Transcript
Prevalence of chronic constipation in general
population
Dr. Vicente Garrigues Gastroenterology Unit Hospital Universitario LA FE Valencia - Spain
• Gastroenterologist since 1985.
• Working in a 1.500-bed University Hospital.
• Interested in Digestive Functional Disorders and in Epidemiology & Statistics.
• At present, Head of Education of the Hospital
Learning objectives
1.To know current definitions of chronic constipation.
2. To find out the prevalence of constipation.
3. To know which variables are associated to constipation.
Performance objectives
1.To select a sample for a prevalence study.
2. To perform statistics in a prevalence study.
3. To understand the meaning of likelihood ratios.
Evaluate the prevalence of chronic constipation in the general population.
Assess agreement among several diagnostic criteria of constipation
Aims
Evaluate the diagnostic accuracy of self-reported definition of constipation; and of symptoms included in Rome II criteria.
Identify factors associated to chronic constipation
Aims
Definition of constipation
•Self-reported by subject
•Rome criteria
•Rome II criteria
Study subjects.
Selection of population
Target population: General population from the town of Aldaya: 23.425 inhabitants
Elegible population: subjects aged between 18 and 65 years: 15.696 subjects
Study subjects.
Selection of sample. For an expected prevalence of 20 + 4% (95% C.I.): 375 subjects were needed. Sampling procedure. Systematic, age-stratified sampling was performed, selecting 506 subjects.
QuestionnaireA validated questionnaire with 21 items was mailed –up to 6 times- to sampled subjects.
Items allowed diagnosis of constipation and evaluated associated variables.
Response
Total51-65yr
31-50 yr
18-30 yr
MenWomen
349 (71.5)
75 (22)
154 (44)
120 (34)
167 (48)
182 (52)
Responders
506 114 (23)
221(43)
171 (34)
256 (51)
250 (49)
Sample
15696 3534 (22)
6854 (44)
5308 (34)
7953 (51)
7743 (49)
Population
349 subjects (71.5%) replied.
Prevalence of constipation
14.0 10.4- 17.7
5.5 2.5- 10.0
22.0 16.0- 28.0
Rome II
19.2 15.1- 23.3
9.0 4.6- 13.3
28.622.0- 35.1
Rome
29.5 24.7- 34.3
18.0 12.1- 23.8
40.1 33.0- 47.2
Self-reported
TotalMenWomen
14.7 6.6- 22.7
14.3 8.7- 19.8
13.37.3- 19.4
Rome II
17.3 9.6- 27.8
18.2 12.1- 24.3
21.7 14.3- 29.0
Rome
30.7 20.5- 42.4
29.2 22.0-36.4
29.2 21.0- 37.3
Self-reported
51-65 yr
31-50 yr
18-30 yr
Prevalence of constipation
18.7 (10.6- 29.3)18.7 (10.6- 29.3)51-65 yr20.8 (14.4- 27.2)20.8 (14.4- 27.2)31-50 yr23.3 (15.8- 30.9)23.3 (15.8- 30.9)18-30 yr9.0 (5.1- 11.4)9.0 (5.1- 11.4)Men32.4 (25.6- 39.2)32.4 (25.6- 39.2)Women21.2 (16.9-22.5)21.2 (16.9-22.5) Global
Rome II criteria including diarrhea
Prevalence of constipation
Agreement among criteria
34934928228267672462462432433310310339396464
TotalTotal--++++--
TotalTotal
Rome
Kappa: 0.68 95%-IC: 0.59- 0.77
Sel
f-re
po
rted
Agreement among criteria
34934930030049492462462452451110310355554848
TotalTotal--++++--
TotalTotal
Rome II
Kappa: 0.55 95%-IC: 0.44- 0.65
Sel
f-re
po
rted
Agreement among criteria
349349300300494928228227727755676723234444
TotalTotal--++++--
TotalTotal
Rome II
Kappa: 0.71 95%-IC: 0.61- 0.81
Ro
me
Diagnostic accuracy of Rome II qualifying symptoms
1.3119822<3 defecations/w1.37.79723Maneuvers1.9∞ 10048Anal blockage1.4159830Incomplete evac.
2.7169664Hard stools2.3569956Straining
1/LR-LR+SpSe
Gold-standard: self-reported
1.47.89631<3 defecations/w1.34.89429Maneuvers3.314.29571Anal blockage1.78.69543Incomplete evac.
11.39.29092Hard stools5.9149484Straining415.48298Self-reported
1/LR-LR+SpSe
Accuracy of self-reported and Rome II symptoms
Gold-standard: Rome II
Variables associated with constipation
0.020.20-0.890.43Occasional exercise
0.030.11-0.870.31Habitual exercise
0.040.14-0.960.38Fiber
0.00041.98-10.64.58Female
ROME II
0.00011.68-4.982.90FemaleSelf-reported
2p95%-CIOR
Conclusions
Constipation is highly prevalent, especially in women. Different prevalence rates are observed using different criteria,although agreement is acceptable. Anal blockage, straining and hard stools show the greatest diagnostic accuracy.
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