IB S IN AMERICA - MultiVu, a Cision company...8 IBS IN AMERICA SUMMARY FINDINGS CONDUCTED BY AGA SURVEY RESULTS IBS SYMPTOMS AND SEVERITY • Overall, those with IBS symptoms report

IBS IN AMERICASURVEY SUMMARY FINDINGS DECEMBER 2015

CONDUCTED BY AGA

THE “IBS IN AMERICA” SURVEY – the most comprehensive survey of both patients and physicians ever conducted – was commissioned by the American Gastroenterological Association (AGA) and conducted with the financial support of Ironwood Pharmaceuticals, Inc. and Allergan plc. Online surveys were conducted by GfK, Sept. 14 through Oct. 29, 2015. In total 3,254 IBS sufferers, both diagnosed and undiagnosed, as well as 302 physicians who treat IBS patients – 151 primary care physicians and 151 gastroenterologists – were interviewed.

Dear reader,

Sincerely,

DR. ANDREA SHIN AND DR. ANTHONY LEMBO American Gastroenterological Association

Irritable bowel syndrome (IBS) is estimated to impact nearly 35 million Americans and causes recurring abdominal pain and constipation or diarrhea. Symptoms are so bothersome that some sufferers report that they would be willing to give up caffeine or even sex for one month in order to obtain a month’s relief from symptoms.

As the trusted voice of the gastrointestinal (GI) community, AGA is committed to arming health-care providers with the tools and resources they need to better understand, diagnose and treat GI conditions, like IBS. It’s been 10 years since a comprehensive survey delved into IBS; therefore AGA, with support from Allergan plc. and Ironwood Pharmaceuticals, Inc. conducted the “IBS in America” survey in an effort to better understand the physical, emotional and social impact of this condition.

The survey made it apparent that the symptoms of IBS are often so bothersome and unpredictable that they interfere with daily life at home, at work and school, and many people suffer for years before seeing a doctor. AGA recommends sufferers Speak Up Early, Completely and Often:

1. Speak Up Early: Instead of suffering in silence or taking advice from people who aren’t health-care professionals, talk to a doctor about recurring abdominal pain and bowel symptoms.

2. Speak Up Completely: Instead of just saying “I have constipation” or “I have diarrhea,” tell a doctor about the full extent of your symptoms, how they impact your life and what approaches you’ve already tried to manage them.

3. Speak Up Often: Tell a doctor if symptoms return despite treatment efforts so that he or she can assess alternative treatments.

With this feedback, doctors are better equipped to help patients navigate their own IBS treatment path. We sincerely believe that a more complete understanding of IBS is possible and, it is our expectation that the results of this landmark “IBS in America” survey will ultimately lead to changes in how IBS is treated.

IBS IN AMERICA SUMMARY FINDINGS | CONDUCTED BY AGA 4

KEY FINDINGS

1. Instead of suffering in silence or taking advice from people who aren’t health-care professionals, talk to a doctor about recurring abdominal pain and bowel symptoms.

2. Instead of just saying “I have constipation” or “I have diarrhea,” tell a doctor about the full extent of symptoms, how they impact life, and what approaches have already been tried to manage them.

3. Tell a doctor if symptoms return despite treatment efforts so they can assess alternatives.

With this feedback, doctors are more likely to be able to help their patients successfully navigate their own IBS treatment path.

SPEAK UP EARLY, COMPLETELY AND OFTEN

FROM SELF-HELP TOCOMMUNICATION Talking to a doctor, not your BFF, is half the battle. Have an honest, open conversation with your doctor, early and often.

RECOGNIZE THE DAILY BURDENAbdominal pain, constipation, diarrhea, bloating or cramping can be dif f icult to predict and impact people physically, emotionally and socially.

REPLACE SPECULATION WITH SCIENCEIBS sufferers of ten take advice from family and friends … but wait to see a doctor.

8 IN10YET Have DISCUSSED

IBS with someone in addition to a doctor –PRIMARILY THEIR FAMILY OR FRIENDS

67% EXPERIENCE SYMPTOMSFor 1+ YEAR before seeing a doctor

2 MISSED DAYS of school / work9 DAYS of impacted productivity

EACH MONTH, ON AVERAGEIBS LEADS TO

NEARLY

1 IN4Report they are “NOT ATALL” ABLE TO ACCURATELY PREDICT if they will experience symptoms on any given day

23

of those who’ve spoken with a doctor are SOMEWHAT/VERY SATISFIED WITH THEIR CARE

Between doctors and patients is the SECOND-MOST-COMMON ANSWER

COMMUNICATION

from physicians when asked what is LACKING IN THE TREATMENT OF IBS

TWO COMMON TYPES OF IRRITABLE BOWEL SYNDROME (IBS) INCLUDE:35M AMERICANS IMPACTED

7 th MOST COMMON DIAGNOSISBY PRIMARY CARE PHYSICIANS

IBS with diarrhea (frequentloose stools, often with an urgent need to go)

IBS with constipation (difficult or infrequentbowel movements)

IBS-C IBS-D


A chronic condition, IBS consists of a constellation of gastrointestinal (GI) symptoms, such as abdominal pain, constipation, diarrhea, gassiness, bloating, urgency or cramping.

IBS is a serious, chronic condition that affects 35 million people in the U.S. It is the seventh most common diagnosis among all physicians and the most common diagnosis made by gastroenterologists. However, due to the acceptance of GI symptoms as “normal” and a variety of potential diagnoses, it remains misunderstood.

Some people with IBS have constipation (difficult or infrequent bowel movements), referred to as IBS-C, while others may have diarrhea (frequent loose stools, often with an urgent need to move the bowels), or IBS-D. People may also experience both, and over time, diarrhea and constipation can even alternate.

IBS is usually diagnosed after doctors identify certain symptoms that are typical for the condition and are pres-ent after excluding other diseases. Recently, the use of specific symptom criteria (known as the Rome Criteria) has helped physicians make a diagnosis of IBS with more confidence. In addition, many will conduct a physical examination and order other diagnostic procedures, such as laboratory tests, X-rays or a colonoscopy, to find out if there is another disease present.

The cause of IBS is unknown, and likely there are many causes. As a result, there is no one treatment for everyone. The good news is that IBS does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to life-threatening disease, such as cancer.

Sometimes IBS is just a mild annoyance, but for some people it can truly be disabling. As our survey showed, they may be afraid to go to social events, to go out to their job or to travel even short distances. Most people with IBS, however, are able to control their symptoms through diet, stress management and, sometimes, with medications prescribed by their doctor.

DEFINING IBS

IBS SYMPTOMS AND SEVERITY

SURVEY RESULTS


SURVEY RESULTSIBS SYMPTOMS AND SEVERITY

7

Do your GI symptoms come and go? How long do you remain symptom-free? Can you predict your symptoms on a daily basis?

• Nearly one in four (22 percent) respondents report that they are “not at all” able to accurately predict if they will experience symptoms on any given day.

• A majority of both IBS-C and IBS-D patients report that they can at least somewhat accurately predict whether or not they will experience symptoms on a given day.

• Compared to diagnosed patients, fewer of both undiagnosed IBS-C and IBS-D sufferers report that they can at least somewhat accurately predict whether or not they will experience symptoms on a given day. In fact, about three in 10 say they cannot at all accurately predict.

Predicting IBS Symptoms

Base: Total respondents, (N=3254); Diagnosed IBS-C (N=1000), Diagnosed IBS-D (N=1001), Undiagnosed IBS-C (N=667), Undiagnosed IBS-D (N=586)

Extremely accurately Very accurately Somewhat accurately A little accurately Not at all accurately

IBS symptoms, including abdominal pain, constipation, diarrhea, bloating, urgency and cramping, are bothersome for sufferers and may be unpredictable from day to day.KEY

TAKEAWAY

7

10

5

6

3

18

23

13

19

10

33

36

30

34

30

20

17

22

20

25

22

14

29

21

32

Total

IBS - C Diagnosed

IBS - C Undiagnosed

IBS - D Diagnosed

IBS - D Undiagnosed



• Overall, those with IBS symptoms report that their symptoms sometimes come and go, but most are only symptom-free for a few days or less.

• Most IBS-C and IBS-D patients are only symptom-free for a few days or less.

• A majority of both undiagnosed IBS-C and IBS-D patients are only symptom-free for a few days or less.

Ever Symptom Free?

Do your gastrointestinal symptoms ever come and go?

How long do you remain symptom-free before symptoms return?


Yes

No

A few hours A few days

A few weeks A few months

10

11

6

11

9

66

70

68

65

62

22

17

25

22

26

2

2

1

2

3

Total

IBS-C Diagnosed

IBS-C Undiagnosed

IBS-D Diagnosed

IBS-D Undiagnosed

83

17

Total

75

25

Diagnosed IBS-C

88

12

Undiagnosed IBS-C

85

15

Diagnosed IBS-D

90

10

Undiagnosed IBS-D



Which of the following symptoms have you experienced during the past 12 months?

Asked about a list of symptoms:

• A majority of diagnosed and undiagnosed IBS-C patients report experiencing all within the last year, with constipation and abdominal discomfort the most common.

• Among IBS-D diagnosed and undiagnosed patients, a majority report experience with all (except loss of bowel control), with abdominal pain and loose watery stools most common.

Experience with IBS Symptoms


Diagnosed IBS-C Diagnosed IBS-DUndiagnosed IBS-C Undiagnosed IBS-D

92

96 Constipation

93

89

Abdominal discomfort

88

77

Abdominal pain

79

76 Bloating

77

73 Straining

77

68

Infrequent stools

75

68

Hardlumpy stools

50

39 Nausea

3

3 Other

94

90

Abdominal pain

90

87

Loose watery stools

86

80

Cramping

86

72

Frequency of bowel

movements

81

71

Urgency

72

64

Bloating

37

24

Loss of bowelcontrol / fecal incontinence



Diagnosed IBS-C Undiagnosed IBS-C

How frequently did you experience each GI symptom during the past three months?

• A majority of IBS-C patients experience bloating, infrequent stools and constipation at least four to six days per week. Compared to the diagnosed, fewer undiagnosed IBS-C sufferers report experiencing symptoms as frequently as four to six times a day or more. The plurality experience most symptoms two to three days per week.

• A majority of IBS-D patients experience frequency of bowel movements at least four to six days per week. Compared to the diagnosed, fewer undiagnosed IBS-D sufferers report experiencing symptoms as frequently as four to six times a day or more.

Every day 4-6 days per week 2-3 days per week 1 day per week 1-2 days per month

16 18 42 15 9 Infrequent

stools

25 26 34 11 4 Bloating 15 19 35 17 13 Bloating

23 29 34 11 3 Infrequent

stools

9 18 39 23 11 Abdominal discomfort

22 30 33 10 5 Constipation 8 18 39 20 15 Constipation

20 28 37 11 4 Abdominal discomfort

6 15 39 28 12 Straining

16 25 36 15 8 Abdominal

pain

5 15 40 26 14 Hard lumpy

stools

13 28 39 14 6 Straining

5 15 36 25 19 Abdominal

pain

12 14 33 20 21 Nausea 3 10 21 24 42 Nausea

9 28 40 16 7 Hard lumpy

stools



Base: Respondents who have the following symptoms; Diagnosed IBS-C (bases vary), Diagnosed IBS-D (bases vary), Undiagnosed IBS-C (bases vary), Undi-agnosed IBS-D (bases vary)

Diagnosed IBS-D Undiagnosed IBS-D

4 8 17 20 51 8 13 19 18 41

24 18 32 19 7 25 27 33 9 6 Frequency

of bowelmovements

Frequencyof bowel

movements

10 18 36 20 16 18 24 38 12 8 BloatingBloating

10 17 34 22 17 15 25 36 15 8 Urgency Urgency

7 19 36 23 15 14 24 38 15 9 Loosewaterystools

Loosewaterystools

Loss of bowelcontrol / fecalincontinence

6 14 42 24 14 13 26 36 18 8 Abdominal

pain Abdominal

pain

5 13 34 26 22 12 21 36 20 11 Cramping Cramping

Loss of bowelcontrol / fecalincontinence

Every day 4-6 days per week 2-3 days per week 1 day per week 1-2 days per month



Which GI symptoms are most bothersome (option to choose top three – IBS-C and D separate options)?

• For IBS-C patients and undiagnosed sufferers, constipation is, by far, the most bothersome symptom.

• For IBS-D patients and undiagnosed sufferers, loss of bowel control/fecal incontinence is, by far, the most bothersome symptom. Bloating is among the least bothersome symptoms.

Most Bothersome IBS Symptoms

Base: Respondents who have the following symptoms; Most bothersome - Diagnosed IBS-C (N=992), Diagnosed IBS-D (N=995), Undiagnosed IBS-C (N=661), Undiagnosed IBS-D (N=575)


44

27

12

10

6

6

5

3

23

35

31

17

15

8

7

7

5

29

Constipation

Abdominal pain

Bloating


Hard lumpy stools

Straining

Nausea

Infrequent stools

Other

49

26

24

17

15

5

6

51

26

30

21

14

12

8

Loss of bowel control / fecal incontinence

Abdominal pain

Urgency

Loose watery stools

Frequency of bowel

movements

Bloating

Cramping



Currently, how bothersome are your GI symptoms on your quality of life?

• Most respondents (52 percent) report that their IBS symptoms are extremely/very bothersome in terms of their quality of life, with nearly one in five saying that the symptoms are extremely bothersome and one-third saying they are very bothersome.

• One-quarter of both diagnosed IBS-C patients and IBS-D patients report that their symptoms are extremely bothersome in terms of their quality of life; about four in 10 say they are very bothersome.

• Compared to the diagnosed, fewer undiagnosed sufferers characterize their symptoms as extremely or very bothersome, with a plurality of IBS-C and IBS-D sufferers reporting that they are somewhat bothersome in terms of their quality of life.

IBS Symptoms and Severity


Extremely bothersome Very bothersome Somewhat bothersome A little bothersome Not at all bothersome

18 34 36 11

24 40 31 5

9 28 43 20

24 35 33 7

8 27 43 20 1

Total

IBS - C Diagnosed

IBS - C Undiagnosed

IBS - D Diagnosed

IBS - D Undiagnosed

THE IMPACT OF IBS ON PATIENTS

SURVEY RESULTS


SURVEY RESULTSTHE IMPACT OF IBS ON PATIENTS

15

PRODUCTIVITY AND DAILY LIFE

In a typical month, how many days do symptoms interfere with your productivity or ability to participate in a personal activity or do you miss work or school?

• Overall, those with IBS symptoms report that these symptoms, interfered with their productivity and performance, on average, nine days per month, and caused those respondents to miss school/work two days per month, on average.

Impact of IBS on Daily Productivity

How many days do these symptoms interfere with

your productivity?

How many days do these symptoms interfere with your ability to participate

in a personal activity?

About how many days do you miss work or school because of

your gastrointestinal symptoms?

IBS symptoms have a significant impact on people’s day-to-day lives and impact people physically, emotionally and socially.KEY

TAKEAWAY

Average ~ 9 days Average ~ 8 days

62 10 or less 68 10 or less 59 10 or less

19 between 11 and 20 14 between

11 and 20 between

11 and 20

8 more than 20 6 more than 20 more than 20

Average ~ 8 days ~ 2 days

Base: Total respondents, (N=3254) Base: Total respondents, (N=3254) Base: Those whose symptoms interfere with productivity, (N=2465)



Honesty About IBS Symptoms

When you miss an activity/call in sick, do you tell people that you were experiencing GI symptoms or tell them it was something else?

• Three in 10 of those with IBS symptoms make an excuse when they miss work or an activity, though a majority will explain it was a gastrointestinal issue without mentioning specific symptoms.

Base: Miss more than one day of work or school in a typical month, (N=667)

31

57

Say it was a gastrointestinal issue,

do not mention specific symptoms

Say it was something else, e.g., headache,

cold, etc.

12 Explain actual

symptoms



Please indicate if you strongly agree, somewhat agree, somewhat disagree or strongly disagree with the following statements (how symptoms make people feel or what they have avoided).

• One-third of those with IBS symptoms say they avoid situations where there isn’t a nearby bathroom. Almost three in 10 say their symptoms make them feel like they’re “not normal” and that they don’t feel like themselves.

• A majority of IBS-D patients say they avoid situations where there isn’t a nearby bathroom.

• More than one-third of IBS-C patients say their symptoms make them feel like they’re “not normal” and that they don’t feel like themselves.

Effect of IBS Daily Life Choices

Base: Total respondents, (N=3254)

34

28

28

25

23

23

23

22

22

22

20

20

12

11

I avoid situations where there won't be a nearby bathroom

My symptoms make me feel like I'm ''not normal''

I don't feel like myself

I feel embarrassed that others notice I am in the bathroom a lot

My symptoms cause me to stay home more often

My symptoms cause me to travel less

I am jealous of others who aren't dealing with my symptoms

My symptoms make me feel self-conscious about how I look

I have avoided sex becauseof my symptoms

It is difficult to plan things as I never knowwhen my symptoms will act up

My symptoms prevent me from enjoying my daily activities

I feel my symptoms prevent me from reaching my full potential

I spend less time with family and friends as a result of my symptoms

I have been told that I don't seem attentive when suffering from my symptoms



Emotions Regarding IBS


EMOTIONAL IMPACT

When your GI symptoms are bothering you, how does that make you feel?

• The most common emotion expressed by those with IBS symptoms is “frustrated,” cited by three-quarters of the respondents. Close to half say they feel “self-conscious.”

74 Frustrated

48 Self-conscious

39 Embarrassed

37 Fed up

34 Depressed

28 Accepting, just part of my life

20 Angry

18 Lacking answers

4 Fine, it is no big deal

4 Other

1 None of the above

SEEKING HELP AND A DIAGNOSIS

SURVEY RESULTS


SURVEY RESULTSSEEKING HELP AND A DIAGNOSIS

What is lacking in treatment of patients?

• The doctor-patient conversation could be improved. In fact, when physicians were asked what is most lacking in the treatment of IBS, the second-most-common answer was communication between doctors and patients.

Base: Total respondents, (N=302), PCP (N=151), GIs (N=151)

What do you feel is most lacking in the treatment of IBS? The doctor-patient conversation could be improved. In fact, when physicians were asked what is most lacking in the treatment of IBS, the second-most-common answer was communication between doctors and patients.

Rank 1

Most Lacking in IBS Treatment

23

15

12

11

11

10

10

9

Biomarkers to guide treatment

Patient-HCP communication

Effective relief of diarrhea/constipation

Availability of treatment options

Treatment algorithms

Effective relief of abdominal pain

Disease awareness

Management guidelines

What do you feel is most lacking in the treatment of IBS? The doctor-patient conversation could be improved. In fact, when physicians were asked what is most lacking in the treatment of IBS, the second-most-common answer was communication between doctors and patients.

Rank 1


23

15

12

11

11

10

10

9

Biomarkers to guide treatment

Patient-HCP communication

Effective relief of diarrhea/constipation

Availability of treatment options

Treatment algorithms

Effective relief of abdominal pain

Disease awareness

Management guidelines





Where do you go to get information about IBS and available treatments?

• The overwhelming majority of diagnosed IBS-C and IBS-D patients report getting information about IBS from their doctor.

• Among both undiagnosed IBS-C and IBS-D sufferers, doctors place third as information sources about IBS.

IBS-C IBS-D


KEY TAKEAWAY

People are talking about their symptoms, but not always having the right conversations with the right people.

Your doctor

WebMD/MayoClinic

Google/other search

Family

Friends

Articles in newspapers

TV

Pharmaceutical/Healthcare

Specific product website

Facebook/Twitter/other

Medical specialty society

Advocacy group

Other

83

66

47

27

23

16

13

14

13

10

4

2

2

43

59

44

25

16

11

7

6

5

3

1

1

6

Your doctor

WebMD/MayoClinic

Google/other search

Family

Friends

Articles in newspapers

TV

Pharmaceutical/Healthcare

Specific product website

Facebook/Twitter/other

Medical specialty society

Advocacy group

Other

87

68

45

27

21

18

7

10

8

5

3

2

38

63

46

21

17

10

6

3

3

2

1

1

6

5



Discussing IBS


SUPPORT FROM FAMILY AND FRIENDS

Who, if anyone, have you discussed your GI symptoms with, other than your doctor? Overall, how supportive have they been about your symptoms (if you’ve told someone)?

• In addition to discussing IBS with their doctor, most commonly, those with IBS symptoms have talked about IBS with their spouse/partner. Fewer, nearly four in 10, have talked about it with friends. A majority report that people have been very (52 percent) or somewhat supportive (40 percent).

54 Spouse/partner

38 Friends

30 Parents/in-laws

17 Kids

11 Significant other/

person you are dating

9 Coworkers

6 Therapist

4 Boss

6 Other

15 No one

Top Box:Strongly Agree



Please indicate to what extent you agree or disagree with the following statements about people who are aware of your symptoms (whether they understand/help/are supportive).

• Overall, those with IBS symptoms seem to report a good amount of support and understanding among friends and family.

• Just one-quarter strongly agree that “it is difficult for other people to understand my symptoms.” IBS-C and IBS-D patients report a fair amount of support and understanding among friends and family, however, about one-third or more strongly agree that others expect that eating, exercising and motivation will make them feel better.

Others’ Perceptions of IBS


30 People think I can improve my condition

by eating better, exercising and just motivating myself to feel better

26 It is difficult for other people to understand my symptoms

23 People think I am fine and I can keep up with things just as well as everyone else

20 People think I am just too stressed out

14 People don't understand why I miss out on family activities and special events

12 Family and friends don't always believe

me when I talk about my symptoms or how they limit my activities



Have you received any advice on the cause of your symptoms or remedies to try to alleviate the symptoms from any of these people? Have you followed their advice?

• A majority of IBS sufferers receive advice from friends and family, and nine in 10 say that have followed this advice.

Total

Received Advice

Followed Advice

Base: Told at least one person about gastrointestinal symptoms

Yes

Yes

No

No

Don’t know

Top Box: Strongly Agree

59 39 2 Total

(N=2757)

90 10 Total

(N=1625)



IBS Symptoms: Typical First Response


SELF-TREATMENT

When you start experiencing GI symptoms, what do you typically do?

• Overall, a majority of those with IBS symptoms say that their typical first response when they start to experience gastrointestinal symptoms is to wait and see if the symptoms will go away or alleviate themselves.

KEY TAKEAWAY

Talking to the right person is half the battle; the other half is having an honest, open conversation with a health-care professional, telling them about the full extent of symptoms, their impact, and what approaches have already been tried to manage them.

61

22

8

6

4

Wait and see if the symptoms will go away or alleviate themselves

Immediately take an over-the-counter medication

Immediately take a prescription medication

Try other relaxation techniques or stress management techniques

Try other nontraditional therapies



Before you spoke to an HCP about your symptoms, did you try taking any OTCs? How many (overall and in an average month) and for how long?

• Overall, three-quarters of those with IBS symptoms tried OTC products before they spoke to a health-care professional about symptoms, reporting that they tried an average of 3.6 OTC products. A majority report taking OTC meds for a year or less before consulting a doctor.

First Trying OTC Products

Total

Base: Saw at least one health-care professional, (N=2674)

Less than six months Six months to one year

One to five years Five to 10 years

10-20 years 20+ years

Yes

No

Have tried to take any over-the-counter products

to manage symptoms?

How long did you take the OTC meds before discussing symptoms with a doctor?

77%

23%

How many over-the-counter medications have your tried?

Average:3.6 over-the-counter medications

29 28 27 10 4 2



GETTING TO A HEALTH-CARE PROFESSIONAL

Which of the following symptoms ultimately led you to speak to an HCP?

• Three-quarters of diagnosed IBS-C patients cite constipation and abdominal pain as the symptoms ultimately leading them speak to a health-care professional. Among the undiagnosed who have seen a health-care professional, half of IBS-C sufferers cite constipation and abdominal pain as the symptoms ultimately leading them to speak to a health-care professional.

• Among diagnosed IBS-D patients, seven in 10 cite abdominal pain, and two-thirds mention loose watery stools as the symptoms ultimately leading them to speak to a health-care professional. Among undiagnosed IBS-D sufferers who’ve spoken with a health-care professional, close to six in 10 cite abdominal pain, and about four in 10 mention loose watery stools.

Symptoms That Led to Treatment

Diagnosed IBS-C Undiagnosed IBS-C Diagnosed IBS-D Undiagnosed IBS-D

77

76

64

43

39

36

37

26

6

51

50

45

27

24

20

14

11

10

Constipation

Abdominal pain


Bloating

Straining

Hard lumpy stools

Infrequent stools

Nausea

Other

70

67

58

53

53

30

27

5

58

42

36

32

23

20

14

10

Abdominal pain

Loose watery stools

Frequency of bowel movements

Cramping

Urgency

Loss of bowel control/ fecal incontinence

Bloating

Other

% of persons who saw at least one health-care professional for Diagnosed IBS-C, (N=976) % of persons who saw at least one health-care professional for Undiagnosed IBS-C, (N=405)

% of persons who saw at least one health-care professional for Diagnosed IBS-D, (N=986) % of persons who saw at least one health-care professional for Undiagnosed IBS-D, (N=307)



How long did you experience symptoms before you went to see a doctor?

• Though one-quarter of IBS-C and IBS-D patients report being diagnosed within one year of first experiencing symptoms, among both groups, it took patients an average of four years to be diagnosed.

• One-third of IBS-C and IBS-D patients say they experienced GI symptoms for less than one year before going to a doctor.

• However, nearly four in 10 IBS-C and IBS-D patients waited more than three years before seeing a doctor about their symptoms.

Length of Symptoms Before Diagnosis


Less than one year One to two years Three to five years Five to 10 years More than 10 years

34 29 17 10 11



Bringing Up Symptoms

Base: Saw at least one health-care professional (N=2674); Diagnosed IBS-C (N=976), Diagnosed IBS-D (N=986), Undiagnosed IBS-C (N=405), Undiagnosed IBS-D (N=307)

% of health-care professional asked about gastrointestinal symptoms during check-up, (N=75)

I was proactive in bringing the issue up to my doctor

I waited for my doctor to ask me questions

Some other way

Don’t recall

Has an HCP ever asked you about GI symptoms or regularity during an annual check-up or exam? Did you tell your HCP about the GI symptoms you were having? What are the reasons that prevented you from telling your HCP about your GI symptoms or issues?

Among the subset who have never sought treatment for their GI symptoms (18 percent), most say that a health-care professional didn’t ask about their GI symptoms during an annual checkup. Among those who were asked, respondents were evenly split on whether they told their HCP about their symptoms.

TotalDid you tell your health-care

professional about the gastrointestinal symptoms

you were having?

Has a health-care professional ever asked you about gastrointestinal symptoms or regularity during an

annual check-up or exam?

YesYes NoNo Don’t rememberDon’t remember

THE CONVERSATIONS WITH THE HEALTH-CARE PROFESSIONAL

Which of the following best describes how your doctor has learned about your symptoms?

• Overall, more than eight in 10 of those with IBS symptoms said they were proactive in bringing their IBS symptoms up with their doctor.

81 12 2 5

13%

71%

16%

39 40 21



How many HCPs have you ever seen or spoken to about your symptoms? How many in the past 12 months?

• Overall, those with IBS symptoms have seen or spoken to an average of two doctors in the past 12 months about their GI symptoms.

• Between one in four and one in five have not consulted a doctor.

Number of Health-care ProfessionalsConsulted in Last Year


14

38

27

17

4

None

1 professional

2 professionals

3 or more professionals

don't know

Average ~ 2

Don’t know



27

15

12

12

10

8

8

7

24

17

11

15

12

9

6

7

31

7

13

18

7

8

12

3

27

19

11

8

11

8

9

9

36

9

16

9

6

7

8

8

I didn't think my symptoms were severe enough to seek medical attention

I didn't think there was anything they could do to help me

I didn't think my symptoms were important enough to bring them up with my doctor

I have other health conditions that take priority over my constipation symptoms

It was too embarrassing

I feel like this is a problem I should deal with on my own

I have learned to deal with it on my own

Other

What reason best describes why you waited to talk to your HCP?

• Before deciding to see a doctor, the most common reason that respondents delayed was that they didn’t think their symptoms were severe enough to seek medical attention.

Deciding to See a Doctor

Base: Saw at least one health-care professional (N=2674); Diagnosed IBS-C (N=976), Diagnosed IBS-D (N=986), Undiagnosed IBS-C (N=405), Undiagnosed IBS-D (N=307)

Total Diagnosed IBS-C Undiagnosed IBS-C Diagnosed IBS-D Undiagnosed IBS-D



When you did seek the care of an HCP, which of the following best describes how he/she recommended treating your symptoms?

• The most common treatment recommendation made to those with IBS symptoms was to adjust their diet, cited by two-thirds, followed by trying probiotics/supplements, cited by nearly four in 10, and increasing activity/exercise by one-third.

• One exception, IBS-C patients were advised to adjust their diet (65 percent), increase their activity/exercise (43 percent) and start a prescription medicine (41 percent).

Most Common Recommended Treatment


39

33

17

17

17

13

6

5

3

1

Adjust diet

Try probiotics or other supplements

Increase activity or exercise

Continue with the non-prescription medicine you started

Start a new non-prescription medicine (OTC)

Start a prescription medicine approved by the FDA for IBS-C

Continue with the non-prescription medicine you started, but take it in a different way

I do not remember what my doctor recommended

My doctor didn't recommend anything

Seek counseling

My doctor let me know there was nothing to be done

65



Overall, how satisfied are you with the care you have received from the HCP(s) you’ve spoken to about your GI symptoms?

• A majority of those with IBS symptoms are very/somewhat satisfied with the care they are receiving. Nearly seven in 10 patients are very/somewhat satisfied with the care they are receiving from the health-care professional they have spoken to about their symptoms.

How satisfied are you with the care you have received from the health-care professional?

Overall, how well do you think your HCP understands how bothersome your symptoms are?

• About half feel their doctor understands extremely/very well how bothersome their symptoms are. A plurality of those with undiagnosed IBS-C and IBS-D, also say they feel that their health-care professional understands only somewhat well how bothersome their symptoms are.

How well do you think your health-care professional understands how bothersome your symptoms are?

Very satisfied

Extremely

Somewhat satisfied

Very well

Neither satisfied or dissatisfied

Somewhat well

Somewhat dissatisfied

Not very well

Very dissatisfied

Not at all


6

11

17

39

26

5

17

29

31

18



Diagnosed IBS-C Diagnosed IBS-D

Base: Respondents diagnosed with IBS-C or IBS-D, Diagnosed IBS-C (N=976), Diagnosed IBS-D (N=986)

Less than one year Less than one year

One to two years One to two years

Three to five years Three to five years

Five to 10 years Five to 10 years

More than 10 years More than 10 years

GETTING TO A DIAGNOSIS

How long did you experience symptoms before you were diagnosed (includes both IBS-C and D)?

• Though one-quarter of IBS-C and IBS-D patients report being diagnosed within one year of first experiencing symptoms, among both groups it took patients an average of four years to be diagnosed.

Average ~ 4 years

14

10

22

30

25

Average ~ 4 years

12

12

22

29

25

TREATMENT AND SATISFACTION

SURVEY RESULTS


SURVEY RESULTSTREATMENT AND SATISFACTION

54 44

47 29

51 33

61 11

57 41

57 25

59 8

48 3

49 7

47 4

25 3

32 -

48 1

50 -

80 3

93 3

12 18

60

48

50

37

28

26

3

12

8

6

4

1

2

4

4

3

Taking fiber

52 Taking non-prescription laxatives

Stool softeners

Home remedies

Increase exercise

Other diet changes

Herbs, vitaminsTaking prescription medicines

FDA approved for IBS-C Using meditation, relaxation or

other stress management techniques

Gluten-free diet

Taking prescription laxativesAccessed online or in-person

education programs Using nontraditional therapies

such as chiropractic care,acupuncture, homeopathy

Seek counseling

Taking other prescription medications

Taking other non-prescription medications

Nothing

Ever Tried Tried Past

Month

54 57

55 43

57 44

51 14

56 46

42 27

51 11

47 27

40 12

40 7

31 12

17 1

32 4

25 4

65 4

74 2

4 3

76

68

53

49

35

31

29

22

15

17

12

11

7

6

4

1

Taking fiber

Stool softeners

Home remedies

Increase exercise

Other diet changes

Herbs, vitamins

Taking prescription medicines FDA approved for IBS-C

Using meditation, relaxation or other stress management

techniques Gluten-free diet

Taking prescription laxativesAccessed online or in-person

education programs Using nontraditional therapies

such as chiropractic care,acupuncture, homeopathy

Seek counselingTaking other prescription

medications Taking other non-prescription

medications

Nothing


Month Recom-mended

Recom-mended

70 Taking non-prescription laxatives

KEY TAKEAWAY

Specific Treatments Tried

IBS-C

How many treatments have you ever tried? How many in the past month? How many were recommended by a doctor?

• IBS-C patients have most commonly taken fiber, non-prescription laxatives and stool softeners, all cited by close to seven out of 10 or more, with doctors most often recommending fiber. Among the undiagnosed IBS-C sufferers have most commonly taken fiber and non-prescription laxatives, and increased exercise, all cited by half or more, with doctors most often recommending fiber.


Treating IBS is challenging as treatment is based on an individual’s predominant symptoms. It isn’t “one size fits all” leading to great dissatisfaction with current treatment options and underscoring the importance of communication between doctors and patients.

Base: Respondents with IBS-C, Diagnosed (N=976), Undiagnosed (N=405)

Doctor



IBS-C Respondents’ Use of Laxative/Stool Softeners

If you ever tried stool softeners, laxatives or prescription laxatives, how long did you take them?

• IBS-C respondents who have used laxatives or stool softeners were asked in detail about their use. Most say they do not limit how often they use these products.


Base: IBS-C respondents, Diagnosed IBS-C (N=853), Undiagnosed IBS-C (N=441) and have used laxatives or stool softeners

One to three days One to three days

One week One week

Two weeks Two weeks

A month A month

There’s not time limit There’s not time limit

66

4 4

9

17

52

6

5 5

32



Satisfaction with Specific Treatments

For each treatment you’ve tried, how satisfied are you when you take them?

• Just one-quarter or fewer IBS-C patients are “very satisfied” with treatments – prescription medicines approved for IBS-C, counseling, and non-prescription medicines get highest marks. Among undiagnosed, few IBS-C and IBS-D sufferers say they are “very satisfied” with treatments. IBS-C sufferers express most satisfaction for prescription medicines and non-prescription medicines.


Base: IBS-C respondents, Diagnosed IBS-C (N=853), Undiagnosed IBS-C (N=441) and have used laxatives or stool softeners

% saying “very satisfied”

26

24

23

21

17

17

14

14

13

13

12

12

10

10

7

9

Taking prescription meds FDA approved for IBS-C

Seek counseling

Taking other non-prescription meds

Taking other prescription meds

Taking prescription laxatives

Gluten-free diet

Using stress management techniques

Taking non-prescription laxatives

Using nontraditional therapies

Taking fiber

Herbs, vitamins

Exercise

Accessed online or in-personeducation programs

Stool softeners

Home remedies

Other diet changes

40

36

21

19

17

16

15

15

13

12

11

11

10

8

12




Taking prescription meds FDA approved for IBS-C

Herbs, vitamins


Exercise


Gluten-free diet

Taking non-prescription laxatives

Taking fiber

Stool softeners

Taking prescription laxatives

Home remedies

Other diet changes



35

30

41

31

25

14

7

2

12

4

10

1

5

1

2

39

13

59 14

42 25

53 10

66 34

46 7

52 9

64 2

29 1

57 4

79 5

78 7

75 1

14 1

20 2

44 1

50 1

64 36

11 25

58

51

42

34

33

26

24

25

13

14

7

11

7

7

7

1

47

2

62 34

45 41

38 11

67 38

46 12

58 20

62 14

38 14

50 5

74 12

69 4

45 10

22 2

39 6

35 5

50 1

63 46

7 8

Taking Imodium

Taking fiber

Taking Pepto Bismol

Exercise

Taking GasX

Using meditation, relaxation techniques

Taking antidepressants

Taking anti-spasmodics




Taking prescription medication FDA


Taking prescription medication FDA

Approved for IBS-D

Accessed online or in-person education programs

Accessed online or in-person education programs

Taking prescription medication Taking prescription medication

Taking bile acid sequestrants Taking bile acid sequestrants

Taking prescription EnteraGam Taking prescription EnteraGam

Other diet changes

Nothing

Taking Imodium

Taking fiber

Taking Pepto Bismol

Exercise

Taking GasX

Using meditation, relaxation techniques





Approved for IBS-D

Other diet changes

Nothing


Month

Doctor Recom-mended Ever Tried

Tried Past Month

Doctor Recom-mended

IBS-D

How many treatments have you ever tried? How many in the past month? How many were recommended by a doctor?

• IBS-D patients have most commonly taken Imodium and fiber, both cited by half or more, with doctors most often recommending fiber. IBS-D sufferers have most commonly taken Pepto-Bismol, IMODIUM®, and fiber, all cited by three in 10 or more, with doctors most often recommending exercise.

Specific Treatments Tried


Base: % of IBS-D who ever tried remedies, Diagnosed IBS-D (N=977), Undiagnosed IBS-D (N=511)



For each remedy you’ve tried, how satisfied were you with each treatment?

Just one in four or fewer IBS-D patients are “very satisfied” with treatments and only prescription meds, EnteraGam®, and prescription meds approved for IBS-D – garner “very satisfied” ratings by more than one-quarter of IBS-D patients. IBS-D sufferers express greatest satisfaction for other prescription medicines and antispasmodics.

Satisfaction with Specific Treatments


33

29

25

22

22

18

17

16

14

14

14

12

7

5

5

10

39

30

26

24

22

21

19

19

19

13

13

13

13

11

10

10

9

13


Taking prescription EnteraGam

Taking prescription meds FDA approved for IBS-D


Taking prescription meds

Exercise


Taking Imodium


Taking bile acid sequestrants

Gluten-free diet


Taking GasX



Taking Pepto Bismol

Taking fiber

Other diet changes


Taking prescription meds FDA approved for IBS-D


Taking prescription meds

Exercise


Taking Imodium

Taking bile acid sequestrants

Gluten-free diet


Taking GasX



Taking Pepto Bismol

Taking fiber

Other diet changes

% saying “very satisfied”

Base: % of IBS-D who ever tried remedies, Diagnosed IBS-D (N=977), Undiagnosed IBS-D (N=511)

PROFILE OF STUDY PARTICIPANTS

SURVEY RESULTS


SURVEY RESULTSPROFILE OF STUDY PARTICIPANTS

$69.05K median income

81%Female

19%Male

15% High school or less42% Some college

43% College

48% Employed7% Self-employed

5% Temporarily employed3% Full-time student

16% Full-time homemaker20% Retired

65% Married or Living with Partner4% Widowed

14% Divorced/Separated17% Single

90% White/Caucasian4% Hispanic

4% Black2% American Indian

2% Asian1% Other

Consumers: Total

$68.11K median income $68.41K median income

Diagnosed IBS - C Diagnosed IBS - D




82%Female

63% Married 4% Widowed15% Divorced

18% Single

19%Male

17% High school or less45% Some College

39% College



2% Asian1% Other




81%Female

19%Male


45% College



2% Asian0% Othe


18% Single

$69.14 K median income $71.70 K median income

Undiagnosed IBS - C Undiagnosed IBS - D




80%Female


16% Single

20%Male


42% College



3% Asian1% Other




83%Female

17%Male


45% College



3% Asian0% Other


17% Single

Due to rounding or weighting, some totals do not add to 100%

65% Married or living with partner

4% Widowed14% Divorced/Separated

17% Single


SURVEY RESULTSPROFILE OF STUDY PARTICIPANTS

15%Female

85%Male

50% Gastroenterology50% Primary Care

23% Northeast22% Midwest33% South22% West

3% Hospital based26% Individual

solo practice63% Community practice

7% Academic practice1% Group1% Private1% Other

43% Less than 20 years57% 20+ years

Physicians: Total

PCP

GIs


23%Female


solo practice59% Community practice

2% Academic practice1% Group1% Private1% Other

77%Male

0% Gastroenterology100% Primary Care


81%Female

19%Male


45% College



solo practice66% Community practice11% Academic practice

1% Group1% Private1% Other


Due to rounding or weighting, some totals do not add to 100%

8%Female

92%Male


SURVEY RESULTS

For general information on digestive health and disorders, and to find an AGA member

physician in your area, visit:

www.gastro.org/patient

List of Resources

Other Resources

For additional information on the symptoms of IBS-C, what to do about it and where

to find support, visit:

www.aboutyourgut.com

International Foundation for Functional Gastrointestinal

Disorders (IFFGD)

National Digestive Diseases Information Clearing House National Institute of Health (NIH)

Mayo Clinic

About the American Gastroenterological Association (AGA)The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. www.gastro.org. For more information, contact Aimee Frank at 301-941-2620 or via email at [email protected]. © 2015 American Gastroenterological Association

CONDUCTED BY AGA

www.niddk.nih.gov/health-information/health-topics/digestive-diseases

About the American Gastroenterological Association (AGA)The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. www.gastro.org. For more information, contact Aimee Frank at 301-941-2620 or via email at [email protected]. © 2015 American Gastroenterological Association

CONDUCTED BY AGA

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IB S IN AMERICA - MultiVu, a Cision company...8 IBS IN AMERICA SUMMARY FINDINGS CONDUCTED BY AGA SURVEY RESULTS IBS SYMPTOMS AND SEVERITY • Overall, those with IBS symptoms report