Irritable Bowel Syndrome Message Boards

Surgery and IBS

Lin Chang, MD

An increased number of abdominal surgeries have been reported in a random population of patients with IBS compared with individuals without IBS.[9,10] Two studies presented during these meeting proceedings evaluated the prevalence of surgery in patients with IBS compared with control subjects in 2 different patient populations.

In one study,[11] the prevalence of potentially unnecessary surgeries was investigated using computerized patient questionnaire data in HMO health examinees. An analysis of health data on 89,008 examinees was performed. IBS was reported in 5.2% of subjects (3.0% of men and 7.2% of women). Of the different types of surgeries, cholecystectomy, appendectomy, hysterectomy, and back surgery were significantly more common in patients with IBS than in patients without IBS. Patients with IBS reported these surgeries 2-3 times more than individuals without IBS, except for back surgery (reported 1.5 times more often). Various medical history parameters were evaluated as predictive factors for the types of surgeries. An IBS diagnosis yielded the highest odds ratio (OR) for cholecystectomy and appendectomy. The diagnoses of IBS and fibromyalgia tied for the highest OR for hysterectomy, and fibromyalgia had the highest OR for back surgery.

The second study[12] retrospectively determined the prevalence of gastrointestinal-related surgeries in a 2-state Medicaid IBS patient population compared with a non-IBS control group matched for age, sex, race, and months of eligibility (both, n = 2546). Patients with IBS had a corresponding ICD (International Classification of Diseases) code as a primary or secondary diagnosis. The gastrointestinal-related procedures included cholecystectomy, appendectomy, colectomy, obesity procedures, and abdominal and vaginal hysterectomy. The 1-year prevalence of gastrointestinal-related procedures in the IBS group was significantly higher than that of the control group (n = 42 [1.65%] vs n = 23 [0.9%]; P = .01). The prevalence of vaginal hysterectomy was higher in the IBS group than in the control group (0.5% vs 0.2%; P = .02).

Summary. These studies confirm that factors that contribute to the increased healthcare and economic burden associated with IBS include physician visits, surgical procedures, medication (prescription and OTC), and alternative treatments (that are frequently used by patients with IBS). The lack of satisfaction and effectiveness of current IBS treatments and decreased QOL and work productivity also contribute to the burden of illness.

References
Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther. 1997;11:1019-1030.
Gralnek IM, Hays RD, Kilbourne A, Naliboff B, Mayer EA. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. 2000;119:654-60.
Frank L, Kleinman L, Rentz A, Ciesla G, Kim JJ, Zacker C. Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. Clin Ther. 2002;24:675-689.
Hungin P, Chang L, Barghout V, Kahler K. The impact of IBS on absenteeism and work productivity: United States and eight European countries. Am J Gastroenterol. 2003;98:S227. [Abstract # 687]
Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500-1151.
Dean BB, Aguilar D, Barghout V, Kahler K, Groves D, Ofman JJ. Impairments in worker productivity and health-related quality of life among employees with irritable bowel syndrome: Does bowel habit predominance make a difference? Am J Gastroenterol. 98:S233, 2003. [Abstract # 703]
Palsson OS, Whitehead WE, Barghout V, et al. IBS severity and health-related quality of life improve with age in women but not in men. Am J Gastroenterol. 98:S272, 2003. [Abstract #818]
Gore M, Frech F, Tai K-S, Nguyen AB, Shetzline MA. Burden of illness in patients with irritable bowel syndrome with constipation. Am J Gastroenterol. 2003;98:S219. [Abstract # 662]
Whitehead WE, Cheskin LJ, Heller BR, et al. Evidence for exacerbation of irritable bowel syndrome during menses. Gastroenterology. 1990;98:1485-1489.
Kennedy TM, Jones RH. Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population. Br J Surg. 2000;87:1568-1563.
Longstreth GF, Yao JF. Irritable bowel syndrome and surgery in HMO health examinees. Am J Gastroenterol. 2003;98:S265. [Abstract #797]
Ganguly R, Barghout V, Pannicker S, Martin BC. Prevalence of GI related surgical procedures among Medicaid eligible patients with and without irritable bowel syndrome. Am J Gastroenterol. 2003 98:S274-S275. [Abstract # 825]
Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999; 45(suppl II):1143-1147.
Dean BB, Aguilar D, Barghout V, Kahler K, Groves D, Ofman JJ. Identifying IBS patients using Rome II symptom criteria: 3- or 12-month reporting? Am J Gastroenterol. 2003;98:S235-S236. [Abstract # 711]
Gore M, Frech F, Nguyen AB, Tai K-S, Shetzline MA. Development of a new symptom-based algorithm for classifying IBS patients into IBS subgroups. Am J Gastroenterol. 2003;98:S219. [Abstract # 663]
Locke GR, Zinsmeister AR, Melton LJ, Talley NJ. Who is an "alternator?" -- a population based study. Am J Gastroenterol. 2003;98:S275. [Abstract # 828]
Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108-2131.
Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140-1156.
Crowell MD, Schettler VA, Lacy BE, Jones MP, Olden KW, Whitehead WE. Impact of somatization on gastrointestinal (GI) and extra-intestinal comorbidities in IBS. Am J Gastroenterol. 2003;98:S271-S272. [Abstract #816]
Muller-Lissner SA, Fumagalli I, Bardhan KD, et al. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther. 2001;15:1655-1666.
Camilleri M, Northcutt AR, Kong S, Dukes GE, McSorley D, Mangel AW. Efficacy and safety of alosetron in women with irritable bowel syndrome: A randomised placebo-controlled trial. Lancet. 2000;355:1035-1040.
Dunger-Baldauf C, Nyhlin H, Rueegg P, Wagner A. Subject's global assessment of satisfactory relief as a measure to assess treatment effect in clinical trials in irritable bowel syndrome (IBS). Am J Gastroenterol. 2003;98:S269. [Abstract #809]
Prather CM, Camilleri M, Zinsmeister AR, McKinzie S, Thomforde G. Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome. Gastroenterology. 2000;118:463-468.
Talley N, Kamm M, Mueller-Lissner S, et al. Tegaserod is effective in relieving the multiple symptoms of constipation: Results from a 12-week multinational study in patients with chronic constipation. Am J Gastroenterol. 2003;98:S269-S270. [Abstract #810]
Kariv R, Tiomny E, Grenshpon R, Waisman G, Halpern Z. Low-dose naltrexone for the treatment of irritable bowel syndrome. Am J Gastroenterol. 2003 98:S268. [Abstract #805]

http://www.medscape.com/viewarticle/463421

--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

Print Remind Me Notify Moderator