Prevalence of chronic constipation in general population Dr. Vicente Garrigues Gastroenterology Unit Hospital Universitario LA FE Valencia - Spain.

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Prevalence of chronic constipation in general population Dr. Vicente Garrigues Gastroenterology Unit Hospital Universitario LA FE Valencia - Spain

Gastroenterologist since Working in a bed University Hospital. Interested in Digestive Functional Disorders and in Epidemiology & Statistics. At present, Head of Education of the Hospital

Learning objectives 1.To know current definitions of chronic constipation. 2. To find out the prevalence of constipation. 3. To know which variables are associated to constipation.

Performance objectives 1.To select a sample for a prevalence study. 2. To perform statistics in a prevalence study. 3. To understand the meaning of likelihood ratios.

 Evaluate the prevalence of chronic constipation in the general population.  Assess agreement among several diagnostic criteria of constipation Aims

 Evaluate the diagnostic accuracy of self-reported definition of constipation; and of symptoms included in Rome II criteria.  Identify factors associated to chronic constipation Aims

Definition of constipation Self-reported by subject Rome criteria Rome II criteria

Study subjects. Selection of population Target population: General population from the town of Aldaya: inhabitants Elegible population: subjects aged between 18 and 65 years: subjects

Study subjects. Selection of sample. For an expected prevalence of % (95% C.I.): 375 subjects were needed. Sampling procedure. Systematic, age-stratified sampling was performed, selecting 506 subjects.

Questionnaire A validated questionnaire with 21 items was mailed – up to 6 times- to sampled subjects. Items allowed diagnosis of constipation and evaluated associated variables.

Response WomenMen yr yr yr Total Population 7743 (49) 7953 (51) 5308 (34) 6854 (44) 3534 (22) Sample 250 (49) 256 (51) 171 (34) 221 (43) 114 (23) 506 Responders 182 (52) 167 (48) 120 (34) 154 (44) 75 (22) 349 (71.5) 349 subjects (71.5%) replied.

Prevalence of constipation WomenMenTotal Self- reported Rome Rome II

18-30 yr yr yr Self- reported Rome Rome II Prevalence of constipation

Rome II criteria including diarrhea Global 21.2 ( ) Women 32.4 ( ) Men 9.0 ( ) yr 23.3 ( ) yr 20.8 ( ) yr 18.7 ( ) Prevalence of constipation

Agreement among criteria Rome +-Total+-Total Kappa: %-IC: Self-reported

Agreement among criteria Rome II +-Total+-Total Kappa: %-IC: Self-reported

Agreement among criteria Rome II +-Total+-Total Kappa: %-IC: Rome

Diagnostic accuracy of Rome II qualifying symptoms SeSpLR+1/LR- Straining Hard stools Incomplete evac Anal blockage 48100∞1.9 Maneuvers <3 defecations/w Gold-standard: self-reported

SeSpLR+1/LR- Self-reported Straining Hard stools Incomplete evac Anal blockage Maneuvers <3 defecations/w Accuracy of self-reported and Rome II symptoms Gold-standard: Rome II

Variables associated with constipation OR95%-CI2p Self- reported Female ROME II Female Fiber Occasional exercise Habitual exercise

Conclusions Constipation is highly prevalent, especially in women. Different prevalence rates are observed using different criteria,although agreement is acceptable. Anal blockage, straining and hard stools show the greatest diagnostic accuracy.