A retrospective and prospective 12-month observational study of the socioeconomic burden of moderate to severe irritable bowel syndrome with constipation in Spain.

INTRODUCTION: The socioeconomic burden of irritable bowel syndrome with constipation (IBS-C) has never been formally assessed in Spain. PATIENTS AND METHODS: This 12-month (6-month retrospective and prospective periods) observational, multicentre study assessed the burden of moderate-to-severe IBS-C in Spain. Patients were included if they had been diagnosed with IBS-C (Rome III criteria) within the last 5 years and had moderate-to-severe IBS-C (IBS Symptom Severity Scale score [IBS-SSS] ≥175) at inclusion. The primary objective was to assess the direct cost to the Spanish healthcare system (HS). RESULTS: A total of 112 patients were included, 64 (57%) of which had severe IBS-C at inclusion. At baseline, 89 (80%) patients reported abdominal pain and distention. Patient quality of life (QoL), measured by the IBS-C QoL and EQ-5D instruments, was found to be impaired with a mean score of 59 and 57 (0-100, worst-best), respectively. Over the 6-month prospective period the mean IBS-C severity, measured using the IBS-SSS showed some improvement (315-234 [0-500, best-worst]). During the year, 89 (80%) patients used prescription drugs for IBS-C, with laxatives being the most frequently prescribed (n=70; 63%). The direct cost to the HS was €1067, and to the patient was €568 per year. The total direct cost for moderate-to-severe IBS-C was €1635. DISCUSSION: The majority of patients reported continuous IBS-C symptoms despite that 80% were taking medication to treat their IBS-C. Overall healthcare resource use and direct costs were asymmetric, with a small group of patients consuming the majority of resources.

Pacientes con trastorno funcional intestinal: eficacia de una dieta baja en FODMAPS para el tratamiento de los síntomas digestivos / Patients with functional bowel disorder: effectiveness of a diet low in FODMAPS for the treatment of gastrointestinal symptoms

Introducción: Investigaciones recientes indican que los síntomas digestivos que presentan los pacientes con trastorno funcional intestinal mejoran con la restricción en la dieta de los hidratos de carbono de cadena corta (Fermentable Oligosaccharides, Disaccharides and Monosaccharides and Polyols: FODMAPs). Objetivos: 1. Valorar la eficacia de una dieta baja en FODMAPs en la mejoría de los síntomas digestivos en pacientes con trastorno funcional intestinal y en aquellos con enfermedades orgánicas del tubo digestivo. 2. Examinar qué alimentos dentro de cada grupo de hidratos de carbono (fructanos, galactanos, lactosa, exceso de fructosa y polioles) vuelven a tolerar los pacientes, después de realizar una dieta de reintroducción de alimentos con FODMAPs. Método: Investigación prospectiva que estudió de forma consecutiva 164 pacientes con trastorno funcional intestinal tratados en la consulta del Área de Nutrición de un hospital universitario de España. Los síntomas que presentaban eran dolor abdominal, distensión, gases, diarreas y/o estreñimiento. Durante 6-8 semanas siguieron dieta baja en FODMAPs, analizando en todos los casos la mejoría y la adherencia al tratamiento dietético. Posteriormente siguieron la dieta de reintroducción de alimentos con FODMAPs, evaluando la tolerancia a cada uno de los alimentos. Resultados: El ochenta y cuatro por ciento de los pacientes presentaron mejoría de los síntomas digestivos con una alta adherencia al tratamiento. Después de realizar la dieta de reintroducción, más del 80% de los pacientes volvieron a tolerar trigo, así como lácteos con lactosa y más del 70% legumbres y 2 raciones de frutas bajas en fructosa en la misma toma. Conclusiones: 1. La dieta baja en FODMAPs es eficaz para mejorar la sintomatología digestiva de los pacientes con trastorno funcional intestinal. 2. La mayor adherencia a la dieta se asocia con una mejoría total de los síntomas digestivos. 3. La mayoría de los pacientes, tras realizar la dieta de reintroducción, vuelve a tolerar trigo, leche, derivados lácteos con lactosa y legumbres, así como una variedad de frutas con alto contenido en FODMAPs (AU)

Introduction: Recent studies indicate that the gastrointestinal symptoms presented by patients with functional bowel disorder improve by restricting the intake of short-chain carbohydrates (Fermentable Oligosaccharides, Disaccharides and Monosaccharides and Polyols: FODMAPs). Objectives: l. Evaluate the efficacy of a diet low in FODMAPs for the improvement of most gastrointestinal symptoms in patients with functional bowel disorder and patients with organic gastrointestinal disorders. 2. Examine the foods within each group of carbohydrates (fructans, galactans, lactose, excess of fructose and polyols) that the patients can again tolerate, after following a diet of reintroducing foods with FODMAPs. Method: Prospective study of 164 patients consecutive with functional bowel disorder attending the Nutrition Unit of a Spanish university hospital. The symptoms presented were abdominal pain, bloating, wind, diarrhoea and/or constipation. Patients followed for 6-8 weeks a diet low in FODMAPs, analysing in every case the improvement and adherence to the dietary treatment. They subsequently followed a re-introductory diet of nutrients with FODMAPs, evaluating their tolerance to each one of the food items. Results: Eighty-four percent of the patients showed an improvement in the gastrointestinal symptoms with a high level of adherence to the dietary treatment. After performing the reintroduction diet, more than 80% of the patients tolerated again wheat as well as dairy products with lactose and more than 70%, legumes and 2 pieces of low-fructose fruits together. Conclusions: 1.The diet low in FODMAPs is effective in improving the gastrointestinal symptoms of patients with functional bowel disorder. 2. Greater adherence to the diet is associated with a general improvement in the gastrointestinal symptoms. 3. The majority of the patients, after following the re-introductory phase, tolerated again wheat, milk, dairy products with lactose and legumes, as well as a variety of fruits with high FODMAPs content (AU)

A retrospective and prospective 12-month observational study of the socioeconomic burden of moderate to severe irritable bowel syndrome with constipation in Spain / Estudio observacional, retrospectivo y prospectivo a 12 meses del coste socioeconómico del síndrome del intestino irritable moderado a grave con estreñimiento en España

Introduction: The socioeconomic burden of irritable bowel syndrome with constipation (IBS-C) has never been formally assessed in Spain. Patients and methods: This 12-month (6-month retrospective and prospective periods) observational, multicentre study assessed the burden of moderate-to-severe IBS-C in Spain. Patients were included if they had been diagnosed with IBS-C (Rome III criteria) within the last 5 years and had moderate-to-severe IBS-C (IBS Symptom Severity Scale score [IBS-SSS] ≥175) at inclusion. The primary objective was to assess the direct cost to the Spanish healthcare system (HS). Results: A total of 112 patients were included, 64 (57%) of which had severe IBS-C at inclusion. At baseline, 89 (80%) patients reported abdominal pain and distention. Patient quality of life (QoL), measured by the IBS-C QoL and EQ-5D instruments, was found to be impaired with a mean score of 59 and 57 (0-100, worst-best), respectively. Over the 6-month prospective period the mean IBS-C severity, measured using the IBS-SSS showed some improvement (315-234 [0-500, best-worst]). During the year, 89 (80%) patients used prescription drugs for IBS-C, with laxatives being the most frequently prescribed (n=70; 63%). The direct cost to the HS was €1067, and to the patient was €568 per year. The total direct cost for moderate-to-severe IBS-C was €1635. Discussion: The majority of patients reported continuous IBS-C symptoms despite that 80% were taking medication to treat their IBS-C. Overall healthcare resource use and direct costs were asymmetric, with a small group of patients consuming the majority of resources

Introducción: El coste socioeconómico del síndrome del intestino irritable con estreñimiento (SII-E) no ha sido evaluado formalmente en España. Pacientes y métodos: Este estudio observacional, multicéntrico a 12 meses (periodos retrospectivo y prospectivo de 6 meses) evaluó el coste del SII-E moderado-grave en España. Se incluyeron pacientes diagnosticados con SII-E (criterios Roma III) en los últimos 5 años y SII-E moderado-grave (puntuación IBS-Symptom Severity Scale [IBS-SSS]≥175) en la inclusión. El objetivo principal fue evaluar el coste directo para el sistema sanitario (SS) español. Resultados: Se incluyeron un total de 112 pacientes, 64 (57%) de los cuales presentaban SII-E grave en la inclusión. En el momento basal, 89 (80%) pacientes presentaron dolor y distensión abdominal. La calidad de vida del paciente, medida mediante los instrumentos IBS-C QoL y EQ-5D, estaba deteriorada, con una puntuación de 59 y 57 (0-100, peor-mejor), respectivamente. En el periodo prospectivo la gravedad media del SII-E, medida mediante IBS-SSS, mostró alguna mejoría (315 a 234 [0-500, mejor-peor]). Durante el periodo a studio, 89 (80%) pacientes usaron fármacos prescritos para el SII-E, principalmente laxantes (n=70; 63%). El coste directo anual fue de 1.067€ y 568€ para el SS y el paciente, respectivamente. El coste total directo del SII-E moderado-grave fue de 1.635€. Discusión: La mayoría de pacientes presentaron síntomas continuos del SII-E pese a que el 80% tomaban medicación específica. El uso de recursos sanitarios y los costes directos globales fueron asimétricos, con un pequeño grupo de pacientes consumiendo la mayoría de los recursos