title: Chronic constipation and co-morbidities: A prospective population-based nested case-control study.
abstract: BACKGROUND
  Chronic constipation (CC) is common in the community but surprisingly little is known about relevant gastro-intestinal (GI) and non-GI co-morbidities.
  
  
  OBJECTIVE
  The purpose of this study was to assess the epidemiology of CC and in particular provide new insights into the co-morbidities linked to this condition.
  
  
  METHODS
  In a prospective, population-based nested case-control study, a cohort of randomly selected community residents (n = 8006) were mailed a validated self-report gastrointestinal symptom questionnaire. CC was defined according to Rome III criteria. Medical records of each case and control were abstracted to identify potential CC comorbidities.
  
  
  RESULTS
  Altogether 3831 (48%) subjects returned questionnaires; 307 met criteria for CC. Age-adjusted prevalence in females was 8.7 (95% confidence interval (CI) 7.1-10.3) and 5.1 (3.6-6.7) in males, per 100 persons. CC was not associated with most GI pathology, but the odds for constipation were increased in subjects with anal surgery relative to those without (odds ratio (OR) = 3.3, 95% CI 1.2-9.1). In those with constipation vs those without, neurological diseases including Parkinson's disease (OR = 6.5, 95% CI 2.9-14.4) and multiple sclerosis (OR = 5.5, 95% CI 1.9-15.8) showed significantly increased odds for chronic constipation, adjusting for age and gender. In addition, modestly increased odds for chronic constipation in those with angina (OR = 1.4, 95% CI 1.1-1.9) and myocardial infarction (OR = 1.5, 95% CI 1.0-2.4) were observed.
  
  
  CONCLUSIONS
  Neurological and cardiovascular diseases are linked to constipation but in the community constipation is unlikely to account for most lower GI pathology.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
authors.forename: Rok S
authors.initials: RS
authors.lastname: Choung
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA; Division of Gastroenterology and Hepatology, Complutense University, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Rey
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
authors.forename: G
authors.initials: G
authors.lastname: Richard Locke
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA.
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Schleck
authors.affiliation: Takeda Pharmaceuticals North America, Inc., Chicago, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Baum
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA; Faculty of Health, University of Newcastle, Callaghan, Australia.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Talley
keywords: Chronic constipation; co-morbidities; community studies