{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:46:43Z","timestamp":1761562003405},"reference-count":42,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T00:00:00Z","timestamp":1436832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 DK097142"],"award-info":[{"award-number":["K23 DK097142"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic constipation is common and exerts a considerable burden on health\u2010related quality of life and healthcare resource utilization. Anorectal manometry (<jats:styled-content style=\"fixed-case\">ARM<\/jats:styled-content>) and colonic transit testing have allowed classification of subtypes of constipation, raising promise of targeted treatments. There has been limited study of the correlation between physiological parameters and healthcare utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients undergoing <jats:styled-content style=\"fixed-case\">ARM<\/jats:styled-content> and colonic transit testing for chronic constipation at two tertiary care centers from 2000 to 2014 were included in this retrospective study. Our primary outcomes included number of constipation\u2010related and gastroenterology visits per year. Multivariate linear regression adjusting for confounders defined independent effect of measures of colonic and anorectal function on healthcare utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Our study included 612 patients with chronic constipation. More than 50% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0333) of patients had outlet obstruction by means of balloon expulsion testing and 43.5% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0266) had slow colonic transit. On unadjusted analysis, outlet obstruction (1.98 <jats:italic>vs<\/jats:italic> 1.68), slow transit (2.40 <jats:italic>vs<\/jats:italic> 2.07) and high resting anal pressure (2.16 <jats:italic>vs<\/jats:italic> 1.76) were all associated with greater constipation\u2010related visits\/year compared to patients without each of those parameters (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05 for all). Outlet obstruction and high resting anal pressure were also associated with greater number of gastroenterology visits\/year. After multivariate adjustment, high resting anal pressure was the only independent predictor of increased constipation\u2010related visits\/year (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.02) and gastroenterology visits\/year (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>Among patients with chronic constipation, high resting anal pressure, rather than outlet obstruction or slow transit, predicts healthcare resource utilization.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.12628","type":"journal-article","created":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T13:30:33Z","timestamp":1436880633000},"page":"1378-1388","source":"Crossref","is-referenced-by-count":20,"title":["Resting anal pressure, not outlet obstruction or transit, predicts healthcare utilization in chronic constipation: a retrospective cohort analysis"],"prefix":"10.1111","volume":"27","author":[{"given":"K.","family":"Staller","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Massachusetts General Hospital and Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Barshop","sequence":"additional","affiliation":[{"name":"Pritzker School of Medicine University of Chicago Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Kuo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Massachusetts General Hospital and Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. N.","family":"Ananthakrishnan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Massachusetts General Hospital and Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,7,14]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.10.028"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2001.05259.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.02981.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640614528175"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.190"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2010.53"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.11.014"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-006-0814-9"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-011-1702-2"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1010863"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2001.21166"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12278"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01199.x"},{"key":"e_1_2_9_15_1","first-page":"1","article-title":"The economic burden of treatment failure amongst patients with irritable bowel syndrome with constipation or chronic constipation: a retrospective analysis of a Medicaid population","volume":"000","author":"Guerin A","year":"2014","journal-title":"J Med Econ"},{"key":"e_1_2_9_16_1","first-page":"1044","volume-title":"Calculating the Benefits of a Research Patient Data Repository","author":"Nalichowski R","year":"2006"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2982.2002.00352.x"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.03.013"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.10.10.842"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2008.01.006"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2013.10.009"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12297"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12307"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.221"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.10.049"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2004.00526.x"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105310367689"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2006.08.004"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2010.54"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2009.10.005"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12573"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.18"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.07.014"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.119"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.148"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12364"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.05.015"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00791.x"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02054062"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800731031"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11938-001-0054-y"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-6529-x"}],"container-title":["Neurogastroenterology &amp; 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