A0341 - High Rates of Chronic Constipation in Inflammatory Bowel Disease Patients

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Sparsh Jain, BS

Medical College of Wisconsin
Wauwatosa, WI

Sparsh Jain, BS¹, Andres Yarur, MD², Sneha Nagavally, MS¹, Daniel J. Stein, MD¹
¹Medical College of Wisconsin, Wauwatosa, WI; ²Cedars-Sinai Medical Center, Los Angeles, CA

Introduction: Even though patients with inflammatory bowel diseases (IBD) typically present with diarrhea and can be an important consideration in clinical scoring systems, some may develop constipation. The prevalence and clinical scenarios in which constipation is seen in IBD patients has not been well described. We aim to evaluate the prevalence of constipation in IBD patients and assess the phenotypic characteristics of those IBD patients that develop it.

Methods: Using a retrospective case-control study, we enrolled 500 patients with a confirmed diagnosis of IBD seen in an outpatient tertiary referral IBD clinic. IBD outpatients seen at a tertiary referral clinic least once in 12 months were included. We excluded patients with a known partial or complete bowel obstruction, those with short gut, colectomies, and an ostomy. Data collected included disease phenotype, clinical and endoscopic disease activity, medication, and previous surgeries. The primary outcome was constipation, defined as subjectively as less than three bowel movements per week and the secondary outcome was constipation per the more stringent Rome IV criteria.

Results: Out of a total of 500 patients included, 50.1% met the subjective criteria for constipation and 27.4% met Rome IV criteria. Female patients were found to significantly (p< 0.001) have at least 2 Rome IV constipation modalities compared to men. Constipated patients significantly (p< 0.001) used more laxatives and fiber. There was a significant (p< 0.001) increase in constipation among patients who were using opioids, as they also scored in at least two Rome IV criteria. No significant association was seen between constipation and active IBD activity, disease characteristics, prior surgeries, or medication use.

Discussion: We found that a large proportion of IBD patients deal with constipation regardless of disease activity, prior surgery, or medication use. Rates of IBD patient constipation is tied to female sex and opioid use which is also seen in the general population. The prevalence does not seem driven by inflammation or post-surgical anatomy, so other etiologies such as slow transit and pelvic dysfunction should be considered. Identifying underlying etiologies of constipation is important as they can guide appropriate therapy.

	Constipation (subjective assessment)				Constipation by at least 2 modalities (Rome IV Criteria)
	N (N=249)	Y (N=251)	Total (N=500)	p value	No (N=363)	Yes (N=137)	Total (N=500)	p value
Age				< 0.001				0.023
Mean (sd)	40.669 (16.431)	45.618 (16.089)	43.158 (16.432)		42.127 (16.517)	45.883 (15.943)	43.158 (16.432)
Range	20.000 - 85.000	20.000 - 88.000	20.000 - 88.000		20.000 - 88.000	21.000 - 87.000	20.000 - 88.000

Gender				< 0.001				< 0.001
F	96 (38.6%)	171 (68.1%)	267 (53.4%)		172 (47.4%)	95 (69.3%)	267 (53.4%)
M	153 (61.4%)	80 (31.9%)	233 (46.6%)		191 (52.6%)	42 (30.7%)	233 (46.6%)
Race				0.035				0.04
White	231 (92.8%)	214 (85.6%)	445 (89.2%)		331 (91.2%)	114 (83.8%)	445 (89.2%)
Black	14 (5.6%)	27 (10.8%)	41 (8.2%)		23 (6.3%)	18 (13.2%)	41 (8.2%)
Others	4 (1.6%)	9 (3.6%)	13 (2.6%)		9 (2.5%)	4 (2.9%)	13 (2.6%)
Alcohol Use				0.41				0.679
N	86 (34.5%)	78 (31.1%)	164 (32.8%)		121 (33.3%)	43 (31.4%)	164 (32.8%)
Y	163 (65.5%)	173 (68.9%)	336 (67.2%)		242 (66.7%)	94 (68.6%)	336 (67.2%)
Active Smoker				0.619				0.573
N	165 (66.3%)	161 (64.1%)	326 (65.2%)		234 (64.5%)	92 (67.2%)	326 (65.2%)
Y	84 (33.7%)	90 (35.9%)	174 (34.8%)		129 (35.5%)	45 (32.8%)	174 (34.8%)
Diagnosis				0.09				0.443
CD	161 (64.7%)	180 (71.7%)	341 (68.2%)		244 (67.2%)	97 (70.8%)	341 (68.2%)
UC	88 (35.3%)	71 (28.3%)	159 (31.8%)		119 (32.8%)	40 (29.2%)	159 (31.8%)
H.O. bowel resection				0.412				0.52
N	161 (64.7%)	171 (68.1%)	332 (66.4%)		238 (65.6%)	94 (68.6%)	332 (66.4%)
Y	88 (35.3%)	80 (31.9%)	168 (33.6%)		125 (34.4%)	43 (31.4%)	168 (33.6%)
Years with IBD				0.554				0.227
Mean (sd)	14.073 (11.068)	13.534 (9.118)	13.802 (10.128)		14.142 (10.914)	12.912 (7.668)	13.802 (10.128)
Range	1.000 - 61.000	1.000 - 52.000	1.000 - 61.000		1.000 - 61.000	1.000 - 41.000	1.000 - 61.000
	3	2	5		5	0	5
Any Neurologic Disorder				0.002				0.083
N	229 (92.0%)	208 (82.9%)	437 (87.4%)		323 (89.0%)	114 (83.2%)	437 (87.4%)
Y	20 (8.0%)	43 (17.1%)	63 (12.6%)		40 (11.0%)	23 (16.8%)	63 (12.6%)
Diabetes				0.479				0.185
N	235 (94.4%)	233 (92.8%)	468 (93.6%)		343 (94.5%)	125 (91.2%)	468 (93.6%)
Y	14 (5.6%)	18 (7.2%)	32 (6.4%)		20 (5.5%)	12 (8.8%)	32 (6.4%)
Chronic kidney disease (CKD)				0.568				0.262
N	244 (98.0%)	244 (97.2%)	488 (97.6%)		356 (98.1%)	132 (96.4%)	488 (97.6%)
Y	5 (2.0%)	7 (2.8%)	12 (2.4%)		7 (1.9%)	5 (3.6%)	12 (2.4%)
Left Sided UC				0.399				0.617
N	73 (84.9%)	55 (79.7%)	128 (82.6%)		96 (83.5%)	32 (80.0%)	128 (82.6%)
Y	13 (15.1%)	14 (20.3%)	27 (17.4%)		19 (16.5%)	8 (20.0%)	27 (17.4%)
Pancolonic UC				0.302				0.711
N	21 (24.4%)	22 (31.9%)	43 (27.7%)		31 (27.0%)	12 (30.0%)	43 (27.7%)
Y	65 (75.6%)	47 (68.1%)	112 (72.3%)		84 (73.0%)	28 (70.0%)	112 (72.3%)
Proctitis				0.051				0.406
N	83 (96.5%)	61 (88.4%)	144 (92.9%)		108 (93.9%)	36 (90.0%)	144 (92.9%)
Y	3 (3.5%)	8 (11.6%)	11 (7.1%)		7 (6.1%)	4 (10.0%)	11 (7.1%)
Ileal CD				0.714				0.227
N	125 (80.1%)	143 (81.7%)	268 (81.0%)		188 (79.3%)	80 (85.1%)	268 (81.0%)
Y	31 (19.9%)	32 (18.3%)	63 (19.0%)		49 (20.7%)	14 (14.9%)	63 (19.0%)
Ileo-Colonic CD				0.258				0.471
N	63 (40.4%)	61 (34.9%)	124 (37.5%)		93 (39.2%)	31 (33.0%)	124 (37.5%)
PERINANAL	0 (0.0%)	2 (1.1%)	2 (0.6%)		1 (0.4%)	1 (1.1%)	2 (0.6%)
Y	93 (59.6%)	112 (64.0%)	205 (61.9%)		143 (60.3%)	62 (66.0%)	205 (61.9%)
Colonic CD				0.616				0.85
N	125 (80.1%)	144 (82.3%)	269 (81.3%)		192 (81.0%)	77 (81.9%)	269 (81.3%)
Y	31 (19.9%)	31 (17.7%)	62 (18.7%)		45 (19.0%)	17 (18.1%)	62 (18.7%)
Inflammatory				0.898				0.58
N	84 (53.8%)	93 (53.1%)	177 (53.5%)		129 (54.4%)	48 (51.1%)	177 (53.5%)
Y	72 (46.2%)	82 (46.9%)	154 (46.5%)		108 (45.6%)	46 (48.9%)	154 (46.5%)
Stricturing				0.732				0.732
N	100 (64.1%)	109 (62.3%)	209 (63.1%)		151 (63.7%)	58 (61.7%)	209 (63.1%)
Y	56 (35.9%)	66 (37.7%)	122 (36.9%)		86 (36.3%)	36 (38.3%)	122 (36.9%)
Fistulizing/Penetrating				0.651				0.466
N	85 (54.5%)	91 (52.0%)	176 (53.2%)		129 (54.4%)	47 (50.0%)	176 (53.2%)
Y	71 (45.5%)	84 (48.0%)	155 (46.8%)		108 (45.6%)	47 (50.0%)	155 (46.8%)
SES (CD)				0.157				0.033
Mean (sd)	4.041 (6.313)	3.044 (5.417)	3.477 (5.833)		3.964 (6.392)	2.345 (4.073)	3.477 (5.833)
Range	0.000 - 37.000	0.000 - 35.000	0.000 - 37.000		0.000 - 37.000	0.000 - 17.000	0.000 - 37.000
Nmiss	128	93	221		168	53	221
Mayo (UC)				0.071				0.185
Mean (sd)	2.942 (3.807)	1.885 (2.602)	2.446 (3.327)		2.677 (3.535)	1.794 (2.591)	2.446 (3.327)
Range	0.000 - 11.000	0.000 - 9.000	0.000 - 11.000		0.000 - 11.000	0.000 - 9.000	0.000 - 11.000
Nmiss	180	190	370		267	103	370
Only rectum inflamed				0.049				0.034
N	237 (100.0%)	242 (98.4%)	479 (99.2%)		348 (99.7%)	131 (97.8%)	479 (99.2%)
Y	0 (0.0%)	4 (1.6%)	4 (0.8%)		1 (0.3%)	3 (2.2%)	4 (0.8%)
Any inflammation				0.161				0.79
N	130 (55.1%)	151 (61.4%)	281 (58.3%)		201 (57.9%)	80 (59.3%)	281 (58.3%)
Y	106 (44.9%)	95 (38.6%)	201 (41.7%)		146 (42.1%)	55 (40.7%)	201 (41.7%)
Base Severity				0.295				0.928
Mild	58 (24.7%)	56 (22.8%)	114 (23.7%)		82 (23.7%)	32 (23.7%)	114 (23.7%)
Mod/Mod-Sev	48 (20.4%)	39 (15.9%)	87 (18.1%)		64 (18.5%)	23 (17.0%)	87 (18.1%)
NAD	129 (54.9%)	151 (61.4%)	280 (58.2%)		200 (57.8%)	80 (59.3%)	280 (58.2%)
Biologics				0.312				0.217
N	3 (1.2%)	1 (0.4%)	4 (0.8%)		4 (1.1%)	0 (0.0%)	4 (0.8%)
Y	246 (98.8%)	250 (99.6%)	496 (99.2%)		359 (98.9%)	137 (100.0%)	496 (99.2%)
Immunomodulators				0.114				0.014
N	91 (36.5%)	75 (29.9%)	166 (33.2%)		132 (36.4%)	34 (24.8%)	166 (33.2%)
Y	158 (63.5%)	176 (70.1%)	334 (66.8%)		231 (63.6%)	103 (75.2%)	334 (66.8%)
Mesalamine				0.418				0.444
N	73 (29.3%)	82 (32.7%)	155 (31.0%)		109 (30.0%)	46 (33.6%)	155 (31.0%)
Y	176 (70.7%)	169 (67.3%)	345 (69.0%)		254 (70.0%)	91 (66.4%)	345 (69.0%)
Systemic Corticosteroids				0.977				0.959
N	24 (9.6%)	24 (9.6%)	48 (9.6%)		35 (9.6%)	13 (9.5%)	48 (9.6%)
Y	225 (90.4%)	227 (90.4%)	452 (90.4%)		328 (90.4%)	124 (90.5%)	452 (90.4%)
Topical Mesalamine				0.315				0.539
N	248 (99.6%)	251 (100.0%)	499 (99.8%)		362 (99.7%)	137 (100.0%)	499 (99.8%)
Y	1 (0.4%)	0 (0.0%)	1 (0.2%)		1 (0.3%)	0 (0.0%)	1 (0.2%)
Topical Corticosteroids				0.598				0.611
N	243 (97.6%)	243 (96.8%)	486 (97.2%)		352 (97.0%)	134 (97.8%)	486 (97.2%)
Y	6 (2.4%)	8 (3.2%)	14 (2.8%)		11 (3.0%)	3 (2.2%)	14 (2.8%)
Harvey Bradshaw Index (CD)				0.799				0.482
Mean (sd)	1.731 (2.785)	1.639 (3.106)	1.679 (2.967)		1.762 (3.128)	1.488 (2.567)	1.679 (2.967)
Range	0.000 - 13.000	0.000 - 21.000	0.000 - 21.000		0.000 - 21.000	0.000 - 13.000	0.000 - 21.000
Nmiss	130	93	223		170	53	223
Partial Mayo Score (UC)				0.041				0.196
Mean (sd)	1.986 (2.728)	1.148 (1.750)	1.598 (2.357)		1.755 (2.520)	1.147 (1.760)	1.598 (2.357)
Range	0.000 - 8.000	0.000 - 6.000	0.000 - 8.000		0.000 - 8.000	0.000 - 6.000	0.000 - 8.000
Nmiss	178	190	368		265	103	368
Simple Inflammatory Bowel Disease Score (SIBDQ)				0.146				0.202
Mean (sd)	57.136 (9.877)	52.682 (10.092)	54.909 (10.122)		56.393 (9.523)	52.312 (10.916)	54.909 (10.122)
Range	33.000 - 68.000	35.000 - 70.000	33.000 - 70.000		33.000 - 68.000	35.000 - 70.000	33.000 - 70.000
Nmiss	227	229	456		335	121	456
CRP				0.697				0.339
Mean (sd)	1.178 (3.047)	1.074 (2.578)	1.124 (2.809)		1.205 (2.957)	0.922 (2.402)	1.124 (2.809)
Range	0.030 - 30.000	0.000 - 25.700	0.000 - 30.000		0.000 - 30.000	0.030 - 25.700	0.000 - 30.000
Nmiss	39	20	59		49	10	59
Calprotectin				0.547				0.696
Mean (sd)	1087.625 (1429.730)	786.346 (2008.924)	930.960 (1744.040)		872.946 (1235.648)	1096.077 (2792.809)	930.960 (1744.040)
Range	30.000 - 5041.000	30.000 - 10000.000	30.000 - 10000.000		30.000 - 5041.000	30.000 - 10000.000	30.000 - 10000.000
Nmiss	225	225	450		326	124	450
Hb				0.057				0.2
Mean (sd)	14.241 (6.936)	13.363 (1.445)	13.787 (4.943)		13.973 (5.764)	13.318 (1.468)	13.787 (4.943)
Range	8.300 - 114.000	9.200 - 17.700	8.300 - 114.000		8.300 - 114.000	9.500 - 17.700	8.300 - 114.000
Nmiss	27	13	40		34	6	40
WBC				0.208				0.935
Mean (sd)	7.472 (2.670)	7.785 (2.654)	7.634 (2.663)		7.628 (2.628)	7.651 (2.760)	7.634 (2.663)
Range	1.700 - 22.000	3.300 - 25.200	1.700 - 25.200		1.700 - 22.000	3.300 - 25.200	1.700 - 25.200
Nmiss	27	12	39		34	5	39
Albumin				0.036				0.092
Mean (sd)	4.316 (0.463)	4.218 (0.518)	4.265 (0.494)		4.290 (0.464)	4.203 (0.559)	4.265 (0.494)
Range	1.800 - 5.500	0.400 - 5.200	0.400 - 5.500		1.800 - 5.500	0.400 - 5.000	0.400 - 5.500
Nmiss	33	16	49		42	7	49
Fiber				< 0.001				< 0.001
N	249 (100.0%)	153 (61.0%)	402 (80.4%)		330 (90.9%)	72 (52.6%)	402 (80.4%)
Y	0 (0.0%)	98 (39.0%)	98 (19.6%)		33 (9.1%)	65 (47.4%)	98 (19.6%)
Any constipation medication				< 0.001				< 0.001
N	249 (100.0%)	23 (9.2%)	272 (54.4%)		265 (73.0%)	7 (5.1%)	272 (54.4%)
Y	0 (0.0%)	228 (90.8%)	228 (45.6%)		98 (27.0%)	130 (94.9%)	228 (45.6%)
Miralax				< 0.001				< 0.001
N	249 (100.0%)	47 (18.7%)	296 (59.2%)		275 (75.8%)	21 (15.3%)	296 (59.2%)
Y	0 (0.0%)	204 (81.3%)	204 (40.8%)		88 (24.2%)	116 (84.7%)	204 (40.8%)
Docusate				< 0.001				< 0.001
N	249 (100.0%)	144 (57.4%)	393 (78.6%)		318 (87.6%)	75 (54.7%)	393 (78.6%)
Y	0 (0.0%)	107 (42.6%)	107 (21.4%)		45 (12.4%)	62 (45.3%)	107 (21.4%)
Other				< 0.001				< 0.001
N	249 (100.0%)	110 (43.8%)	359 (71.8%)		305 (84.0%)	54 (39.4%)	359 (71.8%)
Y	0 (0.0%)	141 (56.2%)	141 (28.2%)		58 (16.0%)	83 (60.6%)	141 (28.2%)
Opioids				< 0.001				< 0.001
N	39 (15.7%)	16 (6.4%)	55 (11.0%)		51 (14.0%)	4 (2.9%)	55 (11.0%)
Y	210 (84.3%)	235 (93.6%)	445 (89.0%)		312 (86.0%)	133 (97.1%)	445 (89.0%)
Anticholinergic				0.185				0.102
N	165 (66.3%)	152 (60.6%)	317 (63.4%)		238 (65.6%)	79 (57.7%)	317 (63.4%)
Y	84 (33.7%)	99 (39.4%)	183 (36.6%)		125 (34.4%)	58 (42.3%)	183 (36.6%)
Tricyclic Antidepressants				0.013				0.002
N	229 (92.0%)	213 (84.9%)	442 (88.4%)		331 (91.2%)	111 (81.0%)	442 (88.4%)
Y	20 (8.0%)	38 (15.1%)	58 (11.6%)		32 (8.8%)	26 (19.0%)	58 (11.6%)

Table: Table 1: Comparing patient Demographics & Diagnoses, UC Phenotype, CD Phenotype, Baseline Evaluation, Clinical Disease Activity, Labs, Medication by Subjective Constipation and Rome IV Definition

Disclosures:

Sparsh Jain indicated no relevant financial relationships.

Andres Yarur: Arena Pharmaceuticals – Consultant. Bristol Myers Squibb – Consultant. Prometheus Laboratories – Consultant. Takeda – Advisory Committee/Board Member.

Sneha Nagavally indicated no relevant financial relationships.

Daniel Stein: Abbvie – Consultant, Speakers Bureau. Brystol Myers Squibb – Advisory Committee/Board Member, Speakers Bureau. Janssen – Speakers Bureau. Pfizer – Speakers Bureau. Takeda – Speakers Bureau.

Sparsh Jain, BS¹, Andres Yarur, MD², Sneha Nagavally, MS¹, Daniel J. Stein, MD¹. A0341 - High Rates of Chronic Constipation in Inflammatory Bowel Disease Patients, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.