Patients with irritable bowel syndrome with constipation (IBS-C) who frequently change therapies may experience substantially higher gastrointestinal (GI)-related healthcare resource utilization (HCRU), according to a large observational analysis of U.S. community gastroenterology practices presented at Digestive Disease Week 2026.

The study, based on data collected from 2018 through 2025, identified psychiatric comorbidities, somatic pain disorders, and Medicaid coverage as key predictors of treatment instability and increased healthcare engagement.

Study Findings Show Treatment Instability Drives Resource Use

The analysis included 31,465 adults with IBS-C who had used at least one approved IBS-C therapy, including tenapanor, linaclotide, lubiprostone, or plecanatide, and who had at least one year of follow-up. Data were sourced from nationwide community GI practices.

Patients were followed for a mean of 5.1 years. The cohort had a mean age of 50 years, with women accounting for 85% of participants. White patients represented 41% of the study population.

Researchers found that annual GI-related HCRU averaged 2.8 encounters per patient, driven primarily by regular office visits (49%) and laboratory testing (37%). High utilizers were common: the top tertile experienced more than 3 GI-related encounters annually, while the top 10% exceeded 6 encounters per year.

Treatment modifications were also frequent. Overall, 41% of patients changed IBS-C therapies at least once during follow-up. When only medication type changes were considered, patients averaged one treatment change every 5 years. Approximately 21% of these changes involved medication swaps or add-on therapies.

Importantly, each treatment change was associated with a 9% increase in GI-related HCRU. Portal messaging activity also increased alongside treatment instability. Among the 4935 patients who used patient portals, each treatment change corresponded to an 11% increase in messaging frequency. Similar patterns were observed when both medication type and dose changes were analyzed.

The study further identified several predictors of higher treatment change rates. Patients with psychiatric disorders, somatic pain syndromes, or Medicaid insurance demonstrated approximately 20% higher rates of treatment modification compared with other patients.

Clinical Implications for IBS-C Management

The findings highlight the clinical and operational burden associated with treatment instability in IBS-C management. IBS-C is widely recognized as a chronic disorder of gut-brain interaction, and the association between psychiatric comorbidity and increased treatment switching reinforces the multidimensional nature of the condition.

The data suggest that improving medication persistence could reduce downstream healthcare utilization, including office visits, laboratory testing, and patient portal communications. Early identification of patients at risk for treatment instability may help practices implement targeted interventions such as behavioral health support, closer follow-up, medication counseling, or multidisciplinary care models.

The elevated treatment change rates among Medicaid recipients may also reflect disparities in healthcare access, medication affordability, or adherence challenges. Addressing these barriers could improve continuity of care and reduce resource strain in GI practices.

Increased portal messaging linked to therapy changes may additionally contribute to clinician workload and healthcare system burden, particularly in high-volume gastroenterology practices.

Reference:

Scott L, Fossa A, Staller K, Viswanathan L, Khapra A. Patient factors associated with irritable bowel syndrome with constipation (IBS-C) treatment changes. Presented at: Digestive Disease Week, May 2-5, 2026. Chicago, Illinois.