The Socioeconomic Impact of Irritable Bowel Syndrome: An Analysis of Direct and Indirect Health Care Costs

Antidepressants in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials

Background

Irritable bowel syndrome (IBS) treatment relies on a low level of evidence. In this systematic review with meta-analysis of randomized, double-blind, placebo-controlled trials we assessed the efficacy of antidepressants in IBS.

Methods

This study followed the PRISMA guidelines and was registered in the PROSPERO database (CRD42024502427). PubMed, EMBASE and the Cochrane Library were searched from inception to January 2024. Only randomized, double-blind, placebo-controlled trials were included. Quality of evidence was assessed using the Cochrane tool (RoB 2). A random-effects model was used. Heterogeneity was evaluated by the I 2 statistic and publication bias by funnel plots and the Egger test.

Results

The search strategy identified 1340 studies, of which 20 were included in the systematic review and 16 in the meta-analysis, totaling 1428 patients. The meta-analysis unveiled the efficacy of antidepressants in patients with IBS in overall symptom improvement (odds ratio [OR] 3.02; 95% confidence interval [CI] 2.16-4.2). Subgroup analysis revealed similar results regarding the efficacy of tricyclic antidepressants (OR 3.39, 95%CI 2.24-5.12); of selective serotonin reuptake inhibitors (OR 2.39, 95%CI 1.14-5.01); in patients refractory to first-line measures (OR 2.96, 95%CI 1.67-5.25); in patients without known comorbid psychological conditions (OR 2.92, 95%CI 1.6-5.31); and in the improvement in abdominal pain (OR 3.27, 95%CI 1.63-6.53), and bloating (OR 2.4, 95%CI 1.11-5.22). Publication bias was detected, and potential sources were identified. Sub-analysis without these sources of bias revealed similar results.

Conclusions

Antidepressants demonstrate efficacy in IBS. These medications can be beneficial to patients resistant to initial treatments and those lacking psychopathological symptoms.

Global prevalence and risk factors of irritable bowel syndrome from 2006 to 2024 using the Rome III and IV criteria: a meta-analysis

Functional gastrointestinal disorders impact 40% of the global population, with irritable bowel syndrome (IBS) standing out due to its complexity, quality-of-life effects, and economic impact. Our meta-analysis explored the global prevalence of IBS, considering diagnostic criteria, subtypes, sampling methods, geographical variations, and risk factors. The literature search used databases like PubMed and Cochrane Library, focusing on IBS studies from 2006 to June 2024. Eligibility criteria included studies on individuals aged ≥18, based on Rome III/IV criteria, using random or convenience sampling. Data on IBS prevalence, subtypes, and sampling methods were extracted, and statistical analysis was performed using Open MetaAnalyst and the review manager. The study reviewed 96 articles on IBS prevalence using Rome III and IV criteria across 52 countries, revealing a global prevalence of 14.1%. Prevalence varied by subtype: IBS-C (26.1%), IBS-D (26.5%), IBS-M (31.4%), and IBS-U (8.3%). IBS-D was more prevalent under Rome III (26.2%), while IBS-C was more common under Rome IV (34.2%). First-world countries like the UK, China, and Japan had the highest prevalence. Females [odds ratios (OR): 1.49], stress (OR: 2.47), anxiety (OR: 2.93), and depression (OR: 2.24) were significantly more prevalent in IBS patients, while no significant differences were found in smoking, alcohol use, or education levels. This meta-analysis reveals regional and subtype variations in IBS prevalence, with psychological factors significantly impacting its development. The influence of sampling techniques and Rome III/IV criteria on prevalence estimates highlights the need for a multidisciplinary treatment approach, with important implications for IBS management.

Association Between Ethnicity and Treatment Preferences in Patients with Irritable Bowel Syndrome

BACKGROUND AND AIMS

Irritable bowel syndrome (IBS) poses a significant healthcare challenge, characterized by chronic gastrointestinal and extraintestinal symptoms impacting individuals' well-being. Treatment preferences may vary among patients from different ethnic groups, such as Arab and Jewish Israelis, necessitating tailored approaches.

METHODS

A bilingual (Hebrew/Arabic) questionnaire assessing patients' preferences regarding treatment goals was developed. It was administered online in Israeli IBS Facebook groups, as well as in two hospital gastroenterology clinics.

RESULTS

The study included 267 IBS patients (91 Arabs and 176 Jews). Demographic analysis revealed a higher proportion of females in both groups, with a significantly greater percentage among Jews compared to Arabs (84% versus 64.8%, respectively, P<0.001). The median age was 32 years for both Arabs and Jews (interquartile ranges of 26-42 and 24-62, respectively). Arabs exhibited higher rates of mixed-type IBS and constipation, while Jews had a higher prevalence of predominant diarrhea IBS. Arabs reported more bloating, higher rates of IBS-related comorbidities, and more medication usage. When asked to rate the importance of treatment goals, both populations preferred improvement in abdominal pain, bloating, and regular defecation, while assigning lower importance to improving difficulty in mental and/or physical aspects of intercourse, as well as arthralgia and myalgia. Arab patients assigned lower importance scores to various symptoms compared to their Jewish counterparts.

CONCLUSION

This study highlights the impact of ethnicity on patients' treatment goals. Understanding patients' preferences will enable tailoring an individual approach to each IBS patient.

Evaluating Equity in Clinical Trial Accessibility: An Analysis of Demographic, Socioeconomic, and Educational Disparities in Irritable Bowel Syndrome Drug Trials

INTRODUCTION

Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, imposes a significant economic burden because of its high prevalence and the chronic nature of its symptoms. IBS currently has 7 United States Food and Drug Administration-approved treatments. Despite efforts to improve diversity in randomized controlled trials' participation, significant disparities remain in various medical fields; yet, these have not been thoroughly examined within the context of IBS. We aimed to investigate the demographic, socioeconomic, educational, and geographic disparities in IBS drug trials.

METHODS

We conducted a systematic review of phase 3 randomized controlled trials on United States Food and Drug Administration-approved drugs for the treatment of IBS with constipation and IBS with diarrhea in the United States. Data on participant demographics and trial site locations were extracted and analyzed to identify disparities.

RESULTS

Our analysis included 17 studies encompassing 21 trials with 17,428 participants. Approximately 77.3% of participants were female, with a mean age of 45.4 years. Race was reported in 95% of the trials, but only 35% disclosed ethnicity. White participants constituted the majority at 79.3%. Hispanics accounted for only 5.9%. Counties without trial sites had smaller average population sizes compared with trial and trial-adjacent counties. Socioeconomic indicators such as poverty rates, median household income, educational attainment, and broadband internet access were lower in counties without trial sites, with higher average Area Deprivation Index scores indicating greater deprivation.

DISCUSSION

The findings highlight significant disparities in IBS trial participation across race, ethnicity, gender, and socioeconomic backgrounds. This raises potential concerns about generalizability of trial outcomes and underscores the need for strategies to enhance inclusivity in clinical research.

Economic Evaluations of Non-Pharmacological Interventions for Treating Disorders of Gut-Brain Interaction: A Scoping Review

BACKGROUND AND OBJECTIVES

Disorders of gut-brain interaction are highly prevalent and burdensome conditions for both patients and healthcare systems. Given the limited effectiveness of pharmacotherapy in treating disorders of gut-brain interaction, non-pharmacological interventions are increasingly used; however, the value for money of non-pharmacological treatments is uncertain. This is the first review to assess the economic evaluation evidence of non-pharmacological interventions for disorders of gut-brain interaction.

METHODS

A scoping review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Reporting adhered to ISPOR's good practices for systematic reviews with cost and cost-effectiveness outcomes. Comprehensive searches were performed on 24 October, 2023, and an updated search was run on 18 May, 2024 in PubMed/MEDLINE, Embase, Web of Science, Scopus and the International HTA database, with two reviewers screening studies in parallel. The novel Criteria for Health Economic Quality Evaluation (CHEQUE) framework was used to assess methodological and reporting quality. Reporting quality was further assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022.

RESULTS

Fifteen studies were included. Most studies examined treatments for irritable bowel syndrome. Cognitive behavioural therapy, dietary interventions and sacral neuromodulation were cost effective. Acupuncture and physiotherapy were not. CHEQUE assessment showed 12 studies met at least 70% of the methodological criteria, and 14 studies achieved 70% or more for reporting quality.

CONCLUSIONS

This review highlights gaps in the current evidence base, particularly in the robustness and generalisability of results due to methodological inconsistencies. Future research should incorporate longer follow-ups, comprehensive cost assessments, subgroup analyses, equity considerations and clearer justifications for modelling assumptions.

The effect of acupuncture on quality of life in patients with irritable bowel syndrome: A systematic review and meta-analysis

BACKGROUND

Acupuncture has been used to improve the quality of life (QoL) of patients in clinical settings. However, the effect of acupuncture on QoL in patients with irritable bowel syndrome (IBS) remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of acupuncture on the QoL of patients with IBS.

METHOD

PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science were screened from inception to September 2023. RCTs published in English comparing acupuncture with sham acupuncture, usual care, pharmacological interventions, or other therapies were analyzed for QoL in patients with IBS. The primary outcome was QoL and secondary outcomes were the IBS-symptom severity scale (IBS-SSS) and abdominal pain. The Cochrane Collaboration recommendations were used to assess the risk of bias.

FINDINGS

Fourteen articles with 2,038 participants were included. The pooled result showed acupuncture can significantly improve the QoL of patients with IBS compared to the conventional treatment (MD = 6.62, 95% CI, 2.30 to 10.94, P<0.001, I2 = 72.45%). Additionally, acupuncture was superior to other interventions in relieving the symptoms' severity of IBS (MD = -46.58, 95% CI, -91.49 to -1.68, P<0.001, I2 = 90.76%). Nevertheless, acupuncture was not associated with abdominal pain reduction (MD = -0.35, 95% CI, -0.91 to 0.20, P = 0.21, I2 = 0.00%). Lower adverse events were observed in the acupuncture group. Thus, the quality of this study was relatively high.

CONCLUSION

The meta-analysis showed that acupuncture improves QoL and symptom severity in patients with IBS and that the optimal parameters for acupuncture to improve QoL in patients with IBS are 30 minutes of acupuncture per session, less than or equal to five sessions per week, and a 4-week course of treatment. However, more high-quality clinical trials are needed to provide stronger evidence.

The burden of irritable bowel syndrome and functional dyspepsia in Poland: a cross-sectional study from West Pomeranian Voivodship

BACKGROUND

Functional gastrointestinal disorders (FGIDs), now known as disorders of gut-brain interaction (DGBIs), such as Irritable Bowel Syndrome (IBS) and Functional Dyspepsia (FD), significantly impact global health, reducing quality of life and burdening healthcare systems. This study addresses the epidemiological gap in Poland, focusing on the West Pomeranian Voivodeship.

METHODS

We conducted a cross-sectional study of 2070 Caucasian patients (58.2% female, mean age 57.5 ± 15.1 years) undergoing gastrointestinal endoscopic examinations at Pomeranian Medical University from 2021 to 2023. Data were collected using Rome IV diagnostic questionnaires and correlated with gastroduodenoscopy and colonoscopy findings. Exclusion criteria were age under 18, pregnancy, Crohn's disease, ulcerative colitis, severe comorbidities, cancer, immunosuppressive therapy, ileostomy/colostomy, incomplete questionnaires, or lack of consent.

RESULTS

Using Rome IV criteria, IBS was diagnosed in 436 participants (21.1%) and FD in 248 participants (12.0%). Post-endoscopic evaluation revised FD diagnoses to 184 individuals (8.9%). Females had a higher prevalence of IBS and FD (OR 1.64 and 1.61, respectively). No significant association was found between higher BMI and increased risk of IBS and FD. Hypertension and diabetes prevalence were 35.1% and 13.0%, respectively. Individuals with a history of COVID-19 had a higher risk of developing IBS (OR 1.47, P = 0.050).

CONCLUSIONS

Our study provides crucial epidemiological data on IBS and FD in Poland, emphasizing the importance of endoscopic evaluations. Our findings highlight the need for regional studies to understand local DGBI prevalence, aiding targeted healthcare strategies.

Oxytocin Analogues for the Oral Treatment of Abdominal Pain

Abdominal pain presents an onerous reality for millions of people affected by gastrointestinal disorders such as irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD). The oxytocin receptor (OTR) has emerged as a new analgesic drug target with OTR expression upregulated on colon-innervating nociceptors in chronic visceral hypersensitivity states, accessible via luminal delivery. However, the low gastrointestinal stability of OTR's endogenous peptide ligand oxytocin (OT) is a bottleneck for therapeutic development. Here, we report the development of potent and fully gut-stable OT analogues, laying the foundation for a new area of oral gut-specific peptide therapeutics. Ligand optimisation guided by structure-gut-stability-activity relationships yielded highly stable analogues (t1/2>24 h, compared to t1/2<10 min of OT in intestinal fluid) equipotent to OT (~3 nM) and with enhanced OTR selectivity. Intra-colonic administration of the lead ligand significantly reduced colonic mechanical hypersensitivity in a concentration-dependent manner in a mouse model of chronic abdominal pain. Moreover, oral administration of the lead ligand also displayed significant analgesia in this abdominal pain mouse model. The generated ligands and employed strategies could pave the way to a new class of oral gut-specific peptides to study and combat chronic gastrointestinal disorders, an area with substantial unmet medical needs.

Toll-like receptor 4 plays a vital role in irritable bowel syndrome: a scoping review

Background

Irritable bowel syndrome (IBS) is a common gastrointestinal disease. Recently, an increasing number of studies have shown that Toll-like receptor 4 (TLR4), widely distributed on the surface of a variety of epithelial cells (ECs) and immune sentinel cells in the gut, plays a vital role in developing IBS.

Objectives

We sought to synthesize the existing literature on TLR4 in IBS and inform further study.

Methods

We conducted a systematic search of the PubMed, Embase (Ovid), Scopus, Web of Science, MEDLINE, and Cochrane Library databases on June 8, 2024, and screened relevant literature. Critical information was extracted, including clinical significance, relevant molecular mechanisms, and therapeutic approaches targeting TLR4 and its pathways.

Results

Clinical data showed that aberrant TLR4 expression is associated with clinical manifestations such as pain and diarrhea in IBS. Aberrant expression of TLR4 is involved in pathological processes such as intestinal inflammation, barrier damage, visceral sensitization, and dysbiosis, which may be related to TLR4, NF-κB, pro-inflammatory effects, and CRF. Several studies have shown that many promising therapeutic options (i.e., acupuncture, herbs, probiotics, hormones, etc.) have been able to improve intestinal inflammation, visceral sensitization, intestinal barrier function, intestinal flora, defecation abnormalities, and depression by inhibiting TLR4 expression and related pathways.

Conclusion

TLR4 plays a crucial role in the development of IBS. Many promising therapeutic approaches alleviate IBS through TLR4 and its pathways. Strategies for targeting TLR4 in the future may provide new ideas for treating IBS.

Non-pharmaceutical treatments for irritable bowel syndrome

Irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction that impacts a significant portion of the population and is associated with substantial morbidity, reduced quality of life, and economic impact globally. The pathophysiology of IBS is complex and incompletely understood, and the heterogeneity of IBS is reflected in the variety of pharmaceutical and non-pharmaceutical therapies utilized for the management of IBS. Given limitations with pharmaceutical treatments, many patients with IBS seek non-pharmaceutical options. Several non-pharmaceutical treatments such as the low FODMAP diet and brain-gut behavior interventions such as gut directed hypnosis and cognitive behavioral therapy are now considered standard of care and are part of all major guidelines for the treatment of IBS. However, challenges with access to and optimal implementation of these therapies remain. This review focuses on the current evidence for common non-pharmaceutical treatments for IBS, including the latest advances in dietary and brain-gut behavioral care, in addition other complementary and integrative health practices and emerging therapies.

The Impact and Interactions of Race and Gender on Healthcare Use and Spending in Irritable Bowel Syndrome

BACKGROUND & AIMS

Studies examining the effects of social determinants of health on healthcare use in irritable bowel syndrome (IBS) are scarce. We aimed to assess healthcare spending among different racial/ethnic groups and genders in adults with IBS.

METHODS

We performed a retrospective cohort analysis of adults diagnosed with IBS between 2016 and 2021 using Optum's de-identified Clinformatics Data Mart database. We analyzed total annual and IBS-specific costs, utilization and costs of individual services, and prescriptions. We compared outcomes across racial/ethnic groups and by gender after adjusting for covariates and examined race-gender interactions.

RESULTS

Among 95,319 adults with IBS, healthcare spending varied significantly by race and gender. Total all-cause and IBS-specific costs were lower in men than in women and in Asian and Hispanic patients than in White patients. Compared with White patients, Black patients had higher total IBS-specific costs, all-cause prescription costs, IBS-related radiology and laboratory costs, and emergency department (ED) care, while Asian and Hispanic patients incurred lower costs for ED care, hospitalizations, and all-cause prescriptions. Endoscopy costs were lower in racial minority groups. Women had higher spending for most services compared with men, but gender differences in most IBS-related services were small. All-cause hospitalization and endoscopy costs were higher in men, but IBS-specific hospitalization and endoscopy costs were higher in women. Gender disparities in all-cause individual services also varied by race.

CONCLUSIONS

Overall and IBS-related spending is higher in women, but gender differences in IBS-related care are small. Racial/ethnic comparisons show reduced spending in Asian and Hispanic patients, increased ED care in Black patients, and variations in spending patterns. Gender disparities differ by race.

Chronic Abdominal Pain in Patients with Inflammatory Bowel Disease in Remission: A Continuing Challenge for Clinicians

Inflammatory bowel disease (IBD) is a chronic condition that includes ulcerative colitis and Crohn's disease. It is characterized by a relapsing and remitting pattern that negatively impacts quality of life (QoL). Current goals of treatment involve symptomatic, biochemical, and endoscopic remission in a treat-to-target approach. Despite effective treatment and remission of IBD, many patients report frequent and isolated abdominal pain. A wide range of etiologies exist, including surgery-related, infections, pelvic conditions, immune-related, and systemic illnesses. Disorders of the gut-brain interaction (DGBI), frequently characterized by abdominal pain, are increasingly recognized in IBD patients, including those with quiescent disease. Various mechanisms are involved and numerous non-pharmacologic and pharmacologic therapies have been proposed. Hereby, we outline the pertinent findings of the literature on management of chronic abdominal pain, focusing on quiescent IBD.

WenTongGanPi decoction alleviates diarrhea-predominant irritable bowel syndrome by improving intestinal barrier

ETHNOPHARMACOLOGICAL RELEVANCE

WenTongGanPi Decoction (WTGPD) is a representative medical practice of the Fuyang School of Traditional Chinese Medicine (TCM), which originated from the classical Lu's Guizhi method. WTGPD places emphasis on the balance and functionality of yang qi, and is effective in treating TCM symptoms related to liver qi stagnation and spleen yang deficiency. In TCM, diarrhea-predominant irritable bowel syndrome (IBS-D) is often diagnosed as liver depression and spleen deficiency, and the use of WTGPD has shown significant therapeutic effect. However, the underlying mechanism of WTGPD treating IBS-D remains unclear.

AIM OF THE STUDY

To explore the effect and mechanism of WTGPD in the treatment of IBS-D.

MATERIALS AND METHODS

An IBS-D model with liver depression and spleen deficiency was constructed by chronic immobilization stress stimulation and sennae folium aqueous gavage. The impact of WTGPD on IBS-D rats was evaluated through measurements of body weight, fecal water content, and abdominal withdrawal reflex (AWR). Intestinal permeability was assessed using hematoxylin-eosin (HE), alcian blue-periodic acid schiff (AB-PAS), immunofluorescence (IF) staining, and quantitative real-time PCR (qRT-PCR). The components of WTGPD were analyzed using UPLC-Q-TOF-MS. The underlying mechanisms were investigated through network pharmacology, transcriptomics sequencing, western blot (WB), molecular docking, and 16S rRNA sequencing.

RESULTS

WTGPD treatment effectively alleviated diarrhea and abnormal pain in IBS-D rats (P < 0.05). It enhanced the intestinal barrier function by improving colonic structure and increasing the expression of tight junction proteins (P < 0.05). A total of 155 components were identified in WTGPD. Both network pharmacology and transcriptomics sequencing analysis highlighted MAPK as the key signaling pathway in WTGPD's anti-IBS-D effect. The WB results showed a significant decrease in p-p38, p-ERK and p-JNK expression after WTGPD treatment (P < 0.0001). Guanosine, adenosine and hesperetin in WTGPD may be involved in regulating the phosphorylation of p38, ERK and JNK. Additionally, WTGPD significantly enhanced microbial diversity and increased the production of colonic valeric acid in IBS-D rats (P < 0.01).

CONCLUSION

In conclusion, our findings suggest that WTGPD can effectively alleviate IBS-D and improve intestinal barrier likely via inhibiting MAPK signal pathway and improving micobial dysbiosis.

Perspectives on the sustained engagement with digital health tools: protocol for a qualitative interview study among people living with Inflammatory Bowel Disease or irritable bowel syndrome

INTRODUCTION

Digital health tools can be beneficial in the care of patients with chronic conditions and have the potential for widespread impact as readily scalable and cost-effective health interventions. However, benefits are often contingent on users sustaining their engagement with these tools over time. Sustained engagement with digital health tools can be challenging, and high rates of attrition from digital interventions are common. Inflammatory Bowel Disease (IBD) and irritable bowel syndrome (IBS) are prominent gastrointestinal conditions resulting in significant burdens for individuals and society. Emerging evidence suggests digital health tools can be beneficial for IBD and IBS management; however, it is not clear what barriers and enablers are experienced by people living with these conditions to sustaining their engagement with these tools, when necessary. Such knowledge could inform the tailoring of new and existing digital health tools to the needs of people living with IBD and/or IBS. This study will seek to identify the barriers and enablers of sustained engagement with digital health tools among adults living with IBD and/or IBS.

METHODS AND ANALYSIS

We will conduct semistructured interviews with a purposive sample of approximately 30 adults (>18 years) who (a) reside in Canada, (b) self-report that they have been diagnosed with IBD and/or IBS, (c) have ever used a digital health tool (ie, any application/platform) to manage their condition and (d) are capable of providing informed consent. Interviews will be audio and video recorded and transcribed verbatim. Data will be coded deductively and barriers and enablers to sustained engagement will be categorised in accordance with the Theoretical Domains Framework. Data analysis will be verified by a patient research partner.

ETHICS AND DISSEMINATION

The study has been approved by the Ottawa Health Science Network Research Ethics Board. The findings will inform the codevelopment of strategies to overcome modifiable barriers and leverage identified enablers of sustained engagement with digital health tools for IBD and IBS care. These strategies can inform the design of new, or modifications to existing, digital health tools for IBD and IBS care where sustained engagement is desirable. Strategies will be compiled into a guidebook and disseminated via the Inflammation, Microbiome and Alimentation: Gastro-Intestinal and Neuropsychiatric Effects (IMAGINE) Strategy for Patient Oriented Research chronic disease network in Canada.

Review of the Patient Burden and Therapeutic Landscape of Irritable Bowel Syndrome with Constipation in the United States

Irritable bowel syndrome (IBS) is a common disorder of the gut-brain axis. IBS with constipation (IBS-C) accounts for approximately one-third of IBS cases and is associated with substantial burden of illness and decreased quality of life. This narrative review provides an overview of the current and upcoming treatment options and disease management for IBS-C from a US perspective and discusses the importance of the relationship between patient and health care provider in diagnosis and treatment. A positive diagnostic strategy for IBS-C is recommended, based on clinical history, physical examination, and minimal laboratory tests. An effective communication strategy between patients and health care professionals is essential to ensure early diagnosis and reduce both health care costs and overall disease burden. Treatment typically begins with lifestyle interventions and nonpharmacologic options, such as dietary interventions, fiber supplements, and osmotic laxatives. In patients with inadequate response to these therapies, 4 currently available therapies (lubiprostone, linaclotide, plecanatide, and tenapanor) approved by the US Food and Drug Administration may relieve IBS-C symptoms. These agents are generally well tolerated and efficacious in improving IBS-C symptoms, including constipation and abdominal pain. In patients with persistent abdominal pain and/or psychological symptoms, brain-gut behavioral therapy or neuromodulator therapy may be beneficial.

Healthcare Costs of Irritable Bowel Syndrome and Irritable Bowel Syndrome Subtypes in the United States

INTRODUCTION

Contemporaneous data on healthcare costs of irritable bowel syndrome (IBS) in the United States are lacking. We aimed to estimate all-cause and IBS-specific costs in patients with and without IBS and to compare costs across IBS subtypes.

METHODS

Using Optum's deidentified Clinformatics Data Mart Database, we performed a retrospective cohort analysis of patients with and without IBS using data spanning 2016-2021. Patients with IBS were identified by ICD-10 codes. Controls were randomly selected from Clinformatics Data Mart Database participants. Primary outcomes were total all-cause and IBS-specific healthcare costs. Secondary outcomes were costs of individual services associated with any claim. Costs were compared between IBS and control groups and across IBS subtypes using propensity score weighting. Comorbidities were measured with the Elixhauser Comorbidity Index.

RESULTS

Comparison of 102,887 patients with IBS (77.9% female; mean ± SD age 60.3 ± 18.4 years; 75.8% white) and 102,887 controls demonstrated higher median (interquartile range) total costs per year ( P < 0.001) for patients with IBS ($13,288 [5,307-37,071]) than controls ($5,999 [1,800-19,426]). IBS was associated with increased healthcare utilization and higher median annual costs per patient for all services. Median (interquartile range) annual IBS-specific spending was $1,127 (370-5,544) per patient. Propensity score-weighted analysis across IBS subtypes revealed differences in total all-cause and IBS-specific costs and in costs of individual services. Highest spending was observed in IBS with constipation (all-cause $16,005 [6,384-43,972]; IBS-specific $2,222 [511-7,887]).

DISCUSSION

Individuals with IBS exhibit higher healthcare utilization and incur substantially higher all-cause costs than those without. Care costs differ by IBS subtype.

Unplanned 30-Day Readmissions After Hospitalization for Irritable Bowel Syndrome

Background Irritable bowel syndrome (IBS) continues to pose significant healthcare challenges due to its broad differential diagnosis and the often extensive yet inconclusive workup. We investigated the rates and characteristics of unplanned 30-day readmissions in adult patients hospitalized with IBS. In addition, we identified factors that predict readmission within 30 days of initial discharge. Methods We analyzed the 2020 Nationwide Readmission Database. Using the International Classification of Diseases, Tenth Revision, Clinical Modification code, we identified hospitalizations in adult patients with IBS. We excluded hospitalizations for minors and planned or elective readmissions. To compare baseline characteristics between readmissions and index hospitalizations, χ2 tests were employed. We used multivariate Cox regression analyses to identify independent predictors of readmissions. Results A total of 5,729 adult hospitalizations with IBS as the primary diagnosis were discharged alive, and 638 (11.1%) readmissions occurred within 30 days. The most common diagnoses associated with readmission were noninfective gastroenteritis and colitis, sepsis, enterocolitis due to Clostridium difficile, and irritable bowel syndrome with or without diarrhea. Patients in readmissions had a mean age of 56.3 years, similar to index hospitalizations (54.5 years, p=0.093). Readmissions had a higher burden of comorbidity (Charlson comorbidity index (CMI) scores ≥3: 26.7%, 170 cases vs. 16.6%, 953 cases; p<0.001) and were mostly Medicare beneficiaries (49.5%, 316% vs. 44.9%, 2,578) compared with index hospitalizations. Readmissions had a longer mean length of stay (LOS) (5.2 vs. 3.6 days, p<0.0001), higher inpatient mortality (0.8%, 5% vs. 0.2%, 11; p=0.032), and higher mean hospital costs ($47,852 vs. $34,592; p<0.0001) compared with index admissions. Secondary diagnoses of ulcerative colitis (adjusted hazard ratio (AHR), 2.82; p<0.0001), interstitial cystitis (AHR, 5.37; p=0.007), peripheral vascular disease (AHR, 1.59; p=0.027), and discharge to short-term hospitals (AHR, 1.03; p<0.0001) were significantly associated with a higher likelihood of readmission within 30 days. Conclusion IBS readmissions have poorer outcomes than index hospitalizations. Patients with an existing history of ulcerative colitis, interstitial cystitis, and peripheral vascular disease and those discharged to short-term hospitals following index hospitalization are more likely to be readmitted within 30 days.

Engagement in GI Behavioral Health Is Associated with Reduced Portal Messages, Phone Calls, and ED Visits

BACKGROUND AND AIMS

Chronic digestive disorders are associated with increased costs for healthcare systems and often require provision of both urgent care and non-face-to-face (non-F2F) care, such as responding to patient messages. Numerous benefits of integrated gastroenterology (GI) behavioral health have been identified; however, it is unclear if integrated care impacts healthcare utilization, including urgent care and non-F2F contact. We sought to investigate the association between patient engagement with GI behavioral health and healthcare utilization.

METHODS

We performed a retrospective chart review study of adult patients who were referred for and completed at least one behavioral health appointment between January 1, 2019 and December 21, 2021 in the Gastroenterology and Hepatology department of a large academic medical center. Data on electronic medical record (EMR) messages, phone calls, and Emergency Department utilization were collected 6 months before and 9 months after patient engagement with GI behavioral health.

RESULTS

466 adult patients completed at least one behavioral health visit from 2019 to 2021. Overall, messages, phone calls, and ED visits all decreased significantly from the 6 months before behavioral health treatment to 6 months after (all P values < 0.001).

CONCLUSION

Engagement with integrated GI behavioral health is associated with reduced non-F2F care and emergency department utilization in patients with chronic digestive disorders. Increasing access to GI behavioral health may result in reduced provider workload and healthcare system costs.

The efficacy and real-world effectiveness of a diet low in fermentable oligo-, di-, monosaccharides and polyols in irritable bowel syndrome: A systematic review and meta-analysis

BACKGROUND & AIMS

A diet low in fermentable oligo-, di-, monosaccharides, and polyols (LFD) has been shown to effectively reduce irritable bowel syndrome (IBS) symptoms. Effects resulting from real-world studies may differ from those seen in efficacy studies because of the diversity of patients in real-world settings. This systematic review and meta-analysis aimed to compare the effect of the LFD on reducing IBS symptoms and improving the quality of life (QoL) in efficacy trials and real-world studies.

METHODS

Major databases, trial registries, dissertations, and journals were systematically searched for studies on the LFD in adults with IBS. Meta-analysis was conducted using a random effects model with standardized mean differences (SMD) and 95% confidence intervals (CI). Outcomes of interest were all patient-reported: stool consistency, stool frequency, abdominal pain, overall symptoms, adequate symptom relief, IBS-specific QoL and adherence to the LFD.

RESULTS

Eleven efficacy and 19 real-world studies were reviewed. The meta-analysis results for abdominal pain (SMD 0.35, 95% CI 0.16 to 0.54) and QoL (SMD 0.23, 95% CI -0.05 to 0.50) showed the LFD was beneficial in efficacy studies with no statistically significant results for stool frequency (SMD 0.71, 95% CI 0.34 to 1.07). Real-world studies found improvements in abdominal pain and QoL. Due to heterogeneity, no meta-analysis was done for stool consistency and overall symptoms. In these outcomes, results were mostly supportive of the LFD, but they were not always statistically significant.

CONCLUSIONS

The results of this systematic review and meta-analysis suggest the LFD improves outcomes compared to a control diet (efficacy studies) or baseline data (real-world studies). Because of diverse study designs and heterogeneity of results, a clear superiority of the LFD over control diets could not be concluded. There are no indications of an efficacy-effectiveness gap for the LFD in adults with IBS.

Public knowledge and beliefs about the irritable bowel syndrome - results from the SOMA.SOC study

BACKGROUND

Despite the epidemiological and economic relevance of the irritable bowel syndrome (IBS), there is a lack of research on what the general public knows and thinks about this condition (IBS literacy). Therefore, the aim of this study was to explore public knowledge and beliefs about IBS in Germany. Moreover, associations of knowledge and beliefs about IBS with socio-demographic characteristics as well as illness and treatment experiences were analysed.

METHODS

Analyses made use of a national telephone survey (N = 1,205). A carefully developed vignette describing a person with typical symptoms of IBS was presented. Respondents were then asked to name the disease in question and beliefs about causes and treatment options were assessed. For the analyses respondents were divided into three groups: (1) people who never had IBS symptoms, (2) people who had or have IBS symptoms but never were in treatment and (3) individuals who reported to be or have been treated for IBS symptoms.

RESULTS

Less than 4% of the respondents recognized IBS after presentation of the vignette. About 75% positively evaluated treatability while psychotherapy was evaluated more effective than medication. Stress and unhealthy lifestyle were the most frequently endorsed possible causes of the presented IBS symptoms. There were variations in knowledge and beliefs about IBS according to age, gender, and education. We found minor differences in beliefs and knowledge between individuals who had or have symptoms but never were in treatment and those without respective illness experience. Respondents with illness/treatment experiences rated their knowledge significantly better than those without any experiences.

CONCLUSIONS

Results indicate low levels of public knowledge about IBS regarding illness recognition in Germany. A majority disagreed that they have good knowledge about IBS symptoms. Against this background, it seems reasonable to develop and test interventions to improve IBS literacy by increasing knowledge about symptoms, causes and treatment options.

Psychotherapy for Irritable Bowel Syndrome: A Systematic Review

Psychotherapy has many forms, such as cognitive behavioral therapy (CBT), mindfulness therapy (MFT), and hypnotherapy, to name a few. Cognitive behavioral therapy is the gold standard in therapy-based treatment and is used for cognitive restructuring to reduce safety-seeking and avoidant behaviors. While the main application of psychotherapy is psychological disorders, recent studies have found that it is beneficial for somatic and physiological symptoms such as chronic pain or even irritable bowel syndrome (IBS). Irritable bowel syndrome is a common but debilitating gastrointestinal condition that has a prevalence of 12% in the United States and costs the average patient $9,776 annually in 2023. Irritatable bowel syndrome is a condition of exclusion but consists of abdominal discomfort or pain and must be associated with altered bowel habits as stated in the Rome IV criteria. At least half of these patients also exhibit extracolonic symptoms, most commonly psychological disorders like anxiety and stress. The true etiology of IBS is not understood, but ideas such as the brain-gut axis, stress response system, and gut microbiota have been evaluated. Treatment of IBS is extensive and heavily relies on the patient-physician interaction, but pharmacologic therapies have been employed and are sometimes unsuccessful. Irritable bowel syndrome impacts an individual as a whole, making them hesitate whether or not they eat a particular food or even go out to do an activity because of the unpredictable bowel pattern. Finding a better solution is essential to improving the patient's quality of life (QoL), especially by addressing how they perceive the illness, how they adjust to it, and even how they determine what foods to consume. This paper aims to evaluate whether or not psychotherapy can be employed to improve all aspects of IBS, as well as if it can reduce the cost of IBS treatment.

Improving access to gut-directed hypnotherapy for irritable bowel syndrome in the digital therapeutics' era: Are mobile applications a "smart" solution?

Gut-directed hypnotherapy (GDH) is a highly effective brain-gut behavioral therapy which is recommended in international guidelines for the treatment of irritable bowel syndrome (IBS). There is increasing recognition of the value of GDH as part of integrated care alongside medical and dietary approaches. This has led to recent innovations to widen access to GDH to meet the increasing demand. Recent advances include streamlined courses of individualized GDH, group therapy, and remote delivery. In this issue of Neurogastroenterology and Motility, Peters et al. retrospectively report outcomes of smartphone app-delivered GDH in a population with self-reported IBS. While adherence was low, those that completed smart phone-delivered GDH-achieved symptom benefit. This mini-review summarizes the current evidence-base for available modalities of GDH and discusses the current and future utility and development of mobile health applications in the digital therapeutics' era.