Patients with IBS Report Treatment Dissatisfaction, Lack of Symptom Control

Brian Lacy, MD, PhD

Credit: Mayo Clinic

Findings from a recent study are providing clinicians with an overview of the burden of illness and treatment attitudes among patients with irritable bowel syndrome (IBS).¹

Results highlight abdominal pain and discomfort as bothersome symptoms in patients with IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D), leading to greater rates of presenteeism, overall work productivity loss, and daily activity impairment. Additionally, most patients with IBS reported general treatment dissatisfaction due to a lack of control of bowel-related and abdominal symptoms, although prescription medication use was linked to greater symptom control satisfaction than taking over-the-counter (OTC) medications alone.¹

“The goal of IBS treatment is to manage symptoms as there are no curative therapies,” Brian Lacy, MD, PhD, of the Mayo Clinic in Jacksonville, and colleagues wrote.¹ “Patients with IBS have previously reported low levels of satisfaction with either OTC or prescription medications, with approximately half of patients with IBS-C experiencing constipation and abdominal pain despite active treatment.”

A chronic, often debilitating, and highly prevalent disorder of gut-brain interaction, the American College of Gastroenterology estimates 10-15% of adults in the US suffer from IBS symptoms, but only 5-7% have been diagnosed with the disease. Despite its prevalence, there is no cure for IBS, and few medications have been shown to effectively treat all symptoms.²

To gather insight into the burden of illness and treatment attitudes among individuals with IBS, investigators conducted an observational, cross-sectional study using data collected from a large, United States survey of adults querying demographics, comorbid conditions, quality of life, medication use, satisfaction with symptom control, and work productivity from August 2020 to December 2021. Respondents were recruited from the American Health Research Institute's research panel, invited by email to complete the online survey, and compensated with a prespecified reward.¹

In the overall Acumen Health Research Institute National Health Survey, participants who selected “IBS”, “constipation (chronic or more than occasional)”, or “diarrhea (chronic or more than occasional)” in the comorbid condition checklist were routed to the IBS/CIC module. Once self-identified with IBS, constipation, or diarrhea, participants were classified into cohorts for IBS-C, IBS-D, or CIC according to their responses to questions using Rome IV criteria. Those who did not meet Rome IV criteria for IBS-C or IBS-D were excluded.¹

Investigators noted quality control measures were implemented during the data collection process to validate participants entering the survey, confirm that participants completed only one survey during the study, and identify fraudulent responses.¹

Survey participants were required to be aged ≥18 years and reside in the US. Participants who did not select IBS, constipation (chronic or more than occasional), or diarrhea (chronic or more than occasional) in the survey comorbid conditions checklist were assigned to the control cohort and matched in a 1:1 ratio to participants with IBS according to age, sex, race, region, and Charlson Comorbidity Index score.¹

A total of 35,182 participants were enrolled in the study, 29,359 (83.4%) of whom completed the survey. Of these participants, 11,900 (40.5%) completed the IBS/CIC module, having reported ≥ 1 of the 3 conditions. In total, 956 (3.3%) participants met Rome IV criteria for IBS-C and 910 (95%) were successfully matched to controls. For IBS-D, 699 (2.4%) participants met Rome IV criteria and 669 (96%) were successfully matched to controls.¹

Within the IBS-C cohort, the mean age was 41.2 (Standard deviation [SD], 14.9) years and respondents were primarily female (76.9%) and White (82.2%). Within the IBS-D cohort, the mean age was 41.9 (SD, 15.0) years and respondents were again primarily female (74.6%) and White (84.0%).¹

Investigators noted both the IBS-C and IBS-D cohorts reported significantly higher moderate and severe anxiety (both P <.001) and significantly higher moderate, moderately severe, and severe depression (both P <.001) than the control group. Additionally, both the IBS-C and IBS-D cohorts reported significantly lower health-related quality of life scores than matched controls (P <.001).¹

Most respondents with IBS-C (92.4%) and IBS-D (91.5%) reported seeking medical care for symptoms, with the most reported symptoms being abdominal discomfort (71.0%) for IBS-C and abdominal pain (71.0%) and abdominal discomfort (70.9%) for IBS-D. Among the IBS-C and IBS-D cohorts, investigators reported 74.2% and 65.9%, respectively, took prescription and/or OTC medication for their symptoms. Of note, respondents were more dissatisfied than satisfied with control of their symptoms.¹

Specifically, respondents with IBS-C (n = 910) reported being more dissatisfied than satisfied with the control of their bowel movement-related symptoms (47.4% vs 27.3%) and abdominal symptoms (45.9% vs 27.8%). However, those currently taking a prescription medication with or without an OTC medication were more satisfied with the control of their bowel-movement-related (42.6% vs 22.5%; P <.001) and abdominal (46.6% vs 20.9%; P <.001) symptoms than respondents taking only an OTC medication.¹

Similarly, respondents with IBS-D (n = 669) reported being more dissatisfied than satisfied with the control of their bowel movement-related symptoms (48.1% vs 24.7%) and abdominal symptoms (48.9% vs 26.2%). Again, those currently taking a prescription medication with or without an OTC medication were more satisfied with the control of their bowel movement-related (39.2% vs 21.5%; P <.001) and abdominal (40.3% vs 22.7%; P <.001) symptoms than respondents taking only an OTC medication.¹

Additionally, although no significant differences in absenteeism were reported between respondents with IBS-C and IBS-D compared with matched controls, investigators called attention to significantly greater mean presenteeism, work productivity loss, and daily activity impairment (all P <.001) in respondents with IBS.¹

Investigators outlined multiple limitations to these findings, including survey participation being limited to those with online access and those willing to volunteer; the use of self-reported data that were not verified by medical record review; the potential effect of the COVID-19 pandemic on participants responses; and the inability to infer definitive causation between medication use and patient satisfaction with symptom control due to the observational, cross-sectional nature of the study.¹

“This study provides insight into respondents' experiences of IBS symptoms, satisfaction with control of symptoms, satisfaction with prescription and OTC medications, and the health impact IBS has on work productivity and daily activity,” investigators concluded.¹ “To provide better treatment options and symptom control, future studies should further evaluate the prominence of abdominal pain and consider therapies that target visceral pain such as neuromodulators.”

References

1. ^{Lacy BE, Xu Y, Taylor DCA, et al. Burden of illness and treatment attitudes among participants meeting Rome IV criteria for irritable bowel syndrome: A nationwide survey in the United States. Neurogastroenterology and Motility. https://doi.org/10.1111/nmo.14903}
2. ^{American College of Gastroenterology. Irritable Bowel Syndrome. IBS FAQs. Accessed September 10, 2024. https://gi.org/topics/irritable-bowel-syndrome/#}