Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
Gastroenterology. 2021 Jan;160(1):88-98.e4. doi: 10.1053/j.gastro.2020.09.041. Epub 2020 Oct 1.
BACKGROUND & AIMS: 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.
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, chronic functional abdominal pain, constipation, or diarrhea. The weighted proportion of visits associated with pharmacologic and nonpharmacologic (stress/mental health, exercise, diet counseling) interventions were calculated, and predictors of treatment strategy were evaluated in multivariable multinomial logistic regression.
From 2007-2015, approximately 36.9 million (95% CI, 31.4-42.4) weighted visits in patients of non-federally employed physicians 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 irritable bowel syndrome/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 nonpharmacologic 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 approximately US$358 million (95% CI, 233-482 million).
The management of chronic symptomatic FBDs is associated with considerable health care resource use and cost. There may be an opportunity to improve comprehensive FBD management because fewer than 1 in 5 ambulatory visits include nonpharmacologic treatment strategies.
功能性肠病（FBD）是医生最常治疗的胃肠道疾病。本研究旨在评估美国门诊医疗中慢性有症状 FBD 的负担，并评估治疗模式。
使用全国门诊医疗调查的数据来估计有症状的肠易激综合征、慢性功能性腹痛、便秘或腹泻患者的年度门诊就诊率和相关费用。计算与药物和非药物（压力/心理健康、运动、饮食咨询）干预相关的就诊比例，并使用多变量多项逻辑回归评估治疗策略的预测因素。
2007 年至 2015 年，在非联邦雇医生处接受慢性有症状 FBD 治疗的患者中，抽样了约 3690 万例（95%可信区间，3140-4240）加权就诊。每年加权平均有 270 万例（95%可信区间，230-310）就诊是由于有症状的肠易激综合征/慢性腹痛，100 万例（95%可信区间，80-120）就诊是由于慢性便秘，70 万例（95%可信区间，50-90）就诊是由于慢性腹泻。与非药物干预（95%可信区间，16.0-24.2）相比，药物治疗在 49.7%（95%可信区间，44.7-54.8）的就诊中被开处方，而非药物干预在 19.8%（95%可信区间，16.0-24.2）的就诊中被开处方（P<0.001）。综合治疗策略更可能由初级保健医生实施，并且在患有抑郁症或肥胖症的患者中实施。仅慢性有症状 FBD 的门诊就诊的直接年度费用约为 3.58 亿美元（95%可信区间，2.33-4.82 亿美元）。
慢性有症状 FBD 的管理与大量卫生保健资源的使用和成本相关。可能有机会改善综合 FBD 管理，因为不到 1/5 的门诊就诊包括非药物治疗策略。
