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Global Prevalence of Chronic Idiopathic Constipation According to the Rome Criteria: Systematic Review and Meta-Analysis

Background: Chronic idiopathic constipation (CIC) is a common functional bowel disorder in the community, whose prevalence varies across cross-sectional surveys. We performed a contemporaneous systematic review of studies using comparable methodology, and all iterations of the Rome criteria, to estimate global prevalence. 
 
Methods: MEDLINE, EMBASE, and EMBASE Classic were searched (from 1990 to December 2020) to identify population-based studies reporting the prevalence of CIC in adults (≥18 years old) according to Rome I, II, III, or IV criteria. Prevalence of CIC was extracted, according to criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, odds ratios (OR), and 95% confidence intervals (CIs) were calculated. 
 
Findings: Of 8,174 citations evaluated, 45 studies fulfilled eligibility criteria, representing 80 separate populations, containing 275,260 subjects. Pooled prevalence was 15.3% (95% CI 8.1% to 24.4%) in studies defining CIC according to the Rome I criteria, 10.8% (95% CI 7.3% to 14.8%) using Rome II, 11.3% (95% CI 6.8% to 16.7%) with Rome III, and 10.1% (95% CI 8.7% to 11.6%) when Rome IV criteria were used. Prevalence of CIC was up to two times higher in women, irrespective of definition used. There was significant heterogeneity between studies in all our analyses, which persisted even when the same criteria were applied and similar methodology used. 
 
Interpretation: Even when uniform symptom-based criteria are used to define the presence of CIC, prevalence varies between countries. Thus, environmental, cultural, ethnic, dietary, or genetic factors may influence reporting of symptoms. 
 
Funding: None 
 
Declaration of Interest: None