Background Irritable bowel syndrome with predominant constipation (IBS-C) is a complex disorder with gastrointestinal and nervous system components. The study aim was to assess the economic burden of moderate to severe IBS-C in six European countries (France, Germany, Italy, Spain, Sweden and the UK). Methods An observational, one year retrospective-prospective (6 months each) study of patients diagnosed in the last five years with IBS-C (Rome III criteria) and moderate to severe disease at inclusion (IBS Symptom Severity Scale score ≥ 175). The primary objective was to assess the direct cost to European healthcare systems. Results Five hundred twenty-five patients were included, 60% (range: 43.1–78.8%) suffered from severe IBS-C. During follow-up 11.1–24.0% of patients had a hospitalisation/emergency room (ER) visit, median stay range: 1.5–12.0 days and 41.1–90.4% took prescription drugs for IBS-C. 21.4–50.8% of employed patients took sick leave (mean: 11.6–64.1 days). The mean annual direct cost to the healthcare systems was €937.1- €2108.0. The total direct cost (combined costs to healthcare systems and patient) for IBS-C was €1421.7–€2487.1. Conclusions IBS-C is not a life-threatening condition; however, it has large impact on healthcare systems and society. Direct and indirect costs for moderate to severe IBS-C were high with the largest direct cost driver being hospitalisations/ER visits.

Two young children with salt-losing congenital adrenal hyperplasia developed profound hypoglycaemia. In one child hypoglycaemia occurred after a prolonged fast and in the other it was precipitated by infection. This complication may be more common than the literature suggests, and emergency treatment with glucose or hydrocortisone, given by injection, should be given to any child with the disorder who suddenly or unexpectedly collapses.

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The most prevalent symptoms at baseline were abdominal pain (85.3%), constipation (7.5%) and bloating (76.5%). Mean IBS-QoL was 61.8±18.2 (scale: 0-100 [worst-best]). Mean EQ-5D was 58.4±20.2 (scale: 0-100 [worst-best]) and 85.3% and 50.9% of patients reported moderate-to-severe problems in pain/discomfort and anxiety/depression, respectively. Over the year, 78.4% patients consulted a primary care physician and 69.6% a gastroenterologist, 18.6% patients required emergency department visits/hospitalisation and 66.7% had a diagnostic test. 54.9% patients took prescription drugs for their IBS-C and 69.6% took non-prescription drugs. Mean (95%CI) annual direct costs per patient for Germany's national healthcare system:

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