Low Rates of Physiologic Testing and Prescription Drug Use for FC and IBS-C in Patients With Inflammatory Bowel...

While inflammatory bowel diseases (IBD) are traditionally characterized as a diarrheal illness, comorbid constipation is under-recognized. We evaluated the management patterns of IBD patients with comorbid constipation.

We conducted a retrospective multicenter cohort study of adults with ulcerative colitis (UC) or Crohn's disease (CD) with ≥ 2 gastroenterology visits with a primary diagnosis of constipation between 2016 and 2023. Functional Constipation (FC) and irritable bowel syndrome with constipation (IBS-C) were defined per Rome IV criteria. Multivariable logistic regression identified characteristics associated with the use of FC/IBS-C pharmacotherapies.

We identified 593 IBD patients (UC n = 258; CD n = 335) with ≥ 2 visits for constipation (FC n = 504, 85.0% and IBS-C n = 89, 15.0%). Mean age was 36.6 years (SD 18.7) and most were women (n = 419, 70.7%). Only a minority underwent physiologic testing for evaluation of constipation: transit testing (4.7%), anorectal manometry (11.0%), or defecography (5.1%). Most received oral laxatives (91.1%), fiber (50.3%), and suppositories/enemas (31.2%). Only 125 (21.1%) received prescription pharmacologic therapy (e.g., secretagogues, 5-HT4 agonists, and NH3 inhibitors) and even fewer underwent pelvic floor physical therapy/biofeedback (n = 89, 15.0%). On multivariable regression, female sex (OR 2.4, 95% CI 1.4-4.2), prior physiologic testing for constipation (OR 4.4, 95% CI 2.4-8.4), oral laxative use (OR 9.6, 95% CI 1.3-72.8), and suppository/enema use (OR 2.5, 95% CI 1.6-3.9) were associated with prescription pharmacotherapy for FC/IBS-C.

In this cohort of IBD patients with FC or IBS-C, only a minority underwent physiologic testing or were escalated to prescription pharmacologic therapy. Further research is needed to understand whether standard of care practices are being applied for those with constipation in IBD.