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Epidemiologic Burden and Treatment of Chronic Symptomatic Functional Bowel Disorders in the United States: A Nationwide Analysis

  • Ma, Christopher1, 2
  • Congly, Stephen E.1, 3
  • Novak, Kerri L.1
  • Belletrutti, Paul J.1
  • Raman, Maitreyi1, 2
  • Woo, Matthew1
  • Andrews, Christopher N.1
  • Nasser, Yasmin1
  • 1 Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  • 2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  • 3 O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
Published Article
Publication Date
Oct 01, 2020
DOI: 10.1053/j.gastro.2020.09.041
PMID: 33010247
PMCID: PMC7527275
PubMed Central


Background Functional bowel disorders (FBDs) are the most common gastrointestinal problems managed by physicians. We aimed to assess the burden of chronic symptomatic FBDs on ambulatory care delivery in the United States and evaluate patterns of treatment. Methods Data from the National Ambulatory Medical Care Survey were used to estimate annual rates and associated costs of ambulatory visits for symptomatic irritable bowel syndrome (IBS), chronic functional abdominal pain, constipation, or diarrhea. The weighted proportion of visits associated with pharmacologic and non-pharmacologic (stress/mental health, exercise, diet counseling) interventions were calculated, and predictors of treatment strategy were evaluated in multivariable multinomial logistic regression. Results From 2007-2015, ∼36.9 million [95% CI, 31.4-42.4] weighted visits in non-federal patients for chronic symptomatic FBDs were sampled. There was an annual weighted average of 2.7 million [95% CI, 2.3-3.2] visits for symptomatic IBS/chronic abdominal pain, 1.0 million [95% CI, 0.8-1.2] visits for chronic constipation, and 0.7 million [95% CI, 0.5-0.8] visits for chronic diarrhea. Pharmacologic therapies were prescribed in 49.7% [95% CI, 44.7%-54.8%] of visits, compared to non-pharmacologic interventions in 19.8% [95% CI, 16.0%-24.2%] of visits ( P < .001). Combination treatment strategies were more likely to be implemented by primary care physicians and in patients with depression or obesity. The direct annual cost of ambulatory clinic visits alone for chronic symptomatic FBDs is ∼$358 million USD [95% CI, $233-482 million]. Conclusions The management of chronic symptomatic FBDs is associated with considerable health care resource utilization and cost. There may be an opportunity to improve comprehensive FBD management as fewer than 1 in 5 ambulatory visits include non-pharmacologic treatment strategies.

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