Background & Aims

Prolonged colon transit times may increase the contact time between potential carcinogens in the stool and the colonic mucosa. Nonetheless, previous studies have yielded conflicting results connecting chronic constipation with the risk of colorectal cancer (CRC). We examined the association between chronic constipation and later CRC.

Methods

In this nationwide case-control study, we identified 41,299 CRC cases by colorectal biopsy in Sweden between July 2007 and December 2016 and matched them to 203,181 age- and sex-matched controls from the general population. We compared odds of earlier chronic constipation (defined as ≥2 laxative prescriptions in the Prescribed Drug Register with ≥6 months between the first and last prescription) between CRC cases and controls using logistic regression. In separate analyses, we compared odds of earlier constipation between CRC cases and sibling comparators, but also examined earlier risk of having an inpatient/outpatient specialty diagnosis of chronic constipation before CRC.

Results

Overall, 3943 patients with CRC met our criteria for chronic constipation before CRC. The crude proportion of chronic constipation in CRC patients was 9.5% compared with 8.8% in controls. After multivariable adjustment, there was a modest association between chronic constipation and later CRC (odds ratio [OR], 1.10; 95% CI, 1.06–1.14) that vanished using sibling comparators to control for residual confounding (OR, 1.04; 95% CI, 0.97–1.13). In a sensitivity analysis of 126,650 CRC patients diagnosed from 1989 to 2016, we found no association with earlier chronic constipation diagnosed in inpatient/outpatient specialty clinics (OR, 0.88; 95% CI, 0.75–1.04).

Conclusions

In a nationwide case-control study, chronic constipation was not associated with later CRC.

中文翻译：

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慢性便秘是结直肠癌的危险因素：全国病例对照研究的结果

背景与目标

结肠通过时间延长可能会增加粪便中潜在致癌物与结肠粘膜之间的接触时间。尽管如此，之前的研究得出了将慢性便秘与结直肠癌 (CRC) 风险联系起来的相互矛盾的结果。我们研究了慢性便秘与后来的结直肠癌之间的关联。

方法

在这项全国性病例对照研究中，我们于 2007 年 7 月至 2016 年 12 月期间在瑞典通过结直肠活检确定了 41,299 例结直肠癌病例，并将它们与来自普通人群的 203,181 例年龄和性别匹配的对照进行匹配。我们使用逻辑回归比较了 CRC 病例和对照之间早期慢性便秘（定义为处方药物登记中≥2 种泻药处方，且第一次和最后一次处方之间间隔≥6 个月）的几率。在单独的分析中，我们比较了 CRC 病例和兄弟姐妹之间早期便秘的几率，但也检查了 CRC 之前住院/门诊慢性便秘专业诊断的早期风险。

结果

总体而言，3943 名 CRC 患者符合我们的 CRC 治疗前慢性便秘标准。结直肠癌患者中慢性便秘的粗略比例为 9.5%，而对照组为 8.8%。经过多变量调整后，慢性便秘与后来的 CRC 之间存在适度的关联（比值比 [OR]，1.10；95% CI，1.06-1.14），使用同级比较器控制残留混杂因素时，该关联消失了（OR，1.04；95% CI，1.06-1.14） ，0.97–1.13）。在对 1989 年至 2016 年诊断的 126,650 名 CRC 患者进行的敏感性分析中，我们发现与住院/门诊专科诊所早期诊断的慢性便秘没有关联（OR，0.88；95% CI，0.75-1.04）。

结论

在一项全国范围的病例对照研究中，慢性便秘与晚期结直肠癌无关。