 1 PRISMA flow diagram of study selection for articles reporting the humanistic burden of CIC in the USA.

Abbreviations: CIC, chronic idiopathic constipation; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2 Mean adjusted SF-36 component scores for patients with CIC and age- and sex-matched individuals without CIC in the USA.

Notes: *p<0.05, **p<0.01 versus patients with CIC. Scores are adjusted for comorbidities. Reprinted by permission from Springer Nature Customer Service Centre GmbH: Springer Nature, Quality of Life Research, The impact of functional constipation on quality of life of middle-aged black Americans: a prospective case-control study, Friedenberg FK, Dadabhai A, Palit A, Sankineni A, Copyright © (2012).¹²

Abbreviations: CIC, chronic idiopathic constipation; SF-36, 36-item Short-Form Health Survey

Figure 3 PAC-SYM and PAC-QOL scores in patients with CIC, stratified by (A) age and (B) sex.

Notes: ***p<0.001 versus patients ≥60 years old. ^†p<0.05; ^††p<0.01; ^†††p<0.001 versus men. Data from Nojkov et al.¹⁷

Abbreviations: CIC, chronic idiopathic constipation; PAC-QOL, Patient Assessment of Constipation Quality of Life questionnaire; PAC-SYM, Patient Assessment of Constipation Symptoms questionnaire.

Table 2 Overview of Studies Included in the Economic Burden SLR

Study	Study Type	Parameters Investigated	Objective	Diagnostic Criteria for CIC/FC	Data Source(s)	Study Duration	Number of Patients with CIC/FC
Herrick et al, 2017^Citation18	Population-based retrospective study	HCRU Direct costs	To describe HCRU and compare medical costs for patients with CIC and matched controls	Survey based on modified Rome II questions	EMR Patient survey Health insurance fee schedule	2 years and 10 years	365
Heidelbaugh et al, 2015^Citation19	Population-based cross-sectional survey	HCRU Direct costs	To characterize symptom and disease burden in patients with CIC with or without abdominal symptoms	Rome III	Patient survey	1 year	552
Van Tilburg et al, 2008^Citation20	Prospective survey	HCRU Indirect costs	To determine the prevalence, types, and costs of CAM in patients with CIC	Not specified; diagnosed by healthcare provider	EMR Patient survey Administrative claims at HMO	6 months	159

Abbreviations: CAM, complementary and alternative medicine; CIC, chronic idiopathic constipation; EMR, electronic medical records; FC, functional constipation; HCRU, healthcare resource utilization; HMO, health maintenance organization; SLR, systematic literature review.

Figure 4 Flow diagram of study selection for articles reporting the economic burden of CIC in the USA.

Abbreviations: CIC, chronic idiopathic constipation; CINAHL, Cumulative Index of Nursing and Allied Health Literature; SLR, systematic literature review.

Figure 5 Mean predicted costs (2007–2008) for patients with CIC and age- and sex-matched controls.

Notes: *p<0.05. Data from Herrick et al.¹⁸

Abbreviations: CIC, chronic idiopathic constipation; ER, emergency room.

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Lewicky-Gaupp C, Morgan DM, Chey WD, Muellerleile P, Fenner DE. Successful physical therapy for constipation related to puborectalis dyssynergia improves symptom severity and quality of life. Dis Colon Rectum. 2008;51(11):1686–1691. doi:10.1007/s10350-008-9392-3

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Nojkov B, Baker J, Lee A, et al. Impact of age and gender to severity of constipation-related symptoms and quality of life indices in patients with chronic idiopathic constipation. Gastroenterology. 2017;152(5):S514–S515. doi:10.1016/S0016-5085(17)31896-6

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Wong RK, Palsson OS, Turner MJ, et al. Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome. Am J Gastroenterol. 2010;105(10):2228–2234. doi:10.1038/ajg.2010.200

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Heidelbaugh JJ, Stelwagon M, Miller SA, Shea EP, Chey WD. The spectrum of constipation-predominant irritable bowel syndrome and chronic idiopathic constipation: US survey assessing symptoms, care seeking, and disease burden. Am J Gastroenterol. 2015;110(4):580–587. doi:10.1038/ajg.2015.67

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