Neil Osterweil

October 26, 2015

HONOLULU — Chronic constipation in adults could be a harbinger of more serious gastrointestinal (GI) disorders, including ischemic colitis, colorectal cancer, gastric cancer, and diverticulitis, according to a new study presented here the American College of Gastroenterology 2015 Annual Meeting.

"Patients presenting with chronic constipation symptoms may warrant additional workup, even in younger populations with no red flag symptoms, such as GI bleeding, anemia, or weight loss," said Lauren Gerson, MD, from the California Pacific Medical Center in San Francisco.

Some organic GI disorders, such as colorectal cancer, can present with chronic constipation symptoms, "but chronic constipation has not been well characterized as a risk factor for development of colorectal cancer or other serious organic GI disorders," she said. And in the United States, approximately 15% of adults have chronic constipation disorders.

She and her colleagues identified 12,838 adults 18 to 50 years of age with at least 24 months of follow-up who were treated for chronic constipation from 2008 to 2013 from the Humedica Electronic Medical Record SmartFile database.

They used a propensity score methodology to identify an equal number of control subjects matched for demographic characteristics and for history of depression and anxiety, use of proton-pump inhibitors or histamine h2 blocking agents, and gastroenteritis.

Patients were considered to be chronically constipated if they met one of three criteria: at least two outpatient visits more than 30 days apart with a diagnostic code of constipation; at least one outpatient visit with a diagnostic code of constipation and, at least 30 days later, one or more mention of constipation in the notes of a patient's medical history; or at least two outpatient visits more than 30 days apart with a diagnostic code of constipation.

In five of six disease categories, the risk for GI disease was significantly higher in patients with chronic constipation than in the control group. Although the risk was higher for patients with inflammatory bowel disease, the difference was not significant (hazard ratio, 1.59)

Table: Risk for GI Disorders in Patients With Chronic Constipation

GI Disorder Hazard Ratio
Ischemic colitis 7.68
Colorectal cancer 6.26
GI cancer 5.04
Diverticulitis 5.06
Composite of any disorder 3.28

 

The association has been shown before, but not to this degree, said Dr Gerson.

"We went into this not expecting to find anything new, so it was kind of a surprise to us all," she told Medscape Medical News. "The association between diverticulitis and chronic constipation was not a surprise because the patients tend to be overweight and less active, but the cancer and the ischemic colitis were definitely a surprise."

She and her colleagues plan to extract additional information from the database to see whether the duration of constipation correlates with the development of specific GI disorders.

These data are "surprising and interesting," said session comoderator Christina Surawicz, MD, from the University of Washington School of Medicine in Seattle.

"Clearly this is something we're going to have to look out for," Dr Surawicz said.

The study was supported by Ironwood. Dr Gerson reports serving as a consultant for Ironwood. Dr Surawicz has disclosed no relevant financial relationships.

American College of Gastroenterology (ACG) 2015 Annual Meeting: Abstract 40. Presented October 20, 2015.

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