Prevalence, bowel habit subtypes and medical care-seeking behaviour of patients with irritable bowel syndrome in Northern Greece

Relationship of Cannabis Use Disorder and Irritable Bowel Syndrome (IBS): An Analysis of 6.8 Million Hospitalizations in the United States

Background: Irritable bowel syndrome (IBS) is a chronic multifactorial gastrointestinal condition that substantially affects the quality of life. Research have suggested an increasing trend in cannabis use to alleviate IBS-related psychiatric symptoms. Objectives: We aim to investigate the association of psychiatric comorbidities and cannabis use disorders (CUD) in hospitalized IBS patients. Methods: We analyzed 31,272 IBS hospitalizations in patients (aged 15-54 years) from the Nationwide Inpatient Sample (NIS). We utilized logistic regression to evaluate the adjusted odds ratio (aOR) of CUD and psychiatric comorbidities. Results: Anxiety (26.3%) and depressive (24.8%) disorders were prevalent and increased the odds for IBS-hospitalization by 2.5 and 1.8 times respectively. Tobacco use disorder was most prevalent (24.5%) followed by CUD (3.7%). After controlling for demographics, psychiatric and medical comorbidities, and other substance use disorders, CUD had higher odds for IBS hospitalizations (aOR 1.407, 95% CI 1.32-1.50). IBS hospitalizations with CUD increased by 32.8% from 2010 to 2014. CUD patients were younger (15-24 years, aOR 5.4, 95% CI 4.27-6.77), males (aOR 1.8, 95% CI 1.59-2.09) and African Americans (aOR 2.8, 95% CI 1.45-2.23) and from low-income families (aOR 1.9, 95% CI 1.58-2.39). Conclusions: We found that patients with CUD have 40.7% higher odds for IBS-hospitalizations with a rising trend of CUD and related psychiatric comorbidities which may further worsen IBS and health quality of life. With limited evidence of efficacy and safety of cannabis in IBS, larger, randomized controlled studies are required to examine its therapeutic efficacy.

Impact of occupational stress on irritable bowel syndrome pathophysiology and potential management in active duty noncombat Greek military personnel: a multicenter prospective survey

INTRODUCTION

Irritable bowel syndrome (IBS) is one of the gut-brain axis interaction disorders. It has global distribution with varying prevalence and particular financial and psychological consequences. IBS has been associated with stress and anxiety, conditions that are usually prevalent in the army. There are scarce data investigating the impact of IBS on noncombat active duty military without reports of Greek military or stress in the occupational environment.

MATERIALS AND METHODS

The main exclusion criteria in our noncombat military multicenter prospective survey were gastrointestinal pathologies, malignancies, hematochezia, recent infections and antibiotics prescription, and pregnancy. Questionnaires included a synthesis of baseline information, lifestyle, and diet, psychological and stress-investigating scales and the IBS diagnosis checklist. Hospital Anxiety and Depression Scale and Rome IV criteria were utilized.

RESULTS

Among 1605 participants included finally, the prevalence of IBS was 8% and 131 cases were identified. Women were more vulnerable to IBS, although male sex was prevalent at a ratio of 3.5 : 1 (male:female) in the entire sample. The mean age of all participants was 23.85 years; most of the IBS patients were older than thirty. Abnormal anxiety scores and high levels of occupational stress were related to an IBS diagnosis.

DISCUSSION

This prospective multicenter survey showed, for the first time, the potential impact of occupational stress on IBS in active duty noncombat Greek Military personnel. The diagnosis of IBS by questionnaire is a quick, affordable way that can upgrade, by its management, the quality of life and relieve from the military burden. Our results are comparable with previous studies, although large-scale epidemiological studies are required for the confirmation of a possible causative relationship.

Cognitive and Behavioral Differences Between Subtypes in Refractory Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal syndrome consisting of different bowel pattern subtypes: diarrhea predominant (IBS-D), constipation predominant (IBS-C), and alternating (IBS-A). This paper aimed to identify whether (a) psychological factors implicated in the cognitive behavioral model of IBS were differentially associated with bowel pattern subtypes, (b) whether there were differences in symptom severity and work and social adjustment across the IBS-subtypes. Analysis was conducted on baseline data of 557 individuals with refractory IBS recruited into the Assessing Cognitive Therapy in Irritable Bowel (ACTIB) randomized controlled trial. Correlations assessed the associations between psychological factors, stool patterns, symptom severity, and work and social adjustment. Hierarchical regressions identified whether cognitive and behavioral factors were significantly associated with frequency of loose/watery stools, hard/lumpy stools and symptom severity while controlling for affective (anxiety and depression) and demographic factors (age, gender, symptom duration). One-way ANOVAs were conducted to assess differences across Rome III classified subtypes (IBS-A, D and C) in cognitive, behavioral, affective, symptom severity, and adjustment measures. Psychological factors were significantly associated with symptom severity and work and social adjustment. Increased avoidance behavior and unhelpful gastrointestinal (GI) cognitions were significantly associated with higher frequency of loose/watery stools. Increased control behaviors were associated with higher frequency of hard/lumpy stools. Cognitive and behavioral differences were significant across the Rome III classified IBS subtypes. There were no differences in anxiety, depression, overall symptom severity, or work and social adjustment. The results are discussed in terms of their utility in tailoring cognitive behavioral treatments to IBS subtypes.

Undiagnosed cancer symptoms in the community: does poor quality of life influence the decision to seek help?

PURPOSE

Although a cancer diagnosis is linked with decrements to quality of life (QoL), it is unknown exactly when QoL starts to deteriorate, and whether this occurs during the pre-diagnostic pathway. This study aimed to examine QoL during this phase, and in addition investigate whether QoL levels influence decisions about seeking professional help. This is important, because early diagnosis is linked to lower cancer mortality rates.

METHODS

Working alongside a Cancer Research UK Roadshow in socially deprived communities, the recent QoL of adult visitors was assessed, before attending primary care. Using a cross-sectional design, we compared QoL in those presenting a potential cancer symptom/sign, with others seeking lifestyle advice to reduce cancer risk. Self-reported QoL (WHOQOL-BREF), and intention to seek help, were measured.

RESULTS

Of 107 recruited, 50% were men. The potential cancer symptom group reported significantly poorer general QoL and psychological QoL, than lifestyle controls. Prior poorer physical QoL predicted stronger intentions to consult a general practitioner (GP) in the next 2 weeks, when controlling for symptom presence.

CONCLUSIONS

QoL is poorer for those with potential cancer symptoms, before they first seek advice from primary care. Poorer physical QoL is associated with stronger intentions to make a GP appointment. An implication for longer term health is that if public awareness about the impact of symptoms on QoL was raised, this could provide an impetus to seek help.

Risk of psychiatric disorders in irritable bowel syndrome-A nationwide, population-based, cohort study

AIMS

This cohort study aimed to investigate the association between irritable bowel syndrome (IBS) and the risk of developing psychiatric disorders.

METHODS

Utilizing the National Health Insurance Research Database (NHIRD) of Taiwan, IBS patients were identified and compared with age, sex, and index year-matched controls (1:3).

RESULTS

Of the IBS subjects, 3934 in 22 356 (17.60%, or 1533.68 per 100 000 person-years) developed psychiatric disorders when compared with 6127 in 67 068 (9.14%, or 802 per 100 000 person-years) in the non-IBS control group. Fine and Gray's survival analysis revealed that the study subjects were more likely to develop psychiatric disorders. The crude hazard ratio (HR) is 3.767 (95% CI: 3.614-3.925, P < .001), and the adjusted HR is 3.598 (95% CI: 3.452-3.752, P < .001) in the risk of developing psychiatric disorders after being adjusted for age, sex, comorbidities, geographical area of residence, urbanisation level of residence, and monthly insurance premiums. The cohort study revealed that IBS subjects were associated with an increased risk of anxiety, depression, bipolar, and sleep disorders.

CONCLUSIONS

This cohort study, using NHIRD, shows evidence support that patients with IBS have a 3.6-fold risk of developing psychiatric disorders. Other large or national datasets should be done to explore to underlying mechanisms.

The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review

OBJECTIVES

The global prevalence of IBS is difficult to ascertain, particularly in light of the heterogeneity of published epidemiological studies. The aim was to conduct a literature review, by experts from around the world, of community-based studies on IBS prevalence.

DESIGN

Searches were conducted using predetermined search terms and eligibility criteria, including papers in all languages. Pooled prevalence rates were calculated by combining separate population survey prevalence estimates to generate an overall combined meta-prevalence estimate. The heterogeneity of studies was assessed.

RESULTS

1451 papers were returned and 83, including 288 103 participants in 41 countries, met inclusion criteria. The mean prevalence among individual countries ranged from 1.1% in France and Iran to 35.5% in Mexico. There was significant variance in pooled regional prevalence rates ranging from 17.5% (95% CI 16.9% to 18.2%) in Latin America, 9.6% (9.5% to 9.8%) in Asia, 7.1% (8.0% to 8.3%) in North America/Europe/Australia/New Zealand, to 5.8% (5.6% to 6.0%) in the Middle East and Africa. There was a significant degree of heterogeneity with the percentage of residual variation due to heterogeneity at 99.9%.

CONCLUSIONS

The main finding is the extent of methodological variance in the studies reviewed and the degree of heterogeneity among them. Based on this, we concluded that publication of a single pooled global prevalence rate, which is easily calculated, would not be appropriate or contributory. Furthermore, we believe that future studies should focus on regional and cross-cultural differences that are more likely to shed light on pathophysiology.

Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea

Background

Irritable bowel syndrome (IBS) affects 10–15% of adults in the US, and is associated with significant impairment in health-related quality of life (HRQoL); however, information specific to the diarrhea subtype (IBS-D) is lacking. We assessed the impact of IBS-D on HRQoL, work productivity, and daily activities, and the associated indirect costs, among a sample of the US population.

Methods

Respondents (≥18 years) from the 2012 US National Health and Wellness Survey who reported an IBS-D diagnosis by a physician or symptoms consistent with Rome II criteria for IBS-D were identified as having IBS-D. Controls included respondents without IBS-D or inflammatory bowel disease. HRQoL was assessed via the Short Form 36 Health Survey version 2 questionnaire and summarized into Mental and Physical Component Summary (MCS; PCS) scores and a Short Form-6 dimension (SF-6D) utility score. Work and activity impairment were assessed via the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH), which measures absenteeism, presenteeism, overall work productivity loss, and daily activity impairment. Indirect costs were calculated using unit cost data from the Bureau of Labor Statistics and variables from the WPAI:GH. Generalized linear models were used to examine differences in health outcomes between respondents with IBS-D and controls, controlling for demographic and health characteristics.

Results

In total, 66,491 respondents (1102 IBS-D; 65,389 controls) were analyzed. Mean age was 48.7 years; 50% were female. Compared with controls, the IBS-D cohort reported significantly lower HRQoL (mean MCS: 45.16 vs. 49.48; p < 0.001; mean PCS: 47.29 vs. 50.67; p < 0.001; mean SF-6D: 0.677 vs. 0.741; p < 0.001) and greater absenteeism (5.1% vs. 2.9%; p = 0.004), presenteeism (17.9% vs. 11.3%; p < 0.001), overall work productivity loss (20.7% vs. 13.2%; p < 0.001), and activity impairment (29.6% vs. 18.9%; p < 0.001). Respondents with IBS-D also incurred an estimated $2486 more in indirect costs ($7008 vs. $4522; p < 0.001).

Conclusions

Compared with controls, IBS-D is associated with significantly lower HRQoL, greater impairments in work and daily activities, and higher indirect costs, imposing a substantial burden on patients and employers. These findings suggest a significant unmet need exists for effective IBS-D treatments.

Are floating stools associated with specific functional bowel disorders?

BACKGROUND

Functional bowel disorders are recognized as being common, but remain very difficult to diagnose accurately and to differentiate from one another, despite their significant impact on the quality of life of patients.The aim of this study was to evaluate whether the clinical sign of 'floating stools' is associated with psychological disorders, colonic transit time, or other specific bowel disorders as defined by the Rome III diagnostic criteria.

MATERIALS AND METHODS

A total of 1252 consecutive patients, referred for and found to have functional gastrointestinal disorders, filled in a standard clinical questionnaire on the basis of the Rome III diagnostic criteria and were asked to provide information on the presence of floating stools. Overall, 344 of these scored positive for functional bowel disorders and underwent psychometric testing and colonic transit time studies.

RESULTS

Floating stools were reported by 26% of functional bowel disorder patients and 3% of the other functional gastrointestinal disorder patients (P<0.001). The basic demographic characteristics, psychometric evaluation scores, Bristol stool form scales, and total and segmental colonic transit times were not statistically different according to the presence or not of floating stools in these patients. Logistic regression showed that mixed irritable bowel syndrome was the only functional gastrointestinal disorder associated independently with floating stools (P=0.003).

CONCLUSION

Floating stools are a characteristic of patients with mixed irritable bowel syndrome.

A cross-sectional study of irritable bowel syndrome in nurses in China: prevalence and associated psychological and lifestyle factors

The prevalence of irritable bowel syndrome (IBS) and associated factors, especially psychological and lifestyle factors, in nurses in China have not been investigated previously. The aims of this study were to assess the prevalence of IBS in nurses, to evaluate whether factors, such as psychological disorders, are associated with IBS, and to determine whether psychological disorders can influence the severity of symptoms of IBS and quality of life (QOL). A cross-sectional study was conducted for Chinese nurses from November 2012 to February 2013. Participants were asked to complete questionnaires. The prevalence of IBS was 17.4%. The revised symptom checklist 90 (SCL-90-R) scores were significantly higher for nurses with IBS than for those without IBS (P<0.001), and no difference in scores between IBS subtypes was found (F=1.893, P=0.142). The scores of QOL for nurses with and without IBS were 77.18±21.93 and 88.44±11.89 (P<0.001), respectively. Psychological disorders did not show statistically significant correlations with severity of symptoms of IBS or QOL. Alcohol consumption, low level of exercise, and psychological disorders were risk factors for IBS. In summary, nurses in China show a high prevalence of IBS. Psychological disorders and some related lifestyle factors are probably responsible for the development of IBS in nurses.

Irritable bowel syndrome is associated with gastroesophageal reflux symptom but not erosive esophagitis

BACKGROUND/AIMS

Although several studies have suggested overlaps between gastroesophageal reflux symptom and irritable bowel syndrome (IBS), the studies for the association between erosive esophagitis and IBS are rare. The aim of this study was to evaluate the association among IBS, non-erosive reflux disease (NERD), and erosive esophagitis.

METHODS

A total of 2,769 participants completed questionnaires and underwent esophagogastroduodenoscopy and colonoscopy. IBS was diagnosed by Rome III; NERD was defined as heartburn or acid regurgitation occurring at least once per week without erosive esophagitis. Erosive esophagitis was defined by Los Angeles classification. Psychological distress was evaluated with modified 4 dimensions from revised Hopkins symptom checklist 90.

RESULTS

Psychological distress was associated with both IBS and NERD, but not with erosive esophagitis. IBS was associated with somatization (adjusted OR, 2.88; 95% CI, 1.55-5.36; P < 0.001), anxiety (adjusted OR, 2.82; 95% CI, 1.36-5.88; P = 0.005), and hostility (adjusted OR, 2.06; 95% CI, 1.10-3.87; P = 0.024) and NERD was associated with somatization (adjusted OR, 5.65; 95% CI, 2.92-10.98; P < 0.001) and anxiety (adjusted OR, 3.29; 95% CI, 1.47-7.34; P = 0.004). Erosive esophagitis was associated with somatization (adjusted OR, 2.69; 95% CI, 1.26-7.91; P < 0.001). Hiatal hernia and male sex were related with erosive esophagitis but not with IBS or NERD. H. pylori had an inverse relationship with erosive esophagitis, but had no association with IBS. Whereas IBS was positively associated with NERD (adjusted OR, 2.72; 95% CI, 1.84-4.03; P < 0.001), it had no association with erosive esophagitis.

CONCLUSIONS

IBS shared many risk factors with NERD but not with erosive esophagitis. It partially explains why IBS was associated with NERD, but not with erosive esophagitis.

Luminal cysteine-proteases degrade colonic tight junction structure and are responsible for abdominal pain in constipation-predominant IBS

OBJECTIVES

Luminal serine-proteases lead to increased colonic paracellular permeability and visceral hypersensitivity in patients with diarrhea-predominant irritable bowel syndrome (IBS-D). Other proteases, namely cysteine-proteases (CPs), increase airway permeability by digesting epithelial tight junction proteins. In this study, we focused on constipation-predominant IBS (IBS-C) and we aimed to (i) evaluate CP levels in two cohorts of IBS patients, (ii) test if IBS-C fecal supernatant (FSN) affects permeability, and visceral sensitivity after repeated administrations in mice, and (iii) evaluate occludin expression in IBS-C colonic biopsies.

METHODS

Fecal CP activity was determined using selective substrate and inhibitor (E64). The effect of papain, as positive control, and IBS-C FSN administrations were evaluated on colonic paracellular permeability and mucosal occludin levels in mice and T84 monolayers. Occludin protein levels were evaluated in IBS-C colonic biopsies. Sensitivity to colorectal distension (CRD) was measured after repeated administrations of IBS-C FSN.

RESULTS

We found in a subset of IBS-C patients an enhanced fecal CP activity, in comparison with healthy controls and IBS-D patients. CP activity levels positively correlated with disease severity and abdominal pain scoring. This association was confirmed by receiver operating characteristic curve analysis. In mice, repeated application of IBS-C FSN into colon triggered increased permeability, linked to the enzymatic degradation of occludin, and was associated with enhanced visceral sensitivity to CRD. Finally, occludin levels were found decreased in colonic biopsies from IBS-C patients, and IBS-C FSNs were able to degrade recombinant human occludin in vitro. All these effects were abolished by preincubation of IBS-C FSN with a CP inhibitor, E64.

CONCLUSIONS

These data suggest that luminal CPs may represent a new factor contributing to the genesis of symptoms in IBS.

The global perspective on irritable bowel syndrome: a Rome Foundation-World Gastroenterology Organisation symposium

Although irritable bowel syndrome (IBS) is common worldwide, there is uncertainty regarding similarities and differences in geographical regions and cultural groups. For example, are Western diagnostic criteria applicable to other groups? The interaction between culture and health can impact quality of care and health outcomes and, in research, cause methodological shortcomings that lead to bias and inappropriate interpretations of research results. Two central questions are: do physicians have the cross-cultural competence to effect a participatory model of care; and do we have sufficient knowledge and experience in conducting multinational, cross-cultural research? The Rome Foundation and the World Gastroenterology Organisation convened a symposium to foster interest in the global aspects of IBS, foster cross-cultural competence, improve multinational IBS research, foster international networks for IBS research, increase awareness of culture's impact on patient care and research in the functional gastrointestinal disorders (FGIDs), address cross-cultural issues in multinational clinical drug trials, and facilitate the development of patient-reported outcome measures for FGID research across cultures. This review summarizes key points and messages.

The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome

OBJECTIVES

Many studies have linked irritable bowel syndrome (IBS) with small intestinal bacterial overgrowth (SIBO), although they have done so on a qualitative basis using breath tests even though quantitative cultures are the hallmark of diagnosis. The purpose of this study was to underscore the frequency of SIBO in a large number of Greeks necessitating upper gastrointestinal (GI) tract endoscopy by using quantitative microbiological assessment of the duodenal aspirate.

METHODS

Consecutive subjects presenting for upper GI endoscopy were eligible to participate. Quantitative culture of aspirates sampled from the third part of the duodenum during upper GI tract endoscopy was conducted under aerobic conditions. IBS was defined by Rome II criteria.

RESULTS

Among 320 subjects enrolled, SIBO was diagnosed in 62 (19.4%); 42 of 62 had IBS (67.7%). SIBO was found in 37.5% of IBS sufferers. SIBO was found in 60% of IBS patients with predominant diarrhea compared with 27.3% without diarrhea (P = 0.004). Escherichia coli, Enterococcus spp and Klebsiella pneumoniae were the most common isolates within patients with SIBO. A step-wise logistic regression analysis revealed that IBS, history of type 2 diabetes mellitus and intake of proton pump inhibitors were independently and positively linked with SIBO; gastritis was protective against SIBO.

CONCLUSIONS

Using culture of the small bowel, SIBO by aerobe bacteria is independently linked with IBS. These results reinforce results of clinical trials evidencing a therapeutic role of non-absorbable antibiotics for the management of IBS symptoms.

A global perspective on irritable bowel syndrome: a consensus statement of the World Gastroenterology Organisation Summit Task Force on irritable bowel syndrome

Irritable bowel syndrome (IBS) is common in western Europe and North America, and many aspects of its epidemiology, risk factors, and natural history have been described in these regions. Recent data suggest, however, that IBS is also common in the rest of the world and there has been some evidence to suggest some differences in demographics and presenting features between IBS in the west and as it is experienced elsewhere. The World Gastroenterology Organization, therefore, established a Task Force comprising experts on the topic from all parts of the world to examine IBS from a global perspective. IBS does, indeed, seem to be common worldwide though with some significant variations in prevalence rates between regions and countries and there may well be some potentially interesting variations in presenting symptoms and sex distribution. The global map of IBS is far from complete; community-based prevalence data is not available from many areas. Furthermore, while some general trends are evident in terms of IBS impact and demographics, international comparisons are hampered by differences in diagnostic criteria, study location and methodology; several important unanswered questions have been identified that should form the basis for future collaborative research and have the potential to shed light on this challenging disorder.

Evaluation of health related quality of life in irritable bowel syndrome patients

Background

Quality of life (QOL) is an important measure in the management of Irritable Bowel Syndrome (IBS). Controversy exists in the findings of studies evaluating QOL in IBS subtypes, and little is known about this issue in Iranian patients. Determination of the factors affecting QOL in IBS patients may influence treatment outcomes. The aims of this study are to: 1) compare QOL between subtypes in a sample of Iranian IBS patients, 2) determine the factors associated with QOL in IBS.

Methods

This cross sectional study included two hundred and fifty IBS patients with the mean age (± standard deviation) of 31.62 (± 11.93) years that were referred to outpatient gastroenterology clinic. IBS patients were diagnosed based on Rome-3 criteria by a gastroenterologist, and then they were categorized into three subtypes according to the predominant type of bowel habit. The "QOL specific for IBS", "Stait-trait anxiety inventory", and "Beck depression inventory-2" questioners were used to evaluate QOL, anxiety, and depression symptoms, respectively.

Results

The mean QOL scores in IBS mixed subtype (71.7 ± 25.57), constipation predominant subtype (80.28 ± 25.57), and diarrhea predominant subtype (76.43 ± 19.13) were not different. (P value: 0.05) In multivariate linear regression analysis, anxiety symptom scores were inversely correlated with QOL scores. [Standardized beta: -0.43, (95% confidence interval: -0.70, -0.39), P value: < 0.01]

Conclusion

It seems reasonable to manage anxiety symptoms properly in IBS patients since this might increase their QOL.

Risk factors for constipation-predominant irritable bowel syndrome: an analysis of 100 cases

AIM: To investigate the risk factors for constipation-predominant irritable bowel syndrome (C-IBS) to guide treatment and prevention of the disease.

METHODS: This was a 1:1 case-control study. A questionnaire survey was conducted among 100 patients who were diagnosed with C-IBS and 100 healthy volunteers from November 2010 to January 2011. The questionnaire requested general information and information on life style and psychological factors (depression). Statistical analysis was performed using SPSS17.0 software.

RESULTS: A family history of constipation (RR = 6.493), regular defecation (RR = 0.120) and depression (RR = 2.195) were independently associated with the incidence of C-IBS (all P < 0.05). A family history of constipation and depression were risk factors for C-IBS, whereas regular defecation was a protective factor.

CONCLUSION: Lifestyle and mental status can affect the incidence of C-IBS. Improvement of lifestyle and mental intervention can prevent and relieve C-IBS.

The current prevalence of irritable bowel syndrome in Asia

Irritable bowel syndrome (IBS) has been one of the commonly presented gastrointestinal disorders. It is of interest how commonly it presents in the society. Western studies indicated that most population-based IBS prevalences range 10%-15%. It is believed that IBS is prevalent in both East and West countries without a significant prevalence difference. Most recently, the Asia IBS prevalence has a higher trend in the affluent cities compared to South Asia. Since many Asia IBS prevalence studies have been published in the recent decade, we could compare the IBS prevalence data divided by various criteria in looking whether they were also comparable to this of West community. Summarized together, most Asia community IBS prevalences based on various criteria are usually within the range 1%-10% and are apparently lower than these of selected populations. Within the same population, the prevalence orders are first higher based on Manning criteria, then followed by Rome I criteria and finally reported in Rome II criteria. Overall, the median value of Asia IBS prevalences defined by various criteria ranges 6.5%-10.1%. With regard to gender difference, female predominance is usually found but not uniquely existed. For the IBS subtypes, the proportions of diarrhea predominant-IBS distribute widely from 0.8% to 74.0%, while constipation predominant-IBS proportion ranges 12%-77%. In conclusions, current Asia IBS prevalence is at least equal to the Western countries. Female predominant prevalence in Asia is common but not uniquely existed, while the proportions of IBS subtypes are too variable to find a rule.

Meta-analysis: do irritable bowel syndrome symptoms vary between men and women?

BACKGROUND

Studies suggest that sex and gender-related differences exist in irritable bowel syndrome (IBS), but data is often conflicting.

AIM

To evaluate gender differences and the effect of menstrual cycle and menopausal status on IBS symptoms.

METHODS

We performed a systematic review of MEDLINE to search for studies comparing IBS symptoms between gender, menstrual cycle phases and menopausal states in IBS and/or healthy individuals. We performed meta-analyses to compare the relative risk (RR) of individual IBS symptoms between men and women.

RESULTS

Twenty-two studies measured gender differences in IBS symptoms. Women were more likely to report abdominal pain (RR = 1.12, 95% CI: 1.02, 1.22) and constipation-related symptoms (RR = 1.12, 95% CI: 1.02, 1.23) than men (all P < 0.05). However, men with IBS were more likely to report diarrhoea-related symptoms than women with IBS (RR = 0.84, 95% CI: 0.75, 0.94, P < 0.05). A systematic review of 13 studies demonstrated that both IBS and healthy women reported increased IBS symptoms during menses vs. other phases. There were insufficient data to determine the effect of menopause and hormone supplementation on IBS symptoms.

CONCLUSIONS

In the general and IBS populations, gender differences in IBS symptoms exist, although these differences are modest. Studies suggest that female sex hormones influence the severity of IBS symptoms, but more studies are needed.

Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners

Irritable bowel syndrome (IBS), a chronic gastrointestinal disorder, affects from 3-20% of the US population, depending on sociocultural and comorbid factors. IBS is characterized by a symptom complex of abdominal pain and abnormal bowel habits that present as diarrhea or constipation, and general physical weakness in the absence of abnormal morphological, histological or inflammatory markers. The main diagnostic Rome III criteria as established by international professional organizations are based on exclusion criteria and the occurrence and rate of symptoms. Because the pathophysiology and causes of IBS are poorly understood, treatment approaches are mainly focused on symptom management to maintain everyday functioning and improve quality of life for persons with IBS. The mainstay of intervention is pharmacological treatment with antispasmodics and antidiarrheals for diarrhea, prokinetics and high-fiber diets for constipation, and supportive therapy with low-dose antidepressants to normalize gastrointestinal motility. Other interventions include lifestyle and dietary changes, psychotherapy, herbal therapies and acupuncture. The purpose of this review is to critically assess benefits and risks of current treatment approaches as well as promising complementary and alternative therapies.

Prevalence and risk factors of irritable bowel syndrome in healthy screenee undergoing colonoscopy and laboratory tests

INTRODUCTION

The prevalence of irritable bowel syndrome (IBS) after excluding organic disease has not been reported in Korea.

METHODS

Of 5,605 participants in a health screening program, inclusion criteria were persons who underwent colonoscopy and completed questionnaires. Exclusion criteria were persons diagnosed with colon cancer, inflammatory bowel disease, previous colectomy, and abnormal results of thyroid function tests. IBS was defined by Rome III criteria. Physical and psychological stress was evaluated with visual analogue scales, ranging from 0 to 10. Risk factors for IBS were estimated with odds ratios (OR) and 95% confidence intervals (CI) using logistic regression analysis.

RESULTS

The prevalence of IBS was 8.2% (5,605) in the total population and 9.1% (393/4,296) in the final study sample. IBS had a positive association with female sex (adjusted OR, 1.33; 95% CI, 1.00-1.79; p = 0.05) and current smoking (adjusted OR, 1.31; 95% CI, 1.00-1.71; p = 0.05). The prevalence of IBS increased with increased psychological stress (adjusted p for trend = 0.005) and decreased with increasing age (adjusted p for trend <0.001), with adjusted OR of 0.95 (95% CI, 0.68-1.33) for age of 40.0 to 49.9 years; 0.79 (95% CI, 0.54-1.15) for age of 50.0 to 59.9 years; and 0.51 (95% CI, 0.30-0.86) for age of 60 years or more, compared with age less than 40 years. Drinking status, body mass index, hypertension, diabetes, and use of sedatives had no association with IBS.

CONCLUSIONS

The prevalence of IBS increased with decreasing age and increasing psychological stress, and was positively associated with female sex and current smoking.

Prevalence of irritable bowel syndrome and its relationship with psychological stress status in Chinese university students

BACKGROUND AND AIMS

Although irritable bowel syndrome (IBS) is a common disorder in the West, information on the prevalence of IBS in university students is relatively scant, especially in Asia. The aims of the present study were to investigate the prevalence and pattern of symptoms of IBS and its relationship with psychological stress status in Chinese university students.

METHODS

Basic demographic data and IBS symptoms were sought using the Rome II criteria and a validated bowel symptom questionnaire. Another questionnaire used related to psychosomatic symptoms of depression and anxiety.

RESULTS

In total, 491 of the 530 students in the trial met the selected criteria, which included 241 men. The participants were medical college students (313/491) and non-medical college students (178/491). The apparent prevalence of IBS was 15.7%, with a prevalence of 14.5% in men and 16.8% in women. The most common symptom was abdominal pain associated with change in the consistency of stool (36.9%), followed by altered stool frequency (16.3%), and abdominal pain relieved by defecation (12.4%), predominantly in women. The self-reported psychological and psychosomatic symptoms of anxiety (P < 0.001) and depression (P < 0.001) were encountered more frequently in participants with IBS. The depression (P = 0.03) and anxiety measures (P = 0.02) significantly predicted IBS status.

CONCLUSION

The prevalence of IBS in Chinese university students is often compared with university students in developed countries and the general Chinese population. Depression and anxiety could potentially induce IBS. Medical education should be considered when aiming to reduce stress of university students who are susceptible to IBS.