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Differences in Demographic and Symptom-Related Characteristics among Patients with Irritable Bowel Syndrome with Constipation (IBS-C) and Chronic Idiopathic Constipation (CIC): Results from the Contor Study
AGA Abstracts
cases. Patients were highly reliable in 81% of the cases with regard to meal-related symptoms and in 83% with regard to bowel movements. Overall, inter-rater agreement for the predominant symptomatic profile identified by the WRQ and by the clinician was ‘good' (72.3%, κ= 0.65±0.05). Concordance was the highest for CIN (93%) and EPS (86%), followed by IBS (76%), PDS (64%) and GERD (50%) (Fig. 1). The concordance was 80% for the pooled FD population. Solely based on the answers in the WRQ 45% of GERD patients would have been misdiagnosed with PDS or EPS. PPI usage was a major confounder: 78% of the patients with a physician-based diagnosis of GERD not confirmed by the WRQ received PPI therapy. The prevalence of PPI therapy was also higher in the GERD patients (80%) compared to the other groups (32-64%, p= 0.02). Conclusion: The new WRQ is a reliable, accurate and easy to handle tool that can provide diagnostic guidance in (non-)specialist settings and clinical research. Implementation in clinical practice would standardize and enhance the diagnostic approach for a vast population of FGID patients.
Figure 1: Concordance between WRQ based and interview based predominant symptomatic profiles. Each bar represents the entire patient population with one of the five diagnoses given by the clinician based on their interview. Each bar is subdivided in the diagnoses that patients would have received solely based on their written answers in the WRQ. The concordance for the pooled functional dyspepsia population was 80%. None of the EPS patients would have been designated to a WRQ based diagnosis of PDS.
Mo1666 DIFFERENCES IN DEMOGRAPHIC AND SYMPTOM-RELATED CHARACTERISTICS AMONG PATIENTS WITH IRRITABLE BOWEL SYNDROME WITH CONSTIPATION (IBS-C) AND CHRONIC IDIOPATHIC CONSTIPATION (CIC): RESULTS FROM THE CONTOR STUDY Jessica Abel, Douglas C. Taylor, Jalpa A. Doshi, Carolyn Martin, Alyssa Goolsby Hunter, Breanna Essoi, Paul Buzinec, Robyn T. Carson, David S. Reasner, William D. Chey
Patient-reported symptoms and health-related quality of life among IBS-C and CIC patients
Background: The Chronic Constipation and IBS-C Treatment and Outcomes Real-world Research platform (CONTOR) is a longitudinal, observational platform combining administrative claims and patient survey data to examine associations between symptoms, treatments, and outcomes among IBS-C and CIC patients. This analysis evaluated differences in demographics and symptom-related characteristics among IBS-C and CIC patients at baseline. Methods: Fully insured patients aged ≥18 years were identified from a large, geographically diverse US health plan based on claims from 12/2012 to 6/2015. Criteria included: ≥1 medical claim for constipation (564.0x); or ≥1 claim for IBS (564.1x) or abdominal pain (789.0x) plus ≥1 pharmacy claim for a stool softener/laxative; or ≥1 claim for linaclotide or lubiprostone. Participants completed a self-administered survey including the Patient Assessment of Constipation Symptoms (PAC-SYM) and Quality of Life (PAC-QOL) instruments. Demographics, most bothersome symptoms, symptom severity (PAC-SYM), and condition-related quality of life (PAC-QOL) were assessed between patients reporting a provider diagnosis of IBS-C (including IBS) or CIC (including chronic constipation and functional constipation). Results: Of 2,052 respondents who completed the baseline survey, 41.5% and 24.2% reported a provider diagnosis of IBS-C or CIC, respectively. 93% of both IBS-C and CIC patients were female; CIC patients were older (mean 48.5 vs. 45.7 years, p<0.001). A greater proportion of IBS-C versus CIC patients selected abdominal pain as their most bothersome symptom, while a greater proportion of CIC patients selected hard/ small stools, straining or squeezing, rectal bleeding or tearing, or infrequent bowel movements as most bothersome (Table). Abdominal bloating/distention were most frequently reported by both IBS-C and CIC patients as their most bothersome symptom. Overall symptom severity was not different between IBS-C and CIC patients; however, IBS-C patients had a significantly higher score on the PAC-SYM abdominal subscale (Table). IBS-C patients reported significantly higher PAC-QOL scores both overall and on the psychosocial discomfort subscale, indicating lower QOL compared to CIC patients; CIC patients had significantly higher scores on the satisfaction subscale (Table). Conclusions: The observed differences in symptoms and QOL between IBS-C and CIC patients support mounting evidence suggesting IBS-C and CIC may be different states on a continuous disease spectrum: for example, abdominal pain occurs in both IBS-C and CIC, but is more frequently reported as bothersome in IBS-C. Further, IBS-C patients had significantly lower QOL and were more likely to report pain-related symptoms. These findings indicate that abdominal pain is a key feature of IBSC and an important target for IBS-C treatment.
Mo1667 UNDERSTANDING SYMPTOM BURDEN AND ATTITUDES IN PATIENTS WITH IRRITABLE BOWEL SYNDROME WITH DIARRHEA: RESULTS FROM A PATIENT SURVEY Hans Törnblom, Anton Emmanuel, Richard Goosey, Gwen Wiseman, Stephen Baker Background: Irritable bowel syndrome affects 10-15% of adults, and around one third have diarrhea as the predominant bowel habit (IBS-D). Little is published on the health impact on these patients. This survey aimed to assess the gastrointestinal and wider health burden of IBS-D, including medications used for symptom relief and perceived care shortfalls. Methods: A 30-minute web-based survey was completed in France, Germany, Italy, Spain, UK, Canada, and Australia. Target sample size was 80 patients per country. Screening criteria included: age 18-65 years, being diagnosed with IBS-D by a doctor, having symptoms present within the past 12 months, and currently using prescription or over-the-counter (OTC) medicines for IBS-D. The maximum quota was 30% male and 25% of patients who had never seen a gastroenterologist for their IBS. Attitudes to IBS-D and its management were scored using a 7-point scale (1=completely disagree; 4=neither agree nor disagree; 7= completely agree). Results: 513 eligible patients completed the survey; 357 (70%) were female and mean age was 40.9 (range 18-65) years. As well as stomach pain and diarrhea, 269 (52%) patients had bloating before treatment, 204 (40%) had urgency, and 88 (17%) had fecal incontinence. Mean duration of symptoms was 9.8 years. The most troublesome current symptom was urgency in 136 (27%) patients. In the past 3 months, symptoms were intermittent in 390 (76%) patients and continual in 123 (24%). The most common comorbidities were anxiety in 189 (37%) patients, depression in 137 (27%), and migraine in 133 (26%). OTC drugs were used by 372 (73%) patients (214 [42%] OTC only, 158 [31%] OTC + prescription). The most commonly used agents were antidiarrheals in 416 (81%) patients and antispasmodics in 300 (58%); notably, 91 (18%) used codeine-based painkillers and 79 (15%) used antidepressants. Antidiarrheals were used daily by 63 (12%) patients, and 58 (11%) used daily antispasmodics; 178/384 (46%) and 99/217 (46%) were not satisfied with these agents. Patients had mixed attitudes towards their condition (Table 1: score 6-7): 216 (42%) reported having learned to live with their IBS but 189 (37%) were constantly worried about when their symptoms would return, and 58 (11%) agreed with the statement "When my IBS is bad, I wish I was dead". A substantial proportion (170; 33%) wanted doctors to listen and support more, and 165 (32%) agreed that healthcare professionals do not take IBS seriously. The majority of patients (296; 58%) wanted treatment to significantly improve their quality of life and 237 (46%) were willing to try anything to help manage their IBS. Conclusions: We report the substantial impact of IBS-D on quality of life, medication use, and the desire for more services in this patient population. There is a distinct opportunity for improved pharmacological and supportive management of IBSD patients.
S-745
AGA Abstracts
cases. Patients were highly reliable in 81% of the cases with regard to meal-related symptoms and in 83% with regard to bowel movements. Overall, inter-rater agreement for the predominant symptomatic profile identified by the WRQ and by the clinician was ‘good' (72.3%, κ= 0.65±0.05). Concordance was the highest for CIN (93%) and EPS (86%), followed by IBS (76%), PDS (64%) and GERD (50%) (Fig. 1). The concordance was 80% for the pooled FD population. Solely based on the answers in the WRQ 45% of GERD patients would have been misdiagnosed with PDS or EPS. PPI usage was a major confounder: 78% of the patients with a physician-based diagnosis of GERD not confirmed by the WRQ received PPI therapy. The prevalence of PPI therapy was also higher in the GERD patients (80%) compared to the other groups (32-64%, p= 0.02). Conclusion: The new WRQ is a reliable, accurate and easy to handle tool that can provide diagnostic guidance in (non-)specialist settings and clinical research. Implementation in clinical practice would standardize and enhance the diagnostic approach for a vast population of FGID patients.
Figure 1: Concordance between WRQ based and interview based predominant symptomatic profiles. Each bar represents the entire patient population with one of the five diagnoses given by the clinician based on their interview. Each bar is subdivided in the diagnoses that patients would have received solely based on their written answers in the WRQ. The concordance for the pooled functional dyspepsia population was 80%. None of the EPS patients would have been designated to a WRQ based diagnosis of PDS.
Mo1666 DIFFERENCES IN DEMOGRAPHIC AND SYMPTOM-RELATED CHARACTERISTICS AMONG PATIENTS WITH IRRITABLE BOWEL SYNDROME WITH CONSTIPATION (IBS-C) AND CHRONIC IDIOPATHIC CONSTIPATION (CIC): RESULTS FROM THE CONTOR STUDY Jessica Abel, Douglas C. Taylor, Jalpa A. Doshi, Carolyn Martin, Alyssa Goolsby Hunter, Breanna Essoi, Paul Buzinec, Robyn T. Carson, David S. Reasner, William D. Chey
Patient-reported symptoms and health-related quality of life among IBS-C and CIC patients
Background: The Chronic Constipation and IBS-C Treatment and Outcomes Real-world Research platform (CONTOR) is a longitudinal, observational platform combining administrative claims and patient survey data to examine associations between symptoms, treatments, and outcomes among IBS-C and CIC patients. This analysis evaluated differences in demographics and symptom-related characteristics among IBS-C and CIC patients at baseline. Methods: Fully insured patients aged ≥18 years were identified from a large, geographically diverse US health plan based on claims from 12/2012 to 6/2015. Criteria included: ≥1 medical claim for constipation (564.0x); or ≥1 claim for IBS (564.1x) or abdominal pain (789.0x) plus ≥1 pharmacy claim for a stool softener/laxative; or ≥1 claim for linaclotide or lubiprostone. Participants completed a self-administered survey including the Patient Assessment of Constipation Symptoms (PAC-SYM) and Quality of Life (PAC-QOL) instruments. Demographics, most bothersome symptoms, symptom severity (PAC-SYM), and condition-related quality of life (PAC-QOL) were assessed between patients reporting a provider diagnosis of IBS-C (including IBS) or CIC (including chronic constipation and functional constipation). Results: Of 2,052 respondents who completed the baseline survey, 41.5% and 24.2% reported a provider diagnosis of IBS-C or CIC, respectively. 93% of both IBS-C and CIC patients were female; CIC patients were older (mean 48.5 vs. 45.7 years, p<0.001). A greater proportion of IBS-C versus CIC patients selected abdominal pain as their most bothersome symptom, while a greater proportion of CIC patients selected hard/ small stools, straining or squeezing, rectal bleeding or tearing, or infrequent bowel movements as most bothersome (Table). Abdominal bloating/distention were most frequently reported by both IBS-C and CIC patients as their most bothersome symptom. Overall symptom severity was not different between IBS-C and CIC patients; however, IBS-C patients had a significantly higher score on the PAC-SYM abdominal subscale (Table). IBS-C patients reported significantly higher PAC-QOL scores both overall and on the psychosocial discomfort subscale, indicating lower QOL compared to CIC patients; CIC patients had significantly higher scores on the satisfaction subscale (Table). Conclusions: The observed differences in symptoms and QOL between IBS-C and CIC patients support mounting evidence suggesting IBS-C and CIC may be different states on a continuous disease spectrum: for example, abdominal pain occurs in both IBS-C and CIC, but is more frequently reported as bothersome in IBS-C. Further, IBS-C patients had significantly lower QOL and were more likely to report pain-related symptoms. These findings indicate that abdominal pain is a key feature of IBSC and an important target for IBS-C treatment.
Mo1667 UNDERSTANDING SYMPTOM BURDEN AND ATTITUDES IN PATIENTS WITH IRRITABLE BOWEL SYNDROME WITH DIARRHEA: RESULTS FROM A PATIENT SURVEY Hans Törnblom, Anton Emmanuel, Richard Goosey, Gwen Wiseman, Stephen Baker Background: Irritable bowel syndrome affects 10-15% of adults, and around one third have diarrhea as the predominant bowel habit (IBS-D). Little is published on the health impact on these patients. This survey aimed to assess the gastrointestinal and wider health burden of IBS-D, including medications used for symptom relief and perceived care shortfalls. Methods: A 30-minute web-based survey was completed in France, Germany, Italy, Spain, UK, Canada, and Australia. Target sample size was 80 patients per country. Screening criteria included: age 18-65 years, being diagnosed with IBS-D by a doctor, having symptoms present within the past 12 months, and currently using prescription or over-the-counter (OTC) medicines for IBS-D. The maximum quota was 30% male and 25% of patients who had never seen a gastroenterologist for their IBS. Attitudes to IBS-D and its management were scored using a 7-point scale (1=completely disagree; 4=neither agree nor disagree; 7= completely agree). Results: 513 eligible patients completed the survey; 357 (70%) were female and mean age was 40.9 (range 18-65) years. As well as stomach pain and diarrhea, 269 (52%) patients had bloating before treatment, 204 (40%) had urgency, and 88 (17%) had fecal incontinence. Mean duration of symptoms was 9.8 years. The most troublesome current symptom was urgency in 136 (27%) patients. In the past 3 months, symptoms were intermittent in 390 (76%) patients and continual in 123 (24%). The most common comorbidities were anxiety in 189 (37%) patients, depression in 137 (27%), and migraine in 133 (26%). OTC drugs were used by 372 (73%) patients (214 [42%] OTC only, 158 [31%] OTC + prescription). The most commonly used agents were antidiarrheals in 416 (81%) patients and antispasmodics in 300 (58%); notably, 91 (18%) used codeine-based painkillers and 79 (15%) used antidepressants. Antidiarrheals were used daily by 63 (12%) patients, and 58 (11%) used daily antispasmodics; 178/384 (46%) and 99/217 (46%) were not satisfied with these agents. Patients had mixed attitudes towards their condition (Table 1: score 6-7): 216 (42%) reported having learned to live with their IBS but 189 (37%) were constantly worried about when their symptoms would return, and 58 (11%) agreed with the statement "When my IBS is bad, I wish I was dead". A substantial proportion (170; 33%) wanted doctors to listen and support more, and 165 (32%) agreed that healthcare professionals do not take IBS seriously. The majority of patients (296; 58%) wanted treatment to significantly improve their quality of life and 237 (46%) were willing to try anything to help manage their IBS. Conclusions: We report the substantial impact of IBS-D on quality of life, medication use, and the desire for more services in this patient population. There is a distinct opportunity for improved pharmacological and supportive management of IBSD patients.
S-745
AGA Abstracts