Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: Baseline results from logic (longitudinal outcomes study of gastrointestinal symptoms in Canada), a naturalistic study

doi:10.1016/j.clinthera.2006.10.010

Clinical Therapeutics

Volume 28, Issue 10, October 2006, Pages 1726-1735

https://doi.org/10.1016/j.clinthera.2006.10.010 Get rights and content

Abstract

Background:

Abdominal pain/discomfort, bloating, and constipation are gastrointestinal dysmotility and sensory symptoms associated with irritable bowel syndrome (IBS). No studies have followed patients with IBS symptoms for 1 year under conditions of routine clinical practice to assess prospectively the impact of treatments on health outcomes.

Objective:

The objective of this ongoing, naturalistic study is to assess the long-term impact of IBS treatments on quality of life (QOL), work productivity, and resource utilization. This report describes the baseline characteristics and patterns of care of the patients enrolled in this study.

Methods:

Patients with physician-diagnosed IBS symptoms were enrolled from 147 physician sites across Canada between May 4, 2004, and March 31, 2005. Clinical data were collected at baseline and at the end of the 12-month follow-up (patients were followed for 1 year between May 4, 2005, and March 31, 2006). Patient-reported outcomes were collected at baseline and at months 1, 2, 6, 9, and 12. Health-related QOL, health status, and work productivity were assessed with the IBS-QOL, a 5-item EuroQol descriptive system, and Work Productivity and Activity Impairment questionnaires, respectively. A resource utilization questionnaire elicited information on physician` visits, treatments, and procedures. Baseline data are reported here.

Results:

Data were obtained from 1555 patients; 85.1% (1320/1552) were women. Patients had a mean (SD) age of 45.8 (15.0) years and mean (SD) duration of IBS symptoms of 11.4 (11.5) years. Self-reported bowel patterns were predominantly constipation (41.0%, 587/1433) and constipation alternating with diarrhea (39.4%, 564/1433); 60.3% (938/1555) of subjects used ≥3 IBS treatments in the previous 4 weeks. Approximately 50% of all patients reported distress “quite a bit or “extremely” for abdominal pain, gas, bloating, and constipation. The mean overall IBS-QOL score (0-100 scale, with 0 indicating poor QOL) was 66.3; food avoidance (51.8) and health worry (59.3) were the most serious concerns. Patients reported 5.6% work absenteeism, 31.4% presenteeism, and 34.6% overall work productivity loss, equivalent to 13.8 hours lost productivity per 40-hour workweek.

Conclusions:

The baseline data from this onging, prospective, naturalistic study are consistent with previous findings that suggested significant use of health care resources with concomitant low QOL and decreased work productivity in patients with IBS symptoms.

References (49)

EverhartJ.E. et al.
Irritable bowel syndrome in officebased practice in the United States
Gastroenterology
(1991)
MitchellC.M. et al.
Survey of the AGA membership relating to patients with functional gastrointestinal disorders
Gastroenterology
(1987)
FrankL. et al.
Health-related quality of life associated with irritable bowel syndrome: Comparison with other chronic diseases
Clin Ther
(2002)
GralnekI.M. et al.
The impact of irritable bowel syndrome on health-related quality of life
Gastroenterology
(2000)
PareP. et al.
Development and validation of a questionnaire to evaluate severity of symptoms in patients with IBS-C and IBS-A
Value Health
(2005)
DrossmanD.A. et al.
Further validation of the IBS-QOL: A disease-specific quality-of-life questionnaire
Am J Gastroenterol
(2000)
BrooksR.
EuroQol:The currentstate of play
Health Policy
(1996)
BushnellD.M. et al.
Performance of the EQ-5D in patients with irritable bowel syndrome
Value Health
(2006)
WahlqvistP. et al.
Validity of a Work Productivity and Activity Impairment questionnaire for patients with symptoms of gastro-esophageal reflux disease (WPAI-GERD)-results from a cross-sectional study
Value Health
(2002)
ReillyM.C. et al.
Validation of the Dermatology Life Quality Index and the Work Productivity and Activity Impairment-Chronic Hand Dermatitis Questionnaire in chronic hand dermatitis
J Am Acad Dermatol
(2003)

McDermottA.M. et al.

The burden of neuropathic pain: Results from a cross-sectional survey

Eur J Pain

(2006)

HazellM. et al.

Health related quality of life in individuals with asthma related symptoms

Respir Med

(2003)

American College of Gastroenterology Functional Gastrointestinal Disorders Task Force

Evidence-based position statement on the management of irritable bowel syndrome in North America

Am J Gastroenterol

(2002)

ThompsonW.G.

The treatment of irritable bowel syndrome

Aliment Pharmacol Ther

(2002)

LongstrethG.F. et al.

Irritable bowel-type symptoms in HMO examinees. Prevalence, demographics, and clinical correlates

Dig Dis Sci

(1993)

ThompsonW.G. et al.

Functional gastrointestinal disorders in Canada: First populationbased survey using Rome II criteria with suggestions for improving the questionnaire

Dig Dis Sci

(2002)

WhiteheadW.E. et al.

Impact of irritable bowel syndrome on quality of life

Dig Dis Sci

(1996)

JonesR.H.

Clinical economics review: Gastrointestinal disease in primary care

Aliment Pharmacol Ther

(1996)

DeanB.B. et al.

Impairment in work productivity and health-related quality of life in patients with IBS

Am J Manag Care

(2005)

HahnB.A. et al.

Impact of irritable bowel syndrome on qualiry of life and resource use in the United States and United Kingdom

Digestion

(1999)

HunginA.P. et al.

The prevalence, patterns and impact of irritable bowel syn drome: An international survey of 40,000 subjects

Aliment Pharmacol Ther

(2003)

InadomiJ.M. et al.

Systematic review: The economic impact of irritable bowel syndrome

Aliment Pharmacol Ther

(2003)

KhoshooV. et al.

Effect of a laxative with and with out tegaserod in adolescents with constipation predominant irritable bowel syndrome

Aliment Pharmacol Ther

(2006)

FrissoraC.L.

Diagnosis, treatment, and management of irritable bowel syndrome with constipation and chronic constipation

Med Gen Med

(2005)

Cited by (164)

Acupuncture for irritable bowel syndrome: Study protocol of a prospective, multicentre, registry study in real-world settings
2022, European Journal of Integrative Medicine
Acupuncture is a complex intervention influenced by many factors, and its effectiveness in treating irritable bowel syndrome (IBS) in the real world is unknown. Therefore, we will conduct a registry study to evaluate the effectiveness and safety of acupuncture alone or as adjunctive therapy for IBS in real-world settings.
This is a prospective multicentre registry study. At least 788 patients will be recruited from 6 medical centres. Patients who are diagnosed with IBS, aged over 18 years, and voluntarily sign the informed consent form will be recruited. The interventions will include acupuncture or without acupuncture therapy for IBS. The primary outcome will be the IBS symptom severity score, and the secondary outcomes will include adequate relief of global IBS symptoms, the Bristol Stool Form Scale, the weekly frequency of defecation, the Self-Rating Anxiety Scale, and the Self-Rating Depression Scale. All information will be collected through the Epi Info™7 data platform. Propensity score matching will be used to control for potential confounding factors. The generalized additive mixed model will be used to analyse the curative effect. We posit that the treatment should not be less than 3 times, and 1 follow-up is an effective case.
This study protocol describes the first large-scale, multicentre patient registry of acupuncture for IBS. The findings of the study will confirm the effectiveness and safety of acupuncture alone or as adjunctive therapy in treating IBS and provide the characteristics of acupuncture implementation, the conditions related to more acupuncture benefit, and identify the key factors affecting the clinical effectiveness of acupuncture treatment for IBS in the real world.
Chinese Clinical Trial Registry, ChiCTR2100045329. Registered date on 12 April 2021.
Assessing the post-treatment therapeutic effect of tongxie in irritable bowel syndrome: A randomized controlled trial
2022, Complementary Therapies in Medicine
Citation Excerpt :
IBS is the most common chronic gastrointestinal disorder (approximately 10–15% worldwide).3,4 IBS not only negatively affects patients physically, psychologically, socially, and financially,5,6 but also puts a heavy financial burden on our society – direct and indirect costs are approximately $1.35 billion7 and $20 billion,8 respectively, annually. This huge burden is mainly because of IBS’s high recurrence.9
Diarrhea predominant irritable bowel syndrome (IBS) is a highly relapsing gastrointestinal disorder decreasing the quality of life. Existing studies indicated that the therapeutic effects maintained for a period of time after the treatments were discontinued (post-treatment therapeutic effects or PTTE). In this study, we aim to assess the PTTE of tongxie. We performed a multiple center, controlled, double blind study of patients with IBS randomized to tongxie (n = 120) or placebo (n = 120) for 4 weeks and followed up for 57 weeks. The primary outcomes were abdominal pains and stool consistency. The secondary outcomes were pain frequency and stool frequency. Tertiary outcomes were adverse effects and global overall symptom. The outcome data were collected at days 1, 2, 3, weeks 1 and 4 during the treatment and at days 1, 2, 3, until week 57 during the post-treatment. Significantly more patients receiving tongxie were clinical responders to the primary and secondary endpoints from day 1 until the end of the treatment. The positive effects of tongxie were maintained until 17–25 weeks after tongxie was discontinued. The relapse-free probabilities in the tongxie group were significantly higher than those in the placebo group (P < .001). Twenty-five weeks after the therapies were discontinued could be considered as IBS natural history. During this period, an average of 53.8–56.3% of patients (pool tongxie and placebo data together) had IBS symptoms (pain scale ≥ 3, stool consistency ≥ 5). In particular, at the end of this study (week 61), 145 (54.2%) patients had IBS symptoms. Our results provide clinical insights into efficient and cost-effective management of refractory IBS, and lend support to the IBS management that the selection of a therapy should consider both its effectiveness during treatment and its PTTE after the treatment.
AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation
2022, Gastroenterology
Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction associated with significant disease burden. This American Gastroenterological Association guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS-C and is an update of a prior technical review and guideline.
The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The technical review panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of the following agents: tenapanor, plecanatide, linaclotide, tegaserod, lubiprostone, polyethylene glycol laxatives, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics. The Guideline Panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations.
The panel agreed on 9 recommendations for the management of patients with IBS-C. The panel made a strong recommendation for linaclotide (high certainty) and conditional recommendations for tenapanor, plecanatide, tegaserod, and lubiprostone (moderate certainty), polyethylene glycol laxatives, tricyclic antidepressants, and antispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).
AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea
2022, Gastroenterology
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder associated with significant disease burden. This American Gastroenterological Association Guideline is intended to support practitioners in decisions about the use of medications for the pharmacological management of IBS with predominant diarrhea (IBS-D) and is an update of a prior technical review and guideline.
The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The technical review panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of the following agents: eluxadoline, rifaximin, alosetron, loperamide, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics. The guideline panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations.
The panel agreed on 8 recommendations for the management of patients with IBS-D. The panel made conditional recommendations for eluxadoline, rifaximin, alosetron, (moderate certainty), loperamide (very low certainty), tricyclic antidepressants, and anstispasmodics (low certainty). The panel made a conditional recommendation against the use of selective serotonin reuptake inhibitors (low certainty).
The impact of artificial intelligence algorithms on management of patients with irritable bowel syndrome: A systematic review
2022, Informatics in Medicine Unlocked
Distinguishing Irritable Bowel Syndrome (IBS) from other diseases is one of the most difficult tasks for gastroenterologists. Because IBS symptoms overlap with those of another disease, these obstacles can misdiagnose and impose significant socioeconomic burdens on society. As a result of Artificial Intelligence's (AI) considerable potential, it can be suggested that these issues be improved or eliminated. AI enables machines to simulate human thought and reasoning processes. Thus, these machines can exhibit appropriate responses and reasoning to resolve complex situations problems. Therefore, AI can play a significant role in predicting, diagnosing, and managing IBS. However, no systematic review has been conducted in this field. To this end, the purpose of our paper was to determine the AI algorithms' applications in IBS.
A systematic review was conducted by searching major databases, such as Web of Science, PubMed, and Scopus, for studies written in English that discussed the application of AI algorithms in IBS up to November 8, 2021. We incorporated a variety of keywords, including "artificial intelligence" and "irritable bowel syndrome." Two expert authors evaluated articles independently, and any disagreements were resolved with the assistance of a third reviewer. This review included eligible studies that met the inclusion criteria.
Initially, 508 articles from databases and six studies from the gray literature search were returned. After eliminating duplicates, screening studies, and considering inclusion and exclusion criteria, 20 studies were selected for the final review. The conducted studies indicate that AI techniques can aid in IBS screening and diagnosis, as well as patient classification and overall IBS management and treatment. Additionally, we found that support vector machine (SVM) demonstrated significantly higher specificity (100%), and random forest demonstrated significantly higher accuracy (98.5%) than other algorithms.
According to articles, utilizing AI algorithms for predicting, diagnosing, and managing IBS is cost-effective and can be incorporated into health service organizations' strategic planning as an effective strategy for improving the quality of diagnosis and management of this disease.
Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987–2016
2021, European Journal of Internal Medicine
Citation Excerpt :
The economic impacts of our finding are potentially substantial given the high prevalence of IBS across global societies with high direct healthcare costs [6]. In Europe, a third of IBS patients will undergo colonoscopy [27], and almost 30% of colonoscopies in the US performed in patients under 50 are performed for IBS [5]. Existing data have been mixed as to the yield of endoscopic procedures in IBS.
: Symptoms of irritable bowel syndrome (IBS) are common reasons for endoscopic procedures. We examined the yield of colonoscopy and upper endoscopy in IBS for several organic diseases.
: Matched population-based prevalence study in Sweden. We identified 21,944 participants diagnosed with IBS from 1987 to 2016 undergoing colonoscopy with a biopsy from all of Sweden's 28 pathology departments within 6 months of diagnosis. We compared prevalence of histopathology-proven diagnoses of inflammatory bowel disease (IBD), colorectal cancer, precancerous polyps, and microscopic colitis between patients recently diagnosed with IBS and matched controls without IBS (n = 81,101) undergoing colonoscopy. We also compared prevalence of celiac disease between patients diagnosed with IBS (n = 9,965) and matched controls (n = 45,584) undergoing upper endoscopy with biopsy. IBS patients were also compared to their siblings. Conditioned logistic regression estimated adjusted odds ratios (aORs).
: Biopsy-proven IBD was seen in 1.6% of IBS and in 5.9% of controls (aOR=0.21; 95%CI=0.19–0.24). The prevalence of precancerous polyps was 4.1% vs. 13.0% (aOR=0.28; 95%CI=0.26–0.30), colorectal cancer 0.8% vs. 6.3% (aOR=0.17; 95%CI=0.14–0.20) and celiac disease 1.9% vs. 3.4% (aOR=0.54; 95%CI=0.47–0.63). Conversely, the prevalence of microscopic colitis was 2.9% vs. 1.7% (aOR=1.77; 95%CI=1.61–1.95), with higher prevalence in older patients and patients with IBS with diarrhea. Yield of colonoscopy for precancerous polyps, colorectal cancer, and microscopic colitis increased by age. Our findings were consistent using unaffected siblings as the comparator group.
: The diagnostic yield of upper endoscopy and colonoscopy for organic disease is low in patients with a first-time diagnosis of IBS, though increases with age.

View all citing articles on Scopus

^**: This study was previously published in abstact form in: Paré P, Morgan D, Lam S, et al. Baseline characteristics of Canadian LOGIC (Longitudinal Outcomes study of GI symptoms in Canada). Gastroenterology. 2005;128(Suppl 2):W936; and Paré P, Lam S, Balshaw R, et al. Patient characteristics (irritable bowel syndrome with constipation [IBS-C]): Baseline results from LOGIC (Longitudinal Outcomes study of GI symptoms in Canada). Am J Gastroenterol. 2005;100: S268. Abstract.

View full text

Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: Baseline results from logic (longitudinal outcomes study of gastrointestinal symptoms in Canada), a naturalistic study**

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

Gastroenterology

Gastroenterology

Clin Ther

Gastroenterology

Value Health

Am J Gastroenterol

Health Policy

Value Health

Value Health

J Am Acad Dermatol

Eur J Pain

Respir Med

Evidence-based position statement on the management of irritable bowel syndrome in North America

Am J Gastroenterol

The treatment of irritable bowel syndrome

Aliment Pharmacol Ther

Irritable bowel-type symptoms in HMO examinees. Prevalence, demographics, and clinical correlates

Dig Dis Sci

Functional gastrointestinal disorders in Canada: First populationbased survey using Rome II criteria with suggestions for improving the questionnaire

Dig Dis Sci

Impact of irritable bowel syndrome on quality of life

Dig Dis Sci

Clinical economics review: Gastrointestinal disease in primary care

Aliment Pharmacol Ther

Impairment in work productivity and health-related quality of life in patients with IBS

Am J Manag Care

Impact of irritable bowel syndrome on qualiry of life and resource use in the United States and United Kingdom

Digestion

The prevalence, patterns and impact of irritable bowel syn drome: An international survey of 40,000 subjects

Aliment Pharmacol Ther

Systematic review: The economic impact of irritable bowel syndrome

Aliment Pharmacol Ther

Effect of a laxative with and with out tegaserod in adolescents with constipation predominant irritable bowel syndrome

Aliment Pharmacol Ther

Diagnosis, treatment, and management of irritable bowel syndrome with constipation and chronic constipation

Med Gen Med