Gastroenterology

Gastroenterology

Volume 136, Issue 3, March 2009, Pages 741-754
Gastroenterology

Mini-Reviews and Perspectives
Burden of Digestive Diseases in the United States Part II: Lower Gastrointestinal Diseases

https://doi.org/10.1053/j.gastro.2009.01.015Get rights and content

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Endoscopy of the Lower Gastrointestinal Tract

Data on colonoscopy and sigmoidoscopy were obtained from the National Endoscopy Database of the Clinical Outcomes Research Initiative (CORI) for the period 2001–2005. Of the 885,593 procedures performed, 61.3% were colonoscopies and 6.3% were sigmoidoscopies. The frequency of both procedures peaked at age 50–59 years. Among colonoscopies, 85.9% were performed on non-Hispanic whites, 6.4% on non-Hispanic blacks, and 5.3% on Hispanics. Among sigmoidoscopies, 78.2% were performed on non-Hispanic

Cancer of the Small Intestine

Cancer of the small intestine is often considered rare, but in 2004, there were 5,065 new cases diagnosed (exclusive of intestinal lymphomas), or about one third the total number of esophageal cancers or primary liver cancers, and more than the number of gallbladder cancers. The median age of diagnosis was 67 years (http://seer.cancer.gov/csr/1975_2005/results_merged/topic_med_age.pdf), making this the digestive system cancer with the third youngest age of onset (after anal cancer and primary

Cancer of the Colon and Rectum

In 72.5% of cases of CRC diagnosed in 2004, the colon was the anatomic site. By themselves, colon cancers would be the most common digestive system cancer, and rectal cancers the second most common. Together, these cancers were responsible for an estimated 55% of all digestive system cancers diagnosed in 2004. Therefore, trends in CRC largely determine trends in digestive system cancers as a whole.

Two thirds of the 129,000 new cases of CRC were among persons aged ≥65 years. Among the major

Gastrointestinal Infections

Most gastrointestinal (GI) infections are self-limited and do not come to medical attention, although they are both extremely common and disruptive of daily activities, including school and work. In 2004, more than half of ambulatory care visits for GI infections occurred in those <15 years of age (Table 3). When first listed, the rate in this age group (1930 per 100,000 population), was ≥4 times that of any other age group. In contrast with ambulatory care, persons >65 years of age had both

Functional Intestinal Disorders

Chronic constipation and IBS are the most commonly diagnosed functional intestinal disorders. Together, they were responsible for 9.4 million of the 11.6 million outpatient diagnoses for functional disorders and 912,000 of 1.2 million functional disorders listed on hospital discharges. Other functional conditions that were either uncommon or nonspecific were functional diarrhea, neurogenic bowel and megacolon, anal spasm, and other specified and unspecified functional intestinal disorders.

Chronic Constipation

In 2004, constipation was frequently noted at ambulatory care visits either as a first-listed diagnosis (3.1 million visits) or all-listed diagnoses (6.3 million visits; Table 4), which made it the second most common ambulatory care diagnosis after gastroesophageal reflux disease. Persons <15 years of age had the highest number of visits for chronic constipation and nearly as great a rate as persons age ≥65 years. Chronic constipation and GI infections were the 2 most common reasons for

Irritable Bowel Syndrome

In 2004, there were 3.1 million ambulatory care visits with IBS noted as a diagnosis, of which 52.5% were first-listed diagnoses. Unlike constipation, which was common among children, rates of visits with IBS increased with age only in later adulthood from unmeasurable at <15 years to 2179 per 100,000 population at age ≥65 years. Whites had 2.1 times the age-adjusted rate of blacks. The rate of visits among females was 4.4 times that of males, making IBS the digestive disease with the greatest

Abdominal Wall Hernia

The large majority of abdominal wall hernias (AWH) are inguinal hernias, which frequently occur as a result of incomplete closure of the inguinal canal in male infants. Hence, a substantial number of ambulatory care visits occurred among children and the visit rate among males was more than twice the rate of females in 2004 (Table 5). However, among adults, the rate of visits increased progressively with age. Whites had a higher rate than blacks. AWH was the third most common digestive disease

Appendicitis

Being an acute surgical condition, appendicitis was not especially common at ambulatory care visits, but did account for an estimated 600,000 first-listed ambulatory care visits as frequent as for ulcerative colitis (UC) or pancreatitis. Visit rates were nearly equal across age groups up to age 65 years, at which point visits were too uncommon to provide a reliable estimate. Rates were higher among blacks and males. Hospital discharges more accurately reflected disease occurrence. In 2004,

Inflammatory Bowel Disease

Adding data for the 2 principal inflammatory bowel diseases (IBD) of Crohn's and UC results in the number of ambulatory care visits, hospital discharge diagnoses, and deaths for all IBD. Here they are shown individually. Most care for these chronic diseases occurs in the outpatient setting, with hospitalizations reserved for complications that might require surgery. Mortality is relatively uncommon, such that gastroesophageal reflux disease was more commonly listed as an underlying cause of

Crohn's Disease

In 2004, Crohn's disease resulted in an estimated 847,000 first-listed ambulatory care visits and 1.18 million all-listed visits. Although Crohn's disease affects both children and older adults, 82% of visits were among persons between 15 and 64 years of age. The age-adjusted rate was 20% higher among females than males. Crohn's disease was the first-listed diagnosis at 57,000 hospital discharges and was mentioned as another diagnosis on nearly 100,000 other discharges. Rates increased modestly

Ulcerative Colitis

In 2004, there were an estimated 513,000 first-listed ambulatory care visits for UC and 716,000 all-listed visits. Females had a rate 90% higher than males. Visits were not frequent enough among other groups to provide reliable data. Hospitalizations were relatively uncommon, with 35,000 first-listed discharge diagnoses and 82,000 all-listed diagnoses. Ambulatory care rates for UC increased modestly between 1992–1993 and 2003–2005 (Figure 12), but not nearly as much as for Crohn's disease.

Diverticular Disease

In 2004, diverticular disease was the 5th most common reason for ambulatory care visits, after gastroesophageal reflux disease, constipation, AWH, and hemorrhoids. Diverticular disease is generally considered a disease of the elderly, a belief that is consistent with medical care statistics (Table 7). Rates of ambulatory care visits increased with age, such that half of all visits for diverticular disease were for persons age ≥65 years. Age-adjusted rates were 18% higher among whites than

Hemorrhoids

Hemorrhoids are technically classified as diseases of the circulatory system, but are much more often diagnosed and treated by digestive disease specialists than by those with a primary interest in the circulatory system. The treatment of hemorrhoids is primarily in the ambulatory care setting. In 2004, there were an estimated 2 million ambulatory care visits with hemorrhoids as first-listed diagnosis and 3.3 million visits at which hemorrhoids were an all-listed diagnoses (Table 8), which made

Acknowledgments

The authors thank Danita Byrd-Holt, Bryan Sayer, Sanee Maphungphong, Beny Wu, Laura Fang, Laura Spofford, Polly Gilbert, and Julie Kale of Social & Scientific Systems, Inc, for programming and production of tables and figures. David Lieberman and Nora Mattek of the Clinical Outcomes Research Initiative for the national endoscopy data; Dedun Ingram at the National Center for Health Statistics for advice on age adjustment. This second of 3 articles addresses procedures and diseases of the lower

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References (8)

  • Burden of digestive diseases in the United States

    (2008)
  • J.F. Johanson

    Constipation

  • R.S. Sandler

    Irritable bowel syndrome

  • J.E. Everhart

    Abdominal wall hernia

There are more references available in the full text version of this article.

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Conflicts of Interest The authors disclose no conflicts.

Funding Supported by HHS contracts N267200612918C and N267200700001G.

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