In-hospital costs associated with chronic constipation in Belgium: a retrospective database study

Relationship Between Constipation and Medication

Constipation is very common and can be caused by adverse drug reactions as a result of many drugs. While the adverse effects of several medications such as opioids and anticholinergic agents are well established and well known, other commonly prescribed drugs, such as hypnotics, are less well understood. This review presents the results of an analysis of the relationship between constipation and drugs.

Osteopathic management of chronic constipation in women patients. Results of a pilot study

BACKGROUND AND AIMS

Constipation is a common problem in western countries. The aim of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) for the treatment of constipated women with functional constipation (FC) or defeation disorders (DD).

METHODS

Twenty-one constipated females referred to a tertiary center were recruited. A course of OMT, weekly for four weeks, was given. Clinical questionnaire, Bristol stool form scale and patients' subjective perception of constipation, bloating and abdominal pain, were recorded. Total and segmental colonic transit time (CTT) were performed before and after OMT.

RESULTS

Eleven patients had FC and 10 DD, as defined by Rome III criteria. After OMT, the Knowless Eccersley Scott Symptom score (P=0.020), the oro-anal transit time (P=0.002), the right (P=0.005) and left (P=0.009) CTT had decreased while the stool frequency (P=0.005) and the Bristol Stool Form scale (P=0.003) had increased. After OMT, the intensity of constipation, and the Patient assessment of constipation symptoms score did not change but a decrease of abdominal pain, bloating, quality of life score and drug use was found.

CONCLUSIONS

This study shows OMT has potential benefit for treating functional constipation in women. Further randomised trials are required to confirm these results.

Constipation: Pathophysiology and Current Therapeutic Approaches

Chronic constipation is a common, persistent condition affecting many patients worldwide, presenting significant economic burden and resulting in substantial healthcare utilization. In addition to infrequent bowel movements, the definition of constipation includes excessive straining, a sense of incomplete evacuation, failed or lengthy attempts to defecate, use of digital manoeuvres for evacuation of stool, abdominal bloating, and hard consistency of stools. After excluding secondary causes of constipation, chronic idiopathic or primary constipation can be classified as functional defecation disorder, slow-transit constipation (STC), and constipation-predominant irritable bowel syndrome (IBS-C). These classifications are not mutually exclusive and significant overlap exists. Initial therapeutic approach to primary constipation, regardless of aetiology, consists of diet and lifestyle changes such as encouraging adequate fluid and fibre intake, regular exercise, and dietary modification. Laxatives are the mainstay of pharmacologic treatment for potential long-term therapy in patients who do not respond to lifestyle or dietary modification. After a failed empiric trial of laxatives, diagnostic testing is necessary to understand underlying anorectal and/or colonic pathophysiology. No single test provides a comprehensive assessment for primary constipation; therefore, multiple tests are used to provide complementary information to one another. Dyssynergic defecation, a functional defecation disorder, is an acquired behavioural disorder of defecation present in two-thirds of adult patients, where an inability to coordinate the abdominal, recto-anal, and pelvic floor muscles during attempted defecation exists. Biofeedback therapy is the mainstay treatment for dyssynergic defecation aimed at improving coordination of abdominal and anorectal muscles. A large percentage of patients with dyssynergic defecation also exhibit rectal hyposensitivity and may benefit from the addition of sensory retraining. Our understanding of the pathophysiology of STC is evolving. The advent of high-resolution colonic manometry allows for the improved identification of colonic motor patterns and may provide further insight into pathophysiological mechanisms. In a minority of cases of STC, identification of colonic neuropathy suggests a medically refractory condition, warranting consideration of colectomy. The pathophysiology of IBS-C is poorly understood with multiple etiological factors implicated. Pharmacological advances in the treatment of primary constipation have added therapeutic options to the armamentarium of this disorder. Drug development in the secretagogue, serotonergic prokinetic, and ileal bile acid transporter inhibition pathways has yielded current and future medical treatment options for primary chronic constipation.

The Gut in Older Patients on Peritoneal Dialysis

Age-related changes in gastrointestinal symptoms need to be considered in peritoneal dialysis (PD) patients. A diminishing appetite is associated with aging and may be exacerbated by renal failure and PD treatment, meaning that attention to dietary adequacy is important in the older patient. Constipation and its treatment may increase the risk of peritonitis, but is important for comfort as well as trouble-free dialysis. Diverticulosis increases with age, and whilst there may be ethnic differences in the patterns of this condition, there is conflicting evidence regarding the risks of peritonitis associated with asymptomatic disease. Hernias, urinary incontinence, and prolapse are also common and made worse by PD, so it is important to know about these issues prior to starting. Whilst data around these topics are scant and some studies conflicting, further understanding these issues and considering mitigation strategies may improve technique survival and quality of life.

Cost and co-morbidities associated with hypoglycemic inpatients in Belgium

BACKGROUND AND OBJECTIVES

Little is known about the economic burden of hypoglycemia in Belgium, or its related co-morbidities. This study aimed at estimating the cost and length of stay associated with hypoglycemia-related hospitalizations in diabetic patients in Belgium and the association between hypoglycemia and in-hospital all-cause mortality, incidence of traumatic fractures, depression, and cardiovascular diseases (myocardial infarction or unstable angina), using retrospective data from 2011.

METHODS

Patient data were retrieved from the IMS Hospital Disease Database, including longitudinal (per calendar year) information on diagnoses, procedures, and drugs prescribed in ∼20% of all Belgian hospital beds. The eligible population included all adult (<19 year) diabetic (both types) patients, further split between those with/without a history of hypoglycemia-related hospitalizations. Diabetes, hypoglycemia, and co-morbidities of interest were identified based on International Classification of Diseases and Related Health Problems Version 9 (ICD-9) diagnosis codes. All costs were extrapolated to 2014 using progression in hospitalization costs since 2001.

RESULTS

A total of 43,410 diabetes-related hospitalizations were retrieved, corresponding to 30,710 distinct patients. The average hospitalization cost was €10,258 when hypoglycemia was documented (n = 2625), vs €7173 in other diabetic hospitalized patients (n = 40,785). When controlling for age and sex, a higher mortality risk (OR = 1.59; p-value <0.001), a higher incidence of traumatic fractures (OR = 1.25; p-value = 0.009), and a higher probability of depression-related hospitalizations (OR = 1.90; p-value <0.001) were observed in hypoglycemic patients. A similar risk of cardiovascular event was observed in both groups, but hypoglycemic patients were more at risk of experiencing multiple events.

CONCLUSION

Hospitalizations for hypoglycemia are expensive and associated with an increased risk of depression and traumatic fractures as well as increased in-hospital mortality. Interventions that can help reduce the risk of hypoglycemia, and consequently the burden on hospitals and society, without compromising glycemic control, will help to further improve diabetes management.

Advancing treatment options for chronic idiopathic constipation

INTRODUCTION

Chronic constipation is a global problem affecting all ages and associated with considerable morbidity and significant financial burden for society. Though formerly defined on the basis of a single symptom, infrequent defecation; constipation is now viewed as a syndrome encompassing several complaints such as difficulty with defecation, a sense of incomplete evacuation, hard stools, abdominal discomfort and bloating.

AREAS COVERED

The expanded concept of constipation has inevitably led to a significant change in outcomes in clinical trials, as well as in patient expectations from new therapeutic interventions. The past decades have also witnessed a proliferation in therapeutic targets for new agents. Foremost among these have been novel prokinetics, a new category, prosecretory agents and innovative approaches such as inhibitors of bile salt transport. In contrast, relatively few effective therapies exist for the management of those anorectal and pelvic floor problems that result in difficult defecation.

EXPERT OPINION

Though constipation is a common and often troublesome disorder, many of those affected can resolve their symptoms with relatively simple measures. For those with more resistant symptoms a number of novel, effective and safe options now exist. Those with defecatory difficulty (anismus, pelvic floor dysfunction) continue to represent a significant management challenge.

Constipation prophylaxis reduces length of stay in elderly hospitalized heart failure patients with home laxative use

BACKGROUND AND AIM

Elderly, hospitalized patients suffer disproportionately from constipation; however, little data suggest that constipation prophylaxis reduces length of stay (LOS). We performed a retrospective analysis of elderly patients admitted to our hospital with congestive heart failure (CHF) to determine the effects of constipation prophylaxis on LOS.

METHODS

Patients ≥ 65 years old admitted with the diagnosis of CHF in 2012 were evaluated for home and hospital laxative use on admission. Our primary outcome was LOS. We used linear regression modeling to independently evaluate the impact of constipation prophylaxis on LOS.

RESULTS

Among 618 patients who were eligible for our study, 201 (32.5%) were using laxatives at home, whereas 254 (41.1%) were started on a prophylactic laxative on admission. There was no significant difference in LOS between patients receiving prophylaxis versus those who did not (P = 0.32). Patients with home laxative use had a 1 day longer LOS compared to those without laxative use (6 vs 5, P = 0.03). Among patients with home laxative use, there were 2 days longer LOS in those who were not given constipation prophylaxis on admission (8 vs 6, P = 0.002). After multivariate adjustment, failure to use constipation prophylaxis in patients with home laxative use was the only independent predictor of increased LOS (P = 0.03).

CONCLUSIONS

Among elderly patients admitted for CHF exacerbations, failure to use constipation prophylaxis in patients with home laxative use is associated with a significantly longer LOS. Our data suggest that routine use of bowel prophylaxis for elderly CHF patients with preexisting constipation may reduce LOS.

Economic burden associated with chronic constipation in Sweden: a retrospective cohort study

BACKGROUND

Chronic constipation is a common condition, but few studies have assessed its cost and impact on resource use. The purpose of this cohort study was to assess the health care utilization and costs of chronic constipation in a Swedish population using health care claims data.

METHODS

Data were compiled on health care costs, drug costs, and mortality for Västra Götaland, Sweden (2005-2009). These data were used to identify patients aged 18 years or older with chronic constipation, defined as: at least two health care contacts with a primary diagnosis of constipation within 12 months or at least one care contact with a primary diagnosis of constipation and two dispatches of laxatives 6 months before and 12 months after the index date. Patients with irritable bowel syndrome or taking opioids, both of which can cause constipation, were excluded. Costs, resource use, comorbidities, and laxative use were assessed during a 12-month follow-up period.

RESULTS

In total, 4,043 patients with chronic constipation were identified. They had a mean (SD) age of 67±18 years. Mortality was 7% during the 12-month follow-up period and the most common comorbidity was hypertension (22%). In the 12-month follow-up period, patients with chronic constipation had a mean (SD) of 2.3±7.5 constipation-related health care contacts and a mean (SD) of 15.2±19.5 other health care contacts. Annual costs, adjusted for sex, age group, mortality, and comorbidities, were €5,388, of which €951 were for constipation-related care.

CONCLUSION

Patients with chronic constipation constituted an elderly population with a high disease burden in Sweden between 2005 and 2009. Mean annual constipation-related health care costs, adjusted for potentially confounding factors, were €951 per patient.