1
|
Sun S, Chen J, Li H, Lou Y, Chen L, Lv B. Patients' perspectives on irritable bowel syndrome: a qualitative analysis based on social media in China. Qual Life Res 2023; 32:2561-2571. [PMID: 37093542 PMCID: PMC10123591 DOI: 10.1007/s11136-023-03417-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
AIM To explore the perspectives, experience, and concerns of patients with irritable bowel syndrome (IBS) in China. METHODS We used data mining to investigate posts shared in Baidu Tieba concerned with IBS; we collected the data through the crawler code, and mined the cleaned data's themes based on Latent Dirichlet allocation (LDA) and the Grounded theory. RESULTS We found 5746 network posts related to IBS. LDA analysis generated 20 topics, and grounded theory analysis established eight topics. Combining the two methods, we finally arranged the topics according to five concepts: difficulty in obtaining disease information; serious psychosocial problems; dissatisfied with the treatment; lack of social support; and low quality of life. CONCLUSION Social media research improved patient-centric understanding of patients' experiences and perceptions. Our study may facilitate doctor-patient communication and assist in the formulation of medical policies.
Collapse
Affiliation(s)
- Shaopeng Sun
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiajia Chen
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Heng Li
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yijie Lou
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lixia Chen
- Nursing College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Lv
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China.
| |
Collapse
|
2
|
Cowie S, Choy SH, Shah DM, Gomez MP, Yoong BK, Koong JK. Healthcare System Impact on Deceased Organ Donation and Transplantation: A Comparison Between the Top 10 Organ Donor Countries With 4 Countries in Southeast Asia. Transpl Int 2023; 36:11233. [PMID: 37711402 PMCID: PMC10498995 DOI: 10.3389/ti.2023.11233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/11/2023] [Indexed: 09/16/2023]
Abstract
The need for organ donation is constantly increasing. Some countries have made improvements, while others, such as countries in Southeast Asia (SEA), have some of the lowest rates of deceased donors (pmp). This review aims to compare 14 countries with regards to many variables related to healthcare systems. Countries leading in deceased organ donation spend more on health and education, which is associated with increased potential for deceased organ donation. Out-of-pocket expenditure, is also associated with a decrease in deceased organ donation. Countries in SEA are lacking in healthcare resources such as workforce and materials, which are both necessary for a successful transplant program. Most countries in SEA have an excellent foundation for successful organ donation systems, including proper legislation, government support, and brain death laws along with an overall acceptance of brain death diagnosis. Priorities should include improving coordination, donor identification, and healthcare worker education. Countries in SEA have a lot of potential to increase deceased organ donation, especially by investing in healthcare and education. There is no one size fits all for organ donation programs and countries in SEA should focus on their strengths and take cultural differences into consideration when planning interventions.
Collapse
Affiliation(s)
- Sandra Cowie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Seow-Huey Choy
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Boon-Koon Yoong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jun-Kit Koong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
3
|
Ghoshal UC. Editorial: Recognising the regional variations in profile of irritable bowel syndrome-better late than never! Aliment Pharmacol Ther 2023; 58:474-475. [PMID: 37499102 DOI: 10.1111/apt.17620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
4
|
Ghoshal UC, Sachdeva S, Pratap N, Karyampudi A, Mustafa U, Abraham P, Bhatt CB, Chakravartty K, Chaudhuri S, Goyal O, Makharia GK, Panigrahi MK, Parida PK, Patwari S, Sainani R, Sadasivan S, Srinivas M, Upadhyay R, Venkataraman J. Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology. Indian J Gastroenterol 2023; 42:249-273. [PMID: 36961659 PMCID: PMC10036984 DOI: 10.1007/s12664-022-01333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 03/25/2023]
Abstract
The Indian Neurogastroenterology and Motility Association (INMA), earlier named the Indian Motility and Functional Diseases Association developed this evidence-based practice guidelines for the management of irritable bowel syndrome (IBS). A modified Delphi process was used to develop this consensus containing 28 statements, which were concerning diagnostic criteria, epidemiology, etiopathogenesis and comorbidities, investigations, lifestyle modifications and treatments. Owing to the Coronavirus disease-19 (COVID-19) pandemic, lockdowns and mobility restrictions, web-based meetings and electronic voting were the major tools used to develop this consensus. A statement was regarded as accepted when the sum of "completely accepted" and "accepted with minor reservation" voted responses were 80% or higher. Finally, the consensus was achieved on all 28 statements. The consensus team members are of the view that this work may find use in teaching, patient care, and research on IBS in India and other nations.
Collapse
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, 110 002, India
| | - Nitesh Pratap
- Department of Gastroenterology, KIMS Hospital, Secunderabad, 500 003, India
| | - Arun Karyampudi
- Department of Gastroenterology, GSL Medical College and General Hospital, Rajahmundry , 533 296, India
| | - Uzma Mustafa
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Philip Abraham
- Department of Gastroenterology, P. D. Hinduja Hospital, Mumbai, 400 016, India
| | - Chetan B Bhatt
- Sir HN Reliance Foundation Hospital, Mumbai, 400 004, India
| | - Karmabir Chakravartty
- Department of Gastroenterology, Woodland Multispeciality Hospital, Kolkata, 700 027, India
| | - Sujit Chaudhuri
- Department of Gastroenterology, AMRI Hospitals, Salt Lake, Kolkata, 700 098, India
| | - Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Govind K Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751 019, India
| | - Prasanta Kumar Parida
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, 753 001, India
| | | | - Rajesh Sainani
- Department of Gastroenterology, Jaslok Hospital, Mumbai, 400 026, India
| | - Shine Sadasivan
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, 682 041, India
| | - M Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Rajesh Upadhyay
- Department of Gastroenterology, Max Superspeciality Hospital, New Delhi, 110 017, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
| |
Collapse
|
5
|
Schmulson MJ, Puentes-Leal GA, Bustos-Fernández L, Francisconi C, Hani A, López-Colombo A, Palsson OS, Bangdiwala SI, Sperber AD. Comparison of the epidemiology of disorders of gut-brain interaction in four Latin American countries: Results of The Rome Foundation Global Epidemiology Study. Neurogastroenterol Motil 2023; 35:e14569. [PMID: 36989176 DOI: 10.1111/nmo.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/01/2023] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND In Latin America, there are scarce data on the epidemiology of DGBI. The Rome Foundation Global Epidemiology Study (RFGES) Internet survey included 26 countries, four from Latin America: Argentina, Brazil, Colombia, and Mexico, with a 40.3% prevalence of Rome IV DGBI. We aimed at comparing the prevalence of DGBI and associated factors among these countries. METHODS The frequency of DGBI by anatomical region, specific diagnoses, sex, age, diet, healthcare access, anxiety, depression, and HRQOL, were analyzed and compared. RESULTS Subjects included Argentina n = 2057, Brazil = 2004, Colombia = 2007, and Mexico = 2001. The most common DGBI were bowel (35.5%), gastroduodenal (11.9%), and anorectal (10.0%). Argentina had the highest prevalence of functional diarrhea (p = 0.006) and IBS-D; Brazil, esophageal, gastroduodenal disorders, and functional dyspepsia; Mexico functional heartburn (all <0.001). Overall, DGBI were more common in women vs. men and decreased with age. Bowel disorders were more common in the 18-39 (46%) vs. 40-64-year (39%) groups. Diet was also different between those with DGBI vs. those without with subtle differences between countries. Subjects endorsing criteria for esophageal, gastroduodenal, and anorectal disorders from Mexico, more commonly consulted physicians for bowel symptoms vs. those from Argentina, Brazil, and Colombia. General practitioners were the most frequently consulted, by Mexicans (50.42%) and Colombians (40.80%), followed by gastroenterologists. Anxiety and depression were more common in DGBI individuals in Argentina and Brazil vs. Mexico and Colombia, and they had lower HRQOL. CONCLUSIONS The prevalence of upper and lower DGBI, as well as the burden of illness, psychological impact and HRQOL, differ between these Latin American countries.
Collapse
Affiliation(s)
- Max J Schmulson
- Laboratory of Liver, Pancreas and Motility (HIPAM)-Unit of Research in Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Gerardo A Puentes-Leal
- Unit of Gastroenterology, Centro Hospitalario Serena del Mar, Cartagena de Indias, Colombia
| | | | - Carlos Francisconi
- Gastroenterology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Albis Hani
- Gastroenterology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Aurelio López-Colombo
- UMAE Hospital de Especialidades Centro Médico Nacional Manuel Avila Camacho, Puebla, Mexico
| | - Olafur S Palsson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
6
|
Sperber AD. The Rome Foundation Global Epidemiology study: Conception, implementation, results, and future potential. Neurogastroenterol Motil 2023; 35:e14567. [PMID: 36989175 DOI: 10.1111/nmo.14567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/25/2023] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Methodological problems have impeded successful epidemiological research into disorders of gut-brain interactions (DGBI), as previous studies were limited in terms of study population, diagnostic criteria, number of disorders assessed, data collection methods, and geographic area. Most prevalence estimates were based on pooling data from heterogeneous studies using inappropriate pooling methods, seriously limiting the relevance of the results. The Rome Foundatiion Global Epidemiology Study (RFGES) aimed to rectify these limitations using rigorous methodology to survey the prevalence of 22 DGBI in large population samples in 33 countries. Its aims were to conduct a comprehensive, multinational epidemiological study using rigorous research methodology, gain a better understanding of the burden of the DGBI, gain reliable regional estimates of DGBI prevalence, and advance our understanding of the pathophysiology of IBS. The study questionnaire consisted of the 89-item Rome IV Adult Diagnostic Questionnaire enabling the diagnosis of 22 DGBI, and an 80-item supplemental questionnaire that enabled analyses of the association of multiple factors with DGBI diagnoses. PURPOSE FOR REVIEW ARTICLE This review paper introduces a special issue on the Rome Foundation Global Epidemiology study (RFGES) with a narrative description of its conception, development, and implementation, its outcomes to date, and its potential contribution to neurogastroenterology. It includes 15 papers that reflect the range of RFGES studies from single country papers to intra-regional studies, to inter-regional studies, and one global study.
Collapse
Affiliation(s)
- Ami D Sperber
- Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
7
|
Benchmarking the operational efficiency of Mexican hospitals – a longitudinal study. BENCHMARKING-AN INTERNATIONAL JOURNAL 2023. [DOI: 10.1108/bij-11-2021-0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
PurposeThis study aims to benchmark the operational efficiency of fifty-eight public hospitals across Mexico between 2015 and 2018 and identifies the most critical inputs affecting their efficiency. In doing so, the study analyzes the impact of policy changes in the Mexican healthcare system introduced in recent years.Design/methodology/approachTo measure the operational efficiency of Mexican public hospitals, data envelopment analysis (DEA) window analysis variable returns to scale (VRS) methodology using longitudinal data collected from the National Institute for Transparency and Access to Information (IFAI). Hospital groups are developed and compared using a categorization approach according to their average and most recent efficiency.FindingsResults show that most of the hospitals in the study fall in the moving ahead category. The hospitals in the losing momentum or falling behind categories are mostly large units. Hospitals with initially low efficiency scores have either increased their efficiency or at least maintained a steady improvement. Finally, the findings indicate that most hospitals classified as moving ahead focused on a single care area (cancer, orthopedic care, child care and trauma).Research limitations/implicationsThis study examined the technical efficiency of the Mexican healthcare system over a four-year period. Contrary to conventional belief, results indicate that most public Mexican hospitals are managed efficiently. However, recent changes in public and economic policies that came into effect in the current administration (2018) will likely have long-lasting effects on the hospitals' operational efficiency, which could impact the results of this study.Originality/valueTo the best of authors’ knowledge, this is the first study that examines the efficiency of the complex Mexican healthcare system using longitudinal data.
Collapse
|
8
|
Gwee KA, Lee YY, Suzuki H, Ghoshal UC, Holtmann G, Bai T, Barbara G, Chen MH, Chua ASB, Gibson PR, Hou X, Liu J, Nakajima A, Pratap N, Sachdeva S, Siah KTH, Soh AYS, Sugano K, Tack J, Tan VPY, Tang X, Walker M, Wu DC, Xiao YL, Zulkifli KK, Toh C. Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms. J Gastroenterol Hepatol 2023; 38:197-209. [PMID: 36321167 DOI: 10.1111/jgh.16046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/06/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut-Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom-based sub-classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD-GERD), epigastric pain syndrome with irritable bowel syndrome (EPS-IBS), postprandial distress syndrome with IBS (PDS-IBS), and FD-Constipation. We identified putative pathophysiology to provide a basis for treatment recommendations. A management algorithm is presented to guide primary and secondary care clinicians.
Collapse
Affiliation(s)
- Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and The Gastroenterology Group, Gleneagles Hospital, Singapore City, Singapore
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gerald Holtmann
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Giovanni Barbara
- Department of Internal Medicine and Gastroenterology, and CRBA, University of Bologna, Bologna, Italy
| | - Min-Hu Chen
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinsong Liu
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Nitesh Pratap
- Krishna Institute of Medical Sciences, Secunderabad, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Alex Yu Sen Soh
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | | | - Jan Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Victoria Ping Yi Tan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Xudong Tang
- Institute of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Marjorie Walker
- Anatomical Pathology College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, and Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Lian Xiao
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Khairil Khuzaini Zulkifli
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.,Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Clarissa Toh
- Stomach, Liver and Bowel Centre, Gleneagles Hospital, Singapore City, Singapore
| |
Collapse
|
9
|
Ghoshal UC. Indian Journal of Gastroenterology 2018-2022: Looking back from the Editor's desk! Indian J Gastroenterol 2023; 42:2-5. [PMID: 36905502 PMCID: PMC10007652 DOI: 10.1007/s12664-023-01340-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 03/12/2023]
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, 226 014, India.
| |
Collapse
|
10
|
Hasosah M, Haleem A, Jacobson K, Alshemmeri B, Alenazi A, Badei AA, Massoud P. Knowledge and practice of pediatricians regarding childhood constipation in the Arab world: results from a multicenter survey. BMC Pediatr 2022; 22:478. [PMID: 35933335 PMCID: PMC9356407 DOI: 10.1186/s12887-022-03536-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives We aimed to evaluate knowledge and practice styles among medical providers with different professions and working in different Arab countries regarding their approach to childhood constipation. Methods We conducted a cross-sectional multinational survey in eight Arab countries. Pediatric care providers (PCPs), including pediatric specialists (PSs), pediatric residents (PRs), pediatric consultants (PCs), pediatric gastroenterologists (PGs), general practitioners (GPs), and pediatric surgeons (PSu), were included in our study. The survey was anonymous, and participants provided input on the definition and management of constipation. Results Of 4000 PCPs, 2579 completed the survey (response rate of 64.5%). Although the majority of respondents were aware of the Rome IV criteria to diagnose constipation, significant differences in the percentage of participants in different geographic countries regarding the definition of constipation were noted. Polyethylene glycol (PEG) was prescribed as a first-line treatment of fecal disimpaction significantly more frequently by pediatricians (PSs, PRs, PCs, PGs) than GPs and PSu (12.8% versus 7.2%, respectively; p < 0.001). Additionally, we found that pediatricians used special milk (high magnesium) as a first-choice formula significantly more often than other physicians (53.7% versus 37%, P < 0.001). For maintenance therapy, both pediatricians and nonpediatricians used dietary management with a special milk formula more than other treatment options (84.2% and 84%, respectively). Conclusions Despite increased awareness of the Rome IV criteria, significant differences in knowledge and practice patterns regarding fecal disimpaction exist among PCPs from different Arab countries. The identification of these gaps may be helpful for policy-makers to produce targeted instructional resources on constipation for PCPs.
Collapse
Affiliation(s)
- Mohammed Hasosah
- Pediatric Gastroenterology Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center's (KAIMRC) National Guard Heath Affairs. Hospital, PO Box: 8202, Jeddah, 21482, Saudi Arabia.
| | - Azad Haleem
- Pediatric Gastroenterology Department, University of Duhok/College of Medicine, Duhok, Iraq
| | - Kevan Jacobson
- Pediatric Gastroenterology, British Colombia Children's Hospital, and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Bassel Alshemmeri
- Pediatric Gastroenterology Department, Kuwait Oil Company Hospital, Ahmadi, Kuwait
| | - Aziz Alenazi
- Pediatric Gastroenterology Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center's (KAIMRC) National Guard Heath Affairs Hospital, Riyad, Saudi Arabia
| | | | - Peggy Massoud
- Saint Joseph University, Novalac MENA Region, Beirut, Lebanon
| |
Collapse
|
11
|
Jiang Y, Wang Y, Tang Y, Lin L. Clinical value of positive BET and pelvic floor dyssynergia in Chinese patients with functional defecation disorder. Scand J Gastroenterol 2022; 57:775-782. [PMID: 35180039 DOI: 10.1080/00365521.2022.2039282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Functional defecation disorder (FDD) is a common subtype of functional constipation (FC). Balloon expulsion test (BET) and high resolution anorectal manometry (HR-ARM) are significant tools but their results are not always consistent. AIMS To investigate the characteristics of patients with positive BET and pelvic floor dyssynergia (PFD) and explore the value of both positive results in FDD diagnosis. METHODS We retrospectively diagnosed FC subtypes and enrolled FDD patients based on Rome-IV criteria. They underwent HR-ARM, BET and CTT tests. Then they were classified to two groups and further stratified by FDD subtypes. Validated questionnaires were applied to investigate patients' constipation, anxiety/depression and quality of life. RESULTS 335 FDD patients were finally enrolled. They were classified into two groups according to whether BET and PFD were both positive (consistent or not). 84.48% showed consistent results. These patients had significantly higher anal residual pressure, lower anal relaxation rate, manometric defecation index (MDI) and a more negative rectoanal pressure gradient (RAPG) (Ps < .05). The specific distribution of FDD phenotypes in two groups showed significant difference (p = .021). Males suffered a more negative RAPG (p < .001) and age was correlated with anal relaxation rate (p < .001). A subset (177 individuals) was investigated with validated questionnaires. Scores for Defecation Symptoms, Physical Discomfort and GAD-7 score were significantly high in Consistent Group (Ps < .05). GAD-7 score was associated with Defecation Symptoms (p < .001) while anal residual pressure, GAD-7 and Defecation Symptoms score were linked to Physical Discomfort (Ps < .05). The diagnostic specificity and PPV for FDD rose significantly with positive BET and PFD. CONCLUSION FDD patients with positive BET and PFD suffered from severe defecation symptoms, anxiety and impaired QOL. Positive BET and PFD could be an ideal tool for screening FDD.
Collapse
Affiliation(s)
- Ya Jiang
- Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yan Wang
- Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yurong Tang
- Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lin Lin
- Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| |
Collapse
|
12
|
Drossman DA, Tack J. Rome Foundation Clinical Diagnostic Criteria for Disorders of Gut-Brain Interaction. Gastroenterology 2022; 162:675-679. [PMID: 34808139 DOI: 10.1053/j.gastro.2021.11.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Douglas A Drossman
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina; Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, Chapel Hill, North Carolina; Rome Foundation, Raleigh, North Carolina USA
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium; Rome Foundation, Raleigh North Carolina
| |
Collapse
|
13
|
Colomier E, Melchior C, Algera JP, Hreinsson JP, Störsrud S, Törnblom H, Van Oudenhove L, Palsson OS, Bangdiwala SI, Sperber AD, Tack J, Simrén M. Global prevalence and burden of meal-related abdominal pain. BMC Med 2022; 20:71. [PMID: 35172840 PMCID: PMC8851773 DOI: 10.1186/s12916-022-02259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with disorders of gut-brain interaction (DGBI) report meal intake to be associated with symptoms. DGBI patients with meal-related symptoms may have more severe symptoms overall and worse health outcomes, but this subgroup has not been well characterized. We aimed to describe the global prevalence of meal-related abdominal pain and characterize this subgroup. METHODS The data analyzed originated from the Internet survey component of the population-based Rome Foundation Global Epidemiology Study, completed in 26 countries (n = 54,127). Adult subjects were asked whether they had abdominal pain and how often this was meal-related. Respondents were categorized into "no," "occasional," and "frequent" meal-related abdominal pain groups based on 0%, 10-40%, and ≥50% of the pain episodes being meal-related, respectively. DGBI diagnoses, frequency of other GI symptoms, psychological distress, non-GI somatic symptoms, quality of life, and healthcare utilization were compared between groups. Mixed linear and ordinal regression was used to assess independent associations between psychological distress, non-GI somatic symptoms, quality of life, other GI symptoms, and meal-related abdominal pain. RESULTS Overall, 51.9% of the respondents reported abdominal pain in the last 3 months, and 11.0% belonged to the group with frequent meal-related abdominal pain, which included more females and younger subjects. DGBI diagnoses were more common in subjects with frequent meal-related abdominal pain, and the frequency of several GI symptoms was associated with having more frequent meal-related abdominal pain. Having meal-related abdominal pain more frequently was also associated with more severe psychological distress, non-GI somatic symptoms, and a poorer quality of life. The group with frequent meal-related abdominal pain also more often consulted a doctor for bowel problems compared to the other groups of meal-related abdominal pain. CONCLUSION Reporting frequent meal-related abdominal pain is common across the globe and associated with other GI and non-GI somatic symptoms, psychological distress, healthcare utilization, and a poorer quality of life. Individuals who frequently experience meal-related abdominal pain also more frequently fulfill the diagnostic criteria for DGBI. Assessing meal-related symptoms in all DGBI patients could be of major importance to improve and individualize symptom management.
Collapse
Affiliation(s)
- Esther Colomier
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.
| | - Chloé Melchior
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Rouen University Hospital, Gastroenterology Department and INSERM CIC-CRB 1404, F-76031, Rouen, France
| | - Joost P Algera
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jóhann P Hreinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stine Störsrud
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for GI Disorders (TARGID), KU Leuven, Leuven, Belgium.,Cognitive & Affective Neuroscience Lab (CANlab), Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Olafur S Palsson
- Center for Functional GI and Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jan Tack
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Functional GI and Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
14
|
Sperber AD. Review article: epidemiology of IBS and other bowel disorders of gut-brain interaction (DGBI). Aliment Pharmacol Ther 2021; 54 Suppl 1:S1-S11. [PMID: 34927754 DOI: 10.1111/apt.16582] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 12/15/2022]
Abstract
The disorders of gut-brain interactions (DGBI) are a spectrum of gastrointestinal (GI) disorders that involve the entire GI tract and are usually categorised into four major anatomic GI regions, oesophageal, gastroduodenal, bowel and anorectal. Irritable bowel syndrome (IBS), a bowel DGBI, is one of the most researched DGBI and has been the subject of copious epidemiological studies. Prevalence rates are based on diagnostic criteria. In the case of IBS, there are three central obstacles to attaining a clear picture of prevalence: the absence of biomarkers, the multitude of diagnostic criteria used over the years, and the heterogeneous nature of the methodology used in epidemiologic surveys. When the results of multiple studies, conducted over a long period of time, using different diagnostic criteria and different research methodology, and involving different study populations are pooled to determine a single summary prevalence rate it is difficult to interpret the results and to determine their reliability and significance. This pitfall is insufficiently recognised and unfortunate because prevalence rates are important for understanding the burden of disease, for allocating healthcare and research resources, and for incentivising and prioritising new treatments. The aims of the present paper are to highlight our knowledge and understanding of IBS epidemiology within the context of other DGBI, and to present strategies to improve epidemiological research, especially in advance of the new Rome V criteria, to be published in 2026.
Collapse
Affiliation(s)
- Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
15
|
Expectations of IBS patients concerning disease and healthcare providers: Results of a prospective survey among members of a French patients' association. Clin Res Hepatol Gastroenterol 2020; 44:961-967. [PMID: 32205115 DOI: 10.1016/j.clinre.2020.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/06/2020] [Accepted: 02/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS IBS patients have an impaired quality of life (QoL) and feel dissatisfaction with medical care. We aim to describe the expectations of members of the French Association of IBS patients (APSSII) concerning health care providers (HCPs) and a patients' organization. PATIENTS AND METHODS From January to June 2013, APSSII members were asked to answer questionnaires on their expectations and experiences concerning IBS and HCP. RESULTS 222/330 (67%) responded (women: 68.5%, 46.5±17.7 years, disease duration: 8.8±0.7 years, IBS-D 33.6%, IBS-C 26.7%, IBS-M 38.2%. IBS-SSS>300 in 53% and HAD score>19 in 45%). QoL impairment was correlated with disease severity and HAD score (r=-0.707 and r=-0.484, P<0.001 respectively), but not with IBS subtype. Expectations for IBS were "improved health", "better information on causes and treatments" (94%) and "better disease recognition" (86%). A significant gap was observed between expectations and experiences with HCPs. Better information, less isolation, recognition of the disease and a decrease in medical expenses were the main expectations for joining a patients' organization. CONCLUSIONS French IBS patients have a severe disease with a significant psychological impact and impaired QoL in half of the patients, certain unsatisfied expectations concerning HCP and high expectations in joining a patients' organization.
Collapse
|
16
|
Black CJ, Ford AC. Global burden of irritable bowel syndrome: trends, predictions and risk factors. Nat Rev Gastroenterol Hepatol 2020; 17:473-486. [PMID: 32296140 DOI: 10.1038/s41575-020-0286-8] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 02/08/2023]
Abstract
Irritable bowel syndrome (IBS) is one of the most common disorders of gut-brain interaction worldwide, defined according to patterns of gastrointestinal symptoms as described by the Rome diagnostic criteria. However, these criteria, developed with reference to research conducted largely in Western populations, might be limited in their applicability to other countries and cultures. Epidemiological data show a wide variation in the prevalence of IBS globally and more rigorous studies are needed to accurately determine any differences that might exist between countries as well as the potential explanations. The effects of IBS on the individual, in terms of their quality of life, and on health-care delivery and society, in terms of economic costs, are considerable. Although the magnitude of these effects seems to be comparable between nations, their precise nature can vary based on the existence of societal and cultural differences. The pathophysiology of IBS is complex and incompletely understood; genetics, diet and the gut microbiome are all recognized risk factors, but the part they play might be influenced by geography and culture, and hence their relative importance might vary between countries. This Review aims to provide an overview of the burden of IBS in a global context, to discuss future implications for the care of people with IBS worldwide, and to identify key areas for further research.
Collapse
Affiliation(s)
- Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK. .,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.
| |
Collapse
|
17
|
Clinical and anorectal manometry profile of patients with functional constipation and constipation-predominant irritable bowel syndrome. Indian J Gastroenterol 2019; 38:211-219. [PMID: 31240564 DOI: 10.1007/s12664-019-00953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C) have significant healthcare impact. Clinical and investigative data of patients with these disorders in Indian population is scarce. We aimed to compare the clinical and anorectal manometric profile of patients with FC and IBS-C. METHODS Consecutive patients with chronic constipation undergoing anorectal manometry (ARM) and balloon expulsion test (BET) were enrolled. Thirty healthy volunteers served as controls (HC). Functional defecatory disorder (FDD) was diagnosed according to ROME IV criteria if both ARM and BET were abnormal. RESULTS Of the 231 patients enrolled (median age 47 years, 87.8% males), FC and IBS-C were diagnosed in 132 (57.1%) and 99 (42.9%) patients, respectively. Significant clinical differences between FC and IBS-C patients included older age, lower stool frequency/week, higher frequency of straining, and greater frequency of incomplete evacuation (p < 0.001). ARM revealed abnormal defecatory pattern in 55.3% (n = 73) FC patients and 47.5% (n = 47) IBS-C patients. Of them, 54.7% (40/73) of FC patients had inadequate defecatory propulsion while 89.4% (42/47) of the IBS-C patients had dyssynergic defecation (p < 0.001). Abnormal BET was seen in 67.4% of FC patients and 43.4% of IBS-C patients. Thus, FDD was diagnosed in 55.3% and 46.5% of FC and IBS-C patients, respectively. Rectal hyposensitivity was present in 60.6% of FC patients compared with 2% of IBS-C patients (p < 0.001). CONCLUSIONS There were significant differences in clinical and manometric profile of FC and IBS-C patients. Compared with IBS-C patients, FC patients were older, had higher prevalence of FDD, less often had dyssynergic defecation, and had higher prevalence of rectal hyposensitivity.
Collapse
|
18
|
Yoon SL, Grundmann O, Smith KF, Mason SR. Dietary Supplement and Complementary and Alternative Medicine Use Are Highly Prevalent in Patients with Gastrointestinal Disorders: Results from an Online Survey. J Diet Suppl 2018; 16:635-648. [PMID: 29958032 DOI: 10.1080/19390211.2018.1472712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The use of complementary and alternative medicine (CAM) is widespread among adults in the United States to self-treat a range of disorders, including gastrointestinal (GI) disorders. This study determined the self-reported use of CAM, including dietary supplements, in managing GI symptoms among Internet users and investigated perceived effects of supplement use on GI symptoms. We used a cross-sectional, descriptive, correlational design. A Qualtrics online survey was utilized to collect data through various websites. Focused areas include demographics, health evaluation, health issue(s), supplement and CAM use, and GI symptoms. Of the participants included in the study, a majority (88%) were women and half (50.1%) were between the ages of 26 and 45. Most participants (84.5%) reported use of herbal supplements, and 84.8% of the participants used herbal supplements for a specific health problem. The most common reported health condition was gastroesophageal reflux (44.4%). The attrition rate was low at 22%. The novelty of using an anonymous online survey to collect data on supplement use in GI disorders indicated a high prevalence of dietary and herbal supplement use among persons with GI disorders comparable to previous reports. Health-care providers should ask patients about supplement use in addition to prescribed medications and communicate effectively if conventional pharmacotherapy is not sufficient to manage symptoms or patients are inclined to use supplements.
Collapse
Affiliation(s)
- Saunjoo L Yoon
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida , Gainesville , FL , USA
| | - Oliver Grundmann
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida , Gainesville , FL , USA.,College of Pharmacy, Department of Medicinal Chemistry, University of Florida , Gainesville , FL , U.S.A
| | - Keore F Smith
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida , Gainesville , FL , USA
| | - Sidney R Mason
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida , Gainesville , FL , USA
| |
Collapse
|
19
|
Wang S, Li Y, Li C, Qiao Y, He S. Distribution and Determinants of Unmet Need for Supportive Care Among Women with Breast Cancer in China. Med Sci Monit 2018; 24:1680-1687. [PMID: 29561832 PMCID: PMC5877206 DOI: 10.12659/msm.905282] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The aim of this study was to determine the need for supportive care among women suffering from breast cancer in China and to identify its potential determinants to inform the development of effective and efficient healthcare services across different settings. Material/Methods In a tertiary-care hospital in Weifang, China, between July 2015 and January 2016, all women attending the Breast Cancer Clinic for regular physical examinations after treatment for breast cancer were consecutively recruited. The 34-item Supportive Care Needs Survey tool (Chinese version) (SCNS-SF34-C) was used to assess the unmet needs among participants. Results Among 264 recruited patients, based on at least single-item endorsement, 60.2% had moderate to high level of need for supportive care, while only 13.3% expressed no need. Lack of information regarding health systems was the most common domain with moderate to high unmet needs, more so among rural patients (8 vs. 5 out of 10). In each information-related domain, huge unmet need was observed among all patients irrespective of urban or rural residence. Both overall and individual information-related domain-specific unmet needs were significantly higher among rural patients as opposed to their urban counterparts. Multiple regression analyses revealed a significant rural-urban variation of unmet needs. Moreover, education and post-diagnosis time duration were negatively associated with unmet needs while stage of cancer was positively associated with these unmet needs. Conclusions There is a huge burden of unmet needs for information on the healthcare system among breast cancer survivors in China. Rural residence, less education, advanced stage of cancer, and shorter duration since diagnosis were the identified determinants requiring targeted intervention.
Collapse
Affiliation(s)
- Shouhua Wang
- Department of Oncology, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China (mainland)
| | - Yanqing Li
- Department of Oncology, The Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China (mainland)
| | - Chaozhuo Li
- Department of Clinical Medicine, Xuzhou Medical University, Xuzhou, Jiangsu, China (mainland)
| | - Yijun Qiao
- Department of Outpatient, Weifang Military Hospital of Shandong Province, Weifang, Shandong, China (mainland)
| | - Shuling He
- Department of Gynecology and Obstetrics, The People's Hospital of Wulian County, Wulian, Shandong, China (mainland)
| |
Collapse
|
20
|
Gwee KA, Ghoshal UC, Chen M. Irritable bowel syndrome in Asia: Pathogenesis, natural history, epidemiology, and management. J Gastroenterol Hepatol 2018; 33:99-110. [PMID: 28901578 DOI: 10.1111/jgh.13987] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/15/2017] [Accepted: 09/07/2017] [Indexed: 12/14/2022]
Abstract
Historically, the epidemiology of gastrointestinal diseases in Asia was different from that in Western countries. Early studies suggested a low prevalence of irritable bowel syndrome (IBS) in Asia. As the diagnosis of IBS is symptom-based and as symptom perception, expression, and interpretation are influenced by sociocultural perspectives including language, the presentation of IBS is expected to vary in different communities. Furthermore, the pathogenesis is multifactorial with psychosocial (stress, illness, behavior, and diet) and biological (infection, gut microbiota, and immune activation) variables interacting, and so, the present study can anticipate that the development of IBS will vary in different environments. In recognition of this aspect of functional gastrointestinal disorders, the recently published Rome IV documents have provided greater focus on cross-cultural factors. In this review, the present study seeks to highlight Asian perspectives by identifying historical trends and recent publications from the region and comparing these with the observations from Western societies.
Collapse
Affiliation(s)
- Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
21
|
Ghoshal UC. Indian Journal of Gastroenterology: The promises fulfilled and waiting for fulfillment! Indian J Gastroenterol 2017; 36:441-442. [PMID: 29333585 DOI: 10.1007/s12664-017-0816-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| |
Collapse
|
22
|
Xiong L, Gong X, Siah KTH, Pratap N, Ghoshal UC, Abdullah M, Syam AF, Bak YT, Choi MG, Lu CL, Gonlachanvit S, Chua ASB, Chong KM, Ricaforte-Campos JD, Shi Q, Hou X, Whitehead WE, Gwee KA, Chen M. Rome foundation Asian working team report: Real world treatment experience of Asian patients with functional bowel disorders. J Gastroenterol Hepatol 2017; 32:1450-1456. [PMID: 28084664 DOI: 10.1111/jgh.13730] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/30/2016] [Accepted: 01/10/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Information on real world treatment experiences of patients with functional bowel disorders is lacking from Asia. This study aimed to describe the medication exposure and treatment satisfaction of patients presenting to gastroenterology clinics across a sampling of Asian cities. METHODS From March 2011 to October 2013, adult patients presenting to hospital-based gastroenterology outpatient clinics in 11 cities across Asia, who fulfilled screening criteria for any functional gastrointestinal disorder, were asked to complete a validated culturally adapted translation of the Rome III diagnostic questionnaire, a checklist of medications received in the preceding 3 months and questions on treatment satisfaction. RESULTS A total of 1376 patients (female 755, male 621, 41.36 ± 13.25 years) comprising irritable bowel (621, 45.1%), unspecified functional bowel disorder (372, 27.8%), functional constipation (202, 14.7%), functional bloating (144, 10.5%), and functional diarrhea (56, 4.1%) completed the study. Of 1105 patients with a previous consultation, 509 (46.1%) were dissatisfied with their treatment, with ineffective treatment being the commonest reason. Satisfaction with previous consultation was lowest by diagnosis for functional constipation (29.2%), and the most bothersome symptom was straining (37.5%). Of 1046 patients who had taken medications for their gastrointestinal symptoms in the last 3 months, 793 (75.8%) had received two or more drugs. For irritable bowel syndrome patients, treatment with proton pump inhibitors and antispasmodics was recorded in 57% and 31%, with overlapping epigastric pain and heartburn predicting proton pump inhibitors use. CONCLUSIONS More attention should be given to treatment gaps with regards to possible under-treatment with antispasmodics in irritable bowel syndrome and to critically evaluating the efficacy of constipation management.
Collapse
Affiliation(s)
- Lishou Xiong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaorong Gong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kewin Tien-Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore
| | - Nitesh Pratap
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Murdani Abdullah
- Division of Gastroenterology, Cipto Mangunkusumo General Hospital, Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia
| | - Ari Fahrial Syam
- Division of Gastroenterology, Cipto Mangunkusumo General Hospital, Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia
| | - Young-Tae Bak
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ching-Liang Lu
- Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University Taipei, Taipei, Taiwan
| | - Sutep Gonlachanvit
- GI Motility Research Unit, Division of Gastroenterology, Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Jane D Ricaforte-Campos
- Section of Gastroenterology, Department of Internal Medicine, Medical Center Manila, Manila, Philippines
| | - Quan Shi
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaohua Hou
- Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, Hubei, China
| | - William E Whitehead
- Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
23
|
Ghoshal UC. Pros and Cons While Looking Through an Asian Window on the Rome IV Criteria for Irritable Bowel Syndrome: Pros. J Neurogastroenterol Motil 2017; 23:334-340. [PMID: 28672432 PMCID: PMC5503282 DOI: 10.5056/jnm17020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/04/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
A decade after Rome III, in 2016, Rome IV criteria were published. There are major differences between Rome IV and the earlier iteration, some of which are in line with Asian viewpoints. The clinical applicability of the Rome IV criteria of irritable bowel syndrome (IBS) in Asian perspective is reviewed here. Instead of considering functional gastrointestinal disorders (FGIDs) to be largely psychogenic, Rome IV suggested the importance of the gut over brain (“disorders of gut-brain interaction” not “brain-gut interaction”). The word “functional” is underplayed. Multi-dimensional clinical profile attempts to recognize micro-organic nature, like slow colon transit and fecal evacuation disorders in constipation and dietary intolerance including that of lactose and fructose, bile acid malabsorption, non-celiac wheat sensitivity, small intestinal bacterial overgrowth, and gastrointestinal infection in diarrhea. Overlap between different FGIDs has been recognized as Rome IV suggests these to be a spectrum rather than discrete disorders. Bloating, common in Asia, received attention, though less. Sub-typing of IBS may be more clinician-friendly now as the patient-reported stool form may be used than a diary. However, a few issues, peculiar to Asia, need consideration; Rome IV, like Rome III, suggests that Bristol type I–II stool to denote constipation though Asian experts include type III as well. Work-up for physiological factors should be given greater importance. Language issue is important. Bloating, common in IBS, should be listed in the criteria. Threshold values for symptoms in Rome IV criteria are based on Western data. Post-infectious malabsorption (tropical sprue) should be excluded to diagnose post-infectious IBS, particularly in Asia.
Collapse
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
24
|
Hu X, Yuan M, Yin Y, Wang Y, Li Y, Zhang N, Sun X, Yu Z, Xu B. Electroacupuncture at LI11 promotes jejunal motility via the parasympathetic pathway. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:329. [PMID: 28637453 PMCID: PMC5480127 DOI: 10.1186/s12906-017-1826-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 06/06/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastrointestinal motility disorder has been demonstrated to be regulated by acupuncture treatment. The mechanisms underlying the effects of acupuncture stimulation of abdominal and lower limb acupoints on gastrointestinal motility have been thoroughly studied; however, the physiology underlying the effects of acupuncture on the forelimbs to mediate gastrointestinal motility requires further exploration. The aim of this study was to determine whether electroacupuncture (EA) at LI11 promotes jejunal motility, whether the parasympathetic pathway participates in this effect, and if so, which somatic afferent nerve fibres are involved. METHODS A manometric balloon was used to observe jejunal motility. The effects and mechanisms of EA at LI11 were explored in male Sprague-Dawley rats with or without drug administration (propranolol, clenbuterol, acetylcholine, and atropine) and with or without vagotomy. Three types of male mice (β1β2 receptor-knockout [β1β2-/-] mice, M2M3 receptor-knockout [M2M3-/-] mice and wild-type [WT] mice) were also studied by using different EA intensities (1, 2, 4, 6, and 8 mA). A total of 72 rats and 56 mice were included in the study. RESULTS EA at LI11 increased the contractile amplitude of jejunal motility in the majority of both rats and mice. However, EA at LI11 did not enhance jejunal motility in rats administered atropine, rats that underwent vagotomy, and M2M3-/- mice (at all intensities). In WT mice, EA at LI11 significantly increased jejunal motility at all intensities except 1 mA, and a plateau was reached at intensities greater than 4 mA. CONCLUSION Our results suggest that EA at LI11 promotes jejunal motility primarily by exciting the parasympathetic pathway, and that Aδ-fibres and C-fibres may play important roles in the process.
Collapse
Affiliation(s)
- Xuanming Hu
- Key Laboratory of Integrated Acupuncture and Drugs Constructed, Nanjing University of Chinese Medicine, Ministry of Education, Nanjing, 210023 China
| | - Mengqian Yuan
- Key Laboratory of Integrated Acupuncture and Drugs Constructed, Nanjing University of Chinese Medicine, Ministry of Education, Nanjing, 210023 China
| | - Yin Yin
- Key Laboratory of Integrated Acupuncture and Drugs Constructed, Nanjing University of Chinese Medicine, Ministry of Education, Nanjing, 210023 China
| | - Yidan Wang
- Key Laboratory of Integrated Acupuncture and Drugs Constructed, Nanjing University of Chinese Medicine, Ministry of Education, Nanjing, 210023 China
| | - Yuqin Li
- Key Laboratory of Integrated Acupuncture and Drugs Constructed, Nanjing University of Chinese Medicine, Ministry of Education, Nanjing, 210023 China
| | - Na Zhang
- Key Laboratory of Integrated Acupuncture and Drugs Constructed, Nanjing University of Chinese Medicine, Ministry of Education, Nanjing, 210023 China
| | - Xueyi Sun
- Key Laboratory of Integrated Acupuncture and Drugs Constructed, Nanjing University of Chinese Medicine, Ministry of Education, Nanjing, 210023 China
| | - Zhi Yu
- Key Laboratory of Integrated Acupuncture and Drugs Constructed, Nanjing University of Chinese Medicine, Ministry of Education, Nanjing, 210023 China
| | - Bin Xu
- Key Laboratory of Integrated Acupuncture and Drugs Constructed, Nanjing University of Chinese Medicine, Ministry of Education, Nanjing, 210023 China
| |
Collapse
|
25
|
Functional Gastrointestinal Disorders in Children: A Survey on Clinical Approach in the Mediterranean Area. J Pediatr Gastroenterol Nutr 2017; 64:e142-e146. [PMID: 28541259 DOI: 10.1097/mpg.0000000000001550] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Childhood functional gastrointestinal disorders (FGIDs) are common conditions associated with significant morbidity and high healthcare costs. This multicenter study aimed at assessing the clinical approach to infants (0-6 months) and children/adolescents (4-18 years) with suspected FGIDs by pediatricians from the Mediterranean Area. METHODS A survey evaluating the diagnostic approach, including the use of Rome II and III criteria, and the therapeutic management of some of the most prevalent FGIDs, such as irritable bowel syndrome (IBS), functional constipation (FC), and functional regurgitation (FR), was distributed to a sample of pediatricians. RESULTS We collected 278 questionnaires from 9 countries (Croatia, Greece, Israel, Italy, Lebanon, Montenegro, Serbia, Slovenia, and Spain). Rome III criteria are used to diagnose FC by 28.8%. Treatment of FC is based on dietary modifications (97.5%) and osmotic laxatives (93.5%). Rome III criteria are used to diagnose FR by 22.3% of the responders, in contrast to 79.5% who rely on personal experience for diagnosis. Reported treatments mainly consist of reassurance (96.8%) and thickened feedings (77.3%). Nevertheless, 21.2% prescribe proton pump inhibitors or H2-blockers to infants with FR. Rome III criteria are used to diagnose IBS by only 25.9%. Moreover, 86% of the pediatricians base IBS therapy on the predominant symptom. The most prescribed treatments are analgesics (36.6%) for pain control, dietary advice (41.5%) for diarrhea-predominant IBS, and dietary advice (47.8%) for constipation-predominant IBS. CONCLUSIONS Our data show that the use of Rome III diagnostic criteria is not sufficiently widespread among pediatricians, and that large variability remains in the management of FGIDs within the different Mediterranean countries surveyed.
Collapse
|
26
|
Abstract
Chronic constipation (CC) is a common problem in the community and in gastroenterology practice all over the world including India. After release of Rome IV guidelines in April 2016, there is increasing interest among gastroenterologists and physicians in India to look into special issues on CC in the Indian perspective. There are important differences in the bowel habit, definition, epidemiology, and pathophysiology including dietary factors and management of CC in India as compared to the West. As severity and frequency of abdominal pain, a symptom essential to diagnose constipation-predominant irritable bowel syndrome (IBS-C) rather than functional constipation (FC), is less common among Indian patients, FC is commoner than IBS-C in India. The pathophysiological mechanisms of CC may include slow colon transit, fecal evacuation disorder (FED), or a combination of these; though CC in a third to half of patients presenting to tertiary care facilities may result from these pathophysiological mechanisms, most patients presenting to primary care may have lifestyle and dietary issues. The current Rome IV algorithm dictates to explore the underlying physiological factors in the pathogenesis of functional gastrointestinal disorders including CC, which may translate to its personalized management. However, the availability of the methods to explore pathophysiological factors and manage CC caused by FED non-pharmacologically (using biofeedback) in India is limited. Though several pharmacological agents are available in India to manage CC, there are several unmet needs in its treatment. This review explores CC in India in relation to these issues, some of which are unique in the Indian perspective.
Collapse
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| |
Collapse
|
27
|
Abstract
Functional gastrointestinal disorders (FGIDs) are diagnosed and classified using the Rome criteria; the criteria may change over time as new scientific data emerge. The Rome IV was released in May 2016. The aim is to review the main changes in Rome IV. FGIDs are now called disorders of gut-brain interaction (DGBI). Rome IV has a multicultural rather than a Western-culture focus. There are new chapters including multicultural, age-gender-women's health, intestinal microenvironment, biopsychosocial, and centrally mediated disorders. New disorders have been included although not truly FGIDs, but fit the new definition of DGBI including opioid-induced gastrointestinal hyperalgesia , opioid-induced constipation , and cannabinoid hyperemesis . Also, new FGIDs based on available evidence including reflux hypersensitivity and centrally mediated abdominal pain syndrome . Using a normative survey to determine the frequency of normal bowel symptoms in the general population changes in the time frame for diagnosis were introduced. For irritable bowel syndrome (IBS) only pain is required and discomfort was eliminated because it is non-specific, having different meanings in different languages. Pain is now related to bowel movements rather than just improving with bowel movements (ie, can get worse with bowel movement). Functional bowel disorders (functional diarrhea , functional constipation , IBS with predominant diarrhea [IBS-D], IBS with predominant constipation [IBS-C ], and IBS with mixed bowel habits ) are considered to be on a continuum rather than as independent entities. Clinical applications such as diagnostic algorithms and the Multidimensional Clinical Profile have been updated. The new Rome IV iteration is evidence-based, multicultural oriented and with clinical applications. As new evidence become available, future updates are expected.
Collapse
Affiliation(s)
- Max J Schmulson
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental, Facultad de Medicina-Universidad Nacional Autónoma de México (UNAM), Hospital General de México, Dr. Eduardo Liceaga, Mexico City,
Mexico
| | - Douglas A Drossman
- Center for Functional GI and Motility Disorders at University of North Carolina, NC,
USA
- Center for Education and Practice of Biopsychosocial Care and Drossman Gastroenterology, Chapel Hill, NC,
USA
| |
Collapse
|
28
|
Ghoshal UC, Singh R. Frequency and risk factors of functional gastro-intestinal disorders in a rural Indian population. J Gastroenterol Hepatol 2017; 32:378-387. [PMID: 27262283 DOI: 10.1111/jgh.13465] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM As best estimates on functional gastrointestinal disorders (FGIDs) prevalence are expected from community studies, which are scanty from Asia, we evaluated the prevalence and risk factors of FGIDs in a rural Indian community. METHODS House-to-house survey was undertaken by trained interviewers using translated-validated Rome III and hospital anxiety and depression questionnaires. RESULT Among 3426 subjects ≥ 18 years old from 3 villages in Uttar Pradesh, 84% participated, of whom 80% were finally analyzed. Of these 2774 subjects (age 38.4 ± 16.5 years, 1573 [56.7%] male), 2654 [95.7%] were vegetarian and 120 [4.3%] non-vegetarian. Socioeconomic classes were upper (16.7%), upper middle (15.1%), lower middle (22%), upper lower (22.2%), and lower (24%) using Prasad's Classification; 603 (21.7%) had FGIDs (413 [14.9%] dyspepsia, 75 [2.7%] irritable bowel syndrome (IBS) and 115 [4.1%] dyspepsia-IBS overlap), by Rome III criteria. In subjects with dyspepsia, 49/528 (9%) had epigastric pain, 141 (27%) postprandial distress syndromes (EPS, PDS) and 338 (64%) EPS-PDS overlap. IBS was more often diarrhea than constipation-predominant subtype. On univariate analysis, chewing tobacco, aerated drink, tea/coffee, disturbed sleep, vegetarianism, and anxiety parameters and presence of dyspepsia predicting occurrence of IBS were associated with FGIDs. On multivariate analysis, chewing tobacco, aerated soft drink, tea/coffee, vegetarianism, anxiety parameters, and presence of dyspepsia predicting IBS were significant. CONCLUSION Functional gastrointestinal disorders, particularly dyspepsia-IBS overlap, are common in rural Indian population; the risk factors included chewing tobacco, aerated soft drink, tea/coffee, vegetarian diet, disturbed sleep, anxiety, and dyspepsia predicting occurrence of IBS.
Collapse
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajan Singh
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
29
|
|
30
|
Ghoshal UC, Verma A, Misra A. Frequency, spectrum, and factors associated with fecal evacuation disorders among patients with chronic constipation referred to a tertiary care center in northern India. Indian J Gastroenterol 2016; 35:83-90. [PMID: 27041380 DOI: 10.1007/s12664-016-0631-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 03/01/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Data on fecal evacuation disorder (FED) causing chronic constipation (CC) is scanty in India. METHODS Prospectively maintained data of 249 consecutive patients with CC (Rome III) referred for investigations were retrospectively analyzed. RESULTS Of 249 patients (43.7 ± 16.2 years, 174 males), 135/242 (55.8 %), 57/249 (22.9 %), and 83/136 (61.0 %) had abnormal balloon expulsion test (>200 g), anorectal manometry [>100 mmHg resting pressure (n = 4), >167 mmHg squeeze pressure (n = 46), and both (n = 7)], and defecography (anorectal angle not opening by >15° during defecation, perineal descent ≥4 cm, and/or rectocele), respectively. Though 181/249 (72.6 %) had one test abnormality, 86/249 (34 %) had FED (greater than or equal to two abnormalities), 44/65 (67.6 %) of whom had a defecation index ≤1.4. Rome III criteria for irritable bowel syndrome were equally fulfilled by patients with and without FED [74/83 (89 %) vs. 117/144 (81.2 %); p = ns]. On univariate analysis, straining duration, prolonged straining [≥30 min; 21/39 (53.8 %) vs. 15/65 (23.1 %); p = 0.002], incomplete evacuation [75/77 (97.4 %) vs. 95/114 (83.3 %); p = 0.004], and >3 stools/week [60/75 (80 %) vs. 76/128 (60 %); p = 0.004] were commoner among the FED patients though age, gender, symptom duration, mucus, manual evacuation, and stool forms were comparable. Resting and squeeze pressures and balloon volume at maximum tolerable limit were higher, and the sphincter tended to be shorter in FED. Prolonged straining, incomplete evacuation, and squeeze pressure were significant on multivariate analysis. Manometry and defecography abnormalities were commoner among the female FED patients. CONCLUSION FED is not uncommon, which fulfills the Rome III criteria for IBS, and prolonged straining may be suggestive; abnormal defecography and manometry are commoner in female.
Collapse
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
| | - Abhai Verma
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Asha Misra
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| |
Collapse
|
31
|
Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology 2016; 150:S0016-5085(16)00223-7. [PMID: 27144617 DOI: 10.1053/j.gastro.2016.02.032] [Citation(s) in RCA: 1190] [Impact Index Per Article: 148.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 12/02/2022]
Abstract
Functional gastrointestinal disorders (FGIDs), the most common diagnoses in gastroenterology are recognized by morphological and physiological abnormalities that often occur in combination including motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota and altered central nervous system processing. Research on these gut-brain interaction disorders is based on using specific diagnostic criteria. The Rome Foundation has played a pivotal role in creating diagnostic criteria thus operationalizing the dissemination of new knowledge in the field of FGIDs. Rome IV is a compendium of the knowledge accumulated since Rome III was published 10 years ago. It improves upon Rome III by: 1) updating the basic and clinical literature, 2) offering new information on gut microenvironment, gut-brain interactions, pharmacogenomics, biopsychosocial, gender and cross cultural understandings of FGIDs, 3) reduces the use of imprecise and occassionally stigmatizing terms when possible, 4) uses updated diagnostic algorithms, 5) incorporates information on the patient illness experience, and physiological subgroups or biomarkers that might lead to more targeted treatment. This introductory article sets the stage for the remaining 17 articles that follow and offers an historical overview of the FGIDs field, differentiates FGIDs from motility and structural disorders, discusses the changes from Rome III, reviews the Rome committee process, provides a biopsychosocial pathophysiological conceptualization of FGIDs, and offers an approach to patient care.
Collapse
|
32
|
Fang X, Francisconi CF, Fukudo S, Gerson MJ, Kang JY, Schmulson W MJ, Sperber AD. Multicultural Aspects in Functional Gastrointestinal Disorders (FGIDs). Gastroenterology 2016; 150:S0016-5085(16)00179-7. [PMID: 27144623 DOI: 10.1053/j.gastro.2016.02.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 12/12/2022]
Abstract
Cross-cultural factors are important in functional gastrointestinal disorders (FGIDs). In the setting of FGIDs, the aims of this review were to: 1) engender interest in global aspects; 2) gain a clearer understanding of culture, race and ethnicity and their effect on patient care and research; 3) facilitate cross-cultural clinical and research competency; and 4) improve and foster the quality and conduct of cross-cultural, multinational research. Cultural variables are inevitably present in the physician-patient context. Food and diets, which differ among cultural groups, are perceived globally as related to or blamed for symptoms. From an individual perspective, biological aspects, such as genetics, the microbiome, environmental hygiene, cytokines and the nervous system, which are affected by cultural differences, are all relevant. Of equal importance are issues related to gender, symptom reporting and interpretation, and family systems. From the physician's viewpoint, understanding the patient's explanatory model of illness, especially in a cultural context, affects patient care and patient education in a multicultural environment. Differences in the definition and use of Complementary and Alternative Medicine and other issues related to healthcare services for the FGIDs are also a relevant cross-cultural issue. This paper highlights the importance of cross-cultural competence in clinical medicine and research.
Collapse
Affiliation(s)
- Xiucai Fang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1(#)Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Carlos F Francisconi
- Full Professor, Department Internal Medicine, Universidade Federal do Rio Grande do Sul, Chief, Gastroenterology Division, Hospital de Clínicas de Porto Alegre Address: Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350 CEP 90035-003 Porto Alegre RS Brazil.
| | - Shin Fukudo
- PhD, Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575 Japan
| | - Mary-Joan Gerson
- Adjunct Clinical Professor, and Director of the Advanced Specialization Program in Couple and Family Therapy at the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis; Faculty, Mount Sinai School of Medicine, Division of Gastroenterology
| | - Jin-Yong Kang
- Parkside Hospital, 53 Parkside, London, SW17 5NX, United Kingdom
| | - Max J Schmulson W
- MD, Professor of Medicine, Laboratorio de Hígado, Páncreas y Motilidad (HIPAM)-Unit of Research in Experimental Medicine, Faculty of Medicine-Universidad Nacional Autónoma de México (UNAM), Hospital General de México, Dr. Balmis #148, Col. Doctores C.P.06726, México D.F.-México
| | - Ami D Sperber
- Emeritus Professor of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
33
|
Fukudo S, Hahm KB, Zhu Q, Sollano JD, Rani AA, Syam AF, Kachintorn U, Suzuki H, Kamiya T, Joh T, Uchiyama K, Naito Y, Takahashi S, Kinoshita Y, Ueno F, Yamagami H, Chan FKL, Fock KM, Arakawa T. Survey of clinical practice for irritable bowel syndrome in East asian countries. Digestion 2015; 91:99-109. [PMID: 25632923 DOI: 10.1159/000369078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM Sociocultural factors are important because their different effects on the features of irritable bowel syndrome (IBS) between countries will provide clues towards solving this problem. The aims of this study were to depict the clinical realities of IBS in East Asian countries and test the hypothesis that the diagnosis and treatment of IBS differ between countries. SUBJECTS AND METHODS Study participants were 251 physicians involved in the clinical practice of IBS at major institutions in Japan, South Korea, China, the Philippines, Indonesia and Singapore. The questionnaire contained 45 questions focused on the clinical practice of IBS. RESULTS Subjects in Japan, South Korea, China, Indonesia, the Philippines and Singapore accounted for 55.4, 17.9, 8.8, 8.0, 6.4 and 3.6% of the study cohort, respectively. Amongst East Asian physicians, the most important symptom was considered to be abdominal pain by 33.4%, whilst 24.3% regarded alternating diarrhea and constipation to be the most important symptoms. Total colonoscopy and histopathology use showed no difference among countries. Prescriptions given for mild (p < 0.0001), moderate (p < 0.0001), severe (p < 0.0001), intractable (p = 0.002), diarrheal (p < 0.0001) and constipating (p < 0.0001) patients with IBS significantly differed between the countries. Except for several minor points, IBS specialists showed no significant difference in their diagnosis and treatment of IBS when compared to nonspecialists. CONCLUSION This survey provided data on the clinical treatment of IBS among East Asian countries. The results supported the hypothesis that the diagnosis and treatment of IBS differs between countries.
Collapse
Affiliation(s)
- Shin Fukudo
- Digestive Disease Center, CHA University School of Medicine and CHA University Bundang Medical Center, Seongnam, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Ghoshal UC, Gwee KA, Chen M, Gong XR, Pratap N, Hou X, Syam AF, Abdullah M, Bak YT, Choi MG, Gonlachanvit S, Chua ASB, Chong KM, Siah KTH, Lu CL, Xiong L, Whitehead WE. Development, Translation and Validation of Enhanced Asian Rome III Questionnaires for Diagnosis of Functional Bowel Diseases in Major Asian Languages: A Rome Foundation-Asian Neurogastroenterology and Motility Association Working Team Report. J Neurogastroenterol Motil 2015; 21:83-92. [PMID: 25537673 PMCID: PMC4288097 DOI: 10.5056/jnm14045] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS The development-processes by regional socio-cultural adaptation of an Enhanced Asian Rome III questionnaire (EAR3Q), a cultural adaptation of the Rome III diagnostic questionnaire (R3DQ), and its translation-validation in Asian languages are presented. As English is not the first language for most Asians, translation-validation of EAR3Q is essential. Hence, we aimed to culturally adapt the R3DQ to develop EAR3Q and linguistically validate it to show that the EAR3Q is able to allocate diagnosis according to Rome III criteria. METHODS After EAR3Q was developed by Asian experts by consensus, it was translated into Chinese, Hindi-Telugu, Indonesian, Korean and Thai, following Rome Foundation guidelines; these were then validated on native subjects (healthy [n = 60], and patients with irritable bowel syndrome [n = 59], functional dyspepsia [n = 53] and functional constipation [n = 61]) diagnosed by clinicians using Rome III criteria, negative alarm features and investigations. RESULTS Experts noted words for constipation, bloating, fullness and heartburn, posed difficulty. The English back-translated questionnaires demonstrated concordance with the original EAR3Q. Sensitivity and specificity of the questionnaires were high enough to diagnose respective functional gastrointestinal disorders (gold standard: clinical diagnoses) in most except Korean and Indonesian languages. Questionnaires often uncovered overlapping functional gastrointestinal disorders. Test-retest agreement (kappa) values of the translated questionnaires were high (0.700-1.000) except in Korean (0.300-0.500) and Indonesian (0.100-0.400) languages at the initial and 2-week follow-up visit. CONCLUSIONS Though Chinese, Hindi and Telugu translations were performed well, Korean and Indonesian versions were not. Questionnaires often uncovered overlapping FGIDs, which were quite common.
Collapse
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Correspondence: Kok-Ann Gwee, FRCP, PhD, Stomach, Liver and Bowel Center, Gleneagles Hospital, Annexe Block 05-37, 6A Napier Road, Singapore 258500, Singapore, Tel: +65-6474-6848, Fax: +65-6475-8285, E-mail:
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiao R Gong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Nitesh Pratap
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Xiaohua Hou
- Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, Hubei, China
| | - Ari F Syam
- Division of Gastroenterology, Department of Internal Medicine, Cipto Mangunkusumo General Hospital/Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine, Cipto Mangunkusumo General Hospital/Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Young-Tae Bak
- Department of Gastroenterology, Korea University Guro Hospital, Seoul, South Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sutep Gonlachanvit
- GI Motility Research Unit, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Kewin T H Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore
| | - Ching-Liang Lu
- Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University Taipei, Taiwan
| | - Lishou Xiong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - William E Whitehead
- Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
35
|
Sperber AD, Gwee KA, Hungin AP, Corazziari E, Fukudo S, Gerson C, Ghoshal UC, Kang JY, Levy RL, Schmulson M, Dumitrascu D, Gerson MJ, Chen M, Myung SJ, Quigley EMM, Whorwell PJ, Zarzar K, Whitehead WE. Conducting multinational, cross-cultural research in the functional gastrointestinal disorders: issues and recommendations. A Rome Foundation working team report. Aliment Pharmacol Ther 2014; 40:1094-102. [PMID: 25175998 DOI: 10.1111/apt.12942] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 07/29/2014] [Accepted: 08/10/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cross-cultural, multinational research can advance the field of functional gastrointestinal disorders (FGIDs). Cross-cultural comparative research can make a significant contribution in areas such as epidemiology, genetics, psychosocial modulators, symptom reporting and interpretation, extra-intestinal co-morbidity, diagnosis and treatment, determinants of disease severity, health care utilisation, and health-related quality of life, all issues that can be affected by geographical region, culture, ethnicity and race. AIMS To identify methodological challenges for cross-cultural, multinational research, and suggest possible solutions. METHODS This report, which summarises the full report of a working team established by the Rome Foundation that is available on the Internet, reflects an effort by an international committee of FGID clinicians and researchers. It is based on comprehensive literature reviews and expert opinion. RESULTS Cross-cultural, multinational research is important and feasible, but has barriers to successful implementation. This report contains recommendations for future research relating to study design, subject recruitment, availability of appropriate study instruments, translation and validation of study instruments, documenting confounders, statistical analyses and reporting of results. CONCLUSIONS Advances in study design and methodology, as well as cross-cultural research competence, have not matched technological advancements. The development of multinational research networks and cross-cultural research collaboration is still in its early stages. This report is intended to be aspirational rather than prescriptive, so we present recommendations, not guidelines. We aim to raise awareness of these issues and to pose higher standards, but not to discourage investigators from doing what is feasible in any particular setting.
Collapse
Affiliation(s)
- A D Sperber
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|