Persistence of Functional GI Disorders and Health Service use in Pediatric Patients With Functional Abdominal Pain: Results of a 5-15 Year Prospective Study

Introduction: Chronic constipation (CC) is common in the community but surprisingly little is known about relevant co-morbidities.For example, constipation has been reported to precede the development of neurodegenerative disease, specifically Parkinson disease.A number of medications (e.g.cardiovascular) may be a primary cause of constipation.Moreover, constipation may be a major predisposing factor for diverticulitis, or local anal pathology.We aimed to assess the epidemiology of CC and in particular provide new insights into the co-morbidities linked to this condition.Methods: In a prospective, populationbased nested case-control study, a cohort of randomly selected community residents (n= 8006) were mailed a validated self-report symptom questionnaire (Bowel Disease Questionnaire [BDQ]).CC was defined according to Rome III criteria; a control group was selected matched on age, gender and year of registration randomly selected from the remaining respondents.Medical records of each case and control were abstracted using a standardized data collection form to identify diagnoses of potential CC comorbidities.The univariate association with comorbidities was assessed using McNemar's test in an analysis accounting for the matching (a total of 262 matched pairs [cases and controls]), and logistic regression models used for the total of 2020 controls and the 307 cases ignoring the matching, but adjusting for age and gender.Results: A total of 3831 (48%) subjects returned questionnaires; 307 met criteria for CC based on the BDQ.The age-adjusted prevalence per 100 in females was 8.8 (95% CI 7.2, 10.4) and in males 5. 3 (3.8,6.8); an increasing prevalence was observed with increasing age.While Parkinson disease (p=0.006) and eating disorder (p= 0.02) showed a univariate significant association with constipation status by the McNemar's test, several comorbid conditions including anal surgery (OR=3.3[1.2, 9.1]), neurologic disease (specifically, Parkinson disease, OR=6.3 [2.6, 14.9]), cardiovascular disease (angina, OR=1.4 [1.1,1.9] and MI, OR=1.6 [1.0,2.6]) and hysterectomy (OR=1.5 [1.0, 2.2]), all showed a significant association with constipation status by logistic regression.Otherwise, no association with constipation was detected for the other lower GI diseases including hemorrhoids, anal fissures, diverticulosis, diverticulitis, and non-GI diseases including psychiatric, gynecologic, or endocrine disease.Conclusion: Parkinson's disease is very strongly linked to constipation.Anal surgery was also associated with constipation but number was small.