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ACG: Chronic Constipation Linked to Higher Long-Term Mortality Risk


LAS VEGAS -- Chronic constipation may signal a 20% rise in the 10-year risk of mortality, researchers reported here.

LAS VEGAS, Oct. 31 -- Chronic constipation may signal a 20% rise in the 10-year risk of mortality, researchers reported here.

Although chronic constipation is probably not the direct cause of higher morality, it is likely a marker for some yet-to-be-discovered disease process, Nicholas Talley, M.D., Ph.D., of the Mayo Clinic in Rochester, Minn., said at the American College of Gastroenterology meeting here.

His group analyzed survey data obtained from nearly 4,000 residents of Olmstead County, Minn., from 1988 through 1993. The investigators used Minnesota administrative death records to determine which survey respondents had died through the follow-up period, which ran to November 2004.

During the initial survey period, 622 patients reported chronic constipation. Sixty percent of these were female, and at the end of the follow-up period their median age was 65. Non-constipated patients tended to be younger (median, 50) and were evenly divided between men and women.

The analysis determined that the estimated 10-year survival rate from 1990 to 2000 for those with chronic constipation was 73%, compared with 85% for the non-constipated (P<.001), Dr. Talley and colleagues said.

Even after adjusting for age; gender; and potential confounders such as smoking, GERD, and marital status, those with chronic constipation had a 20% greater chance of dying during the 10-year time period (hazard ratio=1.20; 95% confidence interval=1.03 to 1.40), the study found.

The association was weaker after adjusting for the Charlson Comorbidity Index (HR=1.16; 95% CI=0.99 to 1.35). The index includes 19 diseases weighted on their association with mortality, such as cardiovascular disease, various cancers, diabetes, liver disease, and kidney disease.

However, a separate analysis of those without any of the Charlson comorbidities demonstrated that chronically constipated individuals still fared worse in terms of survival. In this analysis, the 10-year survival rate was 85% for those with chronic constipation versus 93% for the non-constipated (P<0.001), the study found. The hazard ratio and 95% confidence interval were not reported.

One possible explanation for the findings is that chronic constipation is linked to increased risk for GI cancers, Dr. Talley said. However, the current analysis did support that hypothesis, he added. (Data not reported.)

Larger population studies examining more potential mechanisms need to be done, Dr. Talley said.

The study was supported in part by Novartis, maker of Zelnorm (tegaserod). The drug is approved by the FDA for treating women with irritable bowel syndrome whose primary symptom is constipation.

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