17581

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.