Background

Functional constipation is a common functional bowel disorder in the community, which has a varying prevalence across cross-sectional surveys. We did a contemporaneous systematic review and meta-analysis of studies using comparable methodology and all iterations of the Rome criteria to estimate the global prevalence of functional constipation.

Methods

In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Embase Classic from Jan 1, 1990, to Dec 31, 2020, to identify population-based cross-sectional studies comprising at least 50 participants that reported the prevalence of functional constipation in adults (age 18 years and older) according to Rome I, II, III, or IV criteria. We excluded studies that reported the prevalence of functional constipation in convenience samples. We extracted prevalence estimates of functional constipation from eligible studies, according to the study criteria used to define it. For each study, we extracted data for country; method of data collection; criteria used to define functional constipation; whether the study used the Rome I, II, III, or IV diagnostic questionnaires or approximated these definitions of the condition using another questionnaire; the total number of participants providing complete data; age; the number of participants with the condition; the number of male and female participants; and the number of male and female participants with the condition. We calculated pooled prevalence, odds ratios (OR), and 95% CIs.

Findings

Of 8174 citations evaluated, 45 studies fulfilled the eligibility criteria, representing 80 separate populations and comprising 275 260 participants. The pooled prevalence of functional constipation was 15·3% (95% CI 8·1–24·4, I²=99·4%) in studies using the Rome I criteria, 11·2% (7·9–14·9; I²=99·6%) in studies that used Rome II criteria, 10·4% (6·5–14·9; I²=99·8%) in those that used Rome III criteria, and 10·1% (8·7–11·6; I²=98·2%) when Rome IV criteria were used. Prevalence of functional constipation was higher in women, irrespective of the Rome criteria used (OR 2·40 [95% CI 2·02–2·86] for Rome I, 1·94 [1·46–2·57] for Rome II, and 2·32 [1·85–2·92] for Rome III; no studies using Rome IV criteria reported prevalence by sex). There was significant heterogeneity between studies in all of our analyses, which persisted even when the same criteria were applied and similar methodologies used.

Interpretation

Even when uniform symptom-based criteria are used to define the presence of functional constipation, prevalence varies between countries. Thus, environmental, cultural, ethnic, dietary, or genetic factors can influence reporting of symptoms. Future studies should aim to elucidate reasons for this geographical variability.

Funding

None.

中文翻译：

---

根据罗马标准，功能性便秘的全球患病率：系统评价和荟萃分析

背景

功能性便秘是社区中常见的功能性肠病，在横断面调查中其患病率各不相同。我们使用可比较的方法和罗马标准的所有迭代对研究进行了同期系统回顾和荟萃分析，以估计功能性便秘的全球患病率。

方法

在这项系统评价和荟萃分析中，我们检索了 1990 年 1 月 1 日至 2020 年 12 月 31 日期间的 MEDLINE、Embase 和 Embase Classic，以确定基于人群的横断面研究，该研究包括至少 50 名报告功能障碍患病率的参与者。根据罗马 I、II、III 或 IV 标准，成人（18 岁及以上）便秘。我们排除了报告便利样本中功能性便秘患病率的研究。我们根据用于定义功能性便秘的研究标准，从符合条件的研究中提取功能性便秘的患病率估计值。对于每项研究，我们提取了国家数据；数据收集方法；用于定义功能性便秘的标准；该研究是否使用了罗马 I、II、III、或 IV 诊断问卷，或使用另一份问卷对病情的这些定义进行近似；提供完整数据的参与者总数；年龄; 有条件的参与者人数；男性和女性参与者的数量；以及患有这种疾病的男性和女性参与者的数量。我们计算了汇总患病率、优势比 (OR) 和 95% CI。

发现

在评估的 8174 篇引文中，45 项研究符合资格标准，代表 80 个不同的人群，包括 275260 名参与者。在使用罗马 I 标准的研究中，功能性便秘的合并患病率为 15·3% (95% CI 8·1–24·4, I ² =99·4%)，11·2% (7·9-14· 9; I ² =99·6%) 在使用罗马 II 标准的研究中，10·4% (6·5–14·9; I ² =99·8%) 在使用罗马 III 标准的研究中，和 10· 1% (8·7–11·6; I ²=98·2%) 当使用罗马 IV 标准时。无论使用何种罗马标准，女性功能性便秘的患病率都较高（罗马 I 的 OR 2·40 [95% CI 2·02-2·86]，罗马的 1·94 [1·46-2·57] II 和 2·32 [1·85–2·92]（罗马 III）；没有使用罗马 IV 标准的研究报告按性别划分的患病率）。在我们所有的分析中，研究之间存在显着的异质性，即使应用相同的标准并使用类似的方法，这种异质性仍然存在。

解释

即使使用统一的基于症状的标准来定义功能性便秘的存在，各国的患病率也不同。因此，环境、文化、种族、饮食或遗传因素会影响症状的报告。未来的研究应旨在阐明这种地理变异的原因。

资金

没有任何。