Postinfection Irritable Bowel Syndrome

Following acute gastroenteritis (AGE) due to bacteria, viruses, or protozoa, a subset of patients develop new onset Rome criteria positive irritable bowel syndrome (IBS), called postinfection IBS (PI-IBS). The pooled prevalence of PI-IBS following AGE was 11.5%. PI-IBS is the best natural model that suggests that a subset of patients with IBS may have an organic basis. Several factors are associated with a greater risk of development of PI-IBS following AGE including female sex, younger age, smoking, severity of AGE, abdominal pain, bleeding per rectum, treatment with antibiotics, anxiety, depression, somatization, neuroticism, recent adverse life events, hypochondriasis, extroversion, negative illness beliefs, history of stress, sleep disturbance, and family history of functional gastrointestinal disorders (FGIDs), currently called disorder of gut-brain interaction. Most patients with PI-IBS present with either diarrhea-predominant IBS or the mixed subtype of IBS, and overlap with other FGIDs, such as functional dyspepsia is common. The drugs used to treat non-constipation IBS may also be useful in PI-IBS treatment. Since randomized controlled trials on the efficacy of drugs to treat PI-IBS are rare, more studies are needed on this issue.     

Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery

BACKGROUND & AIMS: Postinfectious irritable bowel syndrome (PI-IBS) is a common clinical phenomenon. To better define its incidence and epidemiology, a large cohort study was initiated after the contamination of a municipal water supply led to a large outbreak of acute Escherichia coli 0157:H7 and Campylobacter jejuni gastroenteritis. METHODS: Local residents were invited to undergo structured assessments at research clinics established 2 years after the outbreak. Permanent adult residents with no prior history of inflammatory bowel disease or IBS were eligible. Standardized questionnaires defined past and current health. The cohort was divided into controls without gastroenteritis, subjects with clinically suspected gastroenteritis, and subjects with only self-reported gastroenteritis that could not be substantiated by another source. A modified Bowel Disease Questionnaire identified IBS according to Rome criteria. The incidence and epidemiology of PI-IBS was characterized. Risk factors were assessed using multiple logistic regression. RESULTS: There were 2069 eligible study participants. Rome I criteria were met by 71 of 701 controls (10.1%) vs 249 of 904 subjects with self-reported gastroenteritis (27.5%) and 168 of 464 subjects with clinically suspected gastroenteritis (36.2%) (all comparisons, P < 001). Independent risk factors for PI-IBS included younger age, female sex, bloody stools, abdominal cramps, weight loss, and prolonged diarrhea. PI-IBS was more likely than sporadic IBS to show diarrhea-predominant features. CONCLUSIONS: PI-IBS is common after gastroenteritis from water contamination and often is diarrhea-predominant. Characteristics of the acute illness identify patients at increased risk for PI-IBS.     

Prognosis in post-infective irritable bowel syndrome: a six year follow up study

BACKGROUND: Irritable bowel syndrome developing following infective gastroenteritis accounts for approximately 1 in 10 of unselected IBS patients. AIMS: To define the long term natural history of post-infective IBS (PI-IBS). METHODS: A total of 436 individuals, who had previously responded to a questionnaire on their bowel habits following an acute episode of gastroenteritis, were sent a questionnaire about their current bowel habits and physical and mental health six years after their initial illness. RESULTS: Complete data on original bowel habit, episodes of gastroenteritis, mental health history, and subsequent bowel habit at six years were obtained in 192 individuals. Of these, there were 14 cases of "post-infective IBS" (PI-IBS) and 13 who had IBS prior to infection (previous IBS). Over the six year follow up period there were 20 "new non-infective IBS cases" (new IBS). The strongest risk factor for developing any type of IBS was female sex (relative risk 2.2, p<0.05). Compared with new IBS, those with PI-IBS had significantly more days with loose stools (p<0.05) but a similar number of days with pain, urgency, and bloating. Six of 14 (43%) PI-IBS and four of 13 (31%) previous IBS patients recovered by six years (NS). Of 27 IBS patients followed for six years, only 1/8 with a history of anxiety or depression recovered compared with 9/19 without such a history (p=0.19). CONCLUSION: PI-IBS differs from non-infective IBS by having more diarrhoeal features. Less than half of both PI-IBS and non-infective IBS cases recover over six years. A history of anxiety and depression severe enough to warrant treatment may impair recovery but larger numbers are needed to prove this.     

Gastroparesis and Small Bowel Dysmotility in Irritable Bowel Syndrome

Alterations in both gastric emptying (GE) andsmall bowel motility have been reported in irritablebowel syndrome (IBS); the relationship, however, betweenthese different measures of upper gut motor function in IBS has not been assessed. The aims of thisstudy were therefore: (1) to compare the prevalence andcharacteristics of altered small bowel motility in IBSpatients with and without delayed GE; and (2) to assess the interrelationships betweenfasting and postprandial small bowel motility in IBS,accounting for delayed GE. Forty-four IBS patients and25 healthy controls underwent 24 hr ambulant recording of interdigestive and digestive small bowelmotility. On a separate occasion the IBS patients had GEof both solids and liquids measured by a dual-isotopescintigraphic technique. Thirty-nine percent of IBS patients had delayed GE. Patients withnormal GE had no interdigestive small bowelabnormalities. However, in patients with delayed GEfasting phase II burst frequency was higher than incontrols [median 0.21/hr (IQR 0.15–0.34) vs 0.06/hr(0–0,16), P = 0.004]. Postprandially, abnormalphase III-like activity was higher indiarrhea-predominant IBS patients (0–0.08/hr vs0/hr, P = 0.01), than in patients with normal GE or controls. Furthermore, IBSpatients with delayed GE did not have the normalcorrelation between fasting and postprandial motorparameters (percentage occurrence of clusteredcontractions, postprandial pattern duration vs preceding MMC cyclelength). In conclusion, small bowel motor dysfunctionoccurs more frequently in IBS patients with concomitantgastroparesis than in patients with normal GE. These findings provide further evidence that aneuropathic process may contribute to the pathogenesisof IBS in a subgroup of IBS patients.     

The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis

AIM: To determine whether a combination of mood and personality factors together with illness beliefs and behaviours predict the onset of irritable bowel syndrome (IBS) post gastroenteritis, as suggested by the cognitive behavioural model of IBS. METHODS: Primary care patients with a positive test for Campylobacter gastroenteritis, and no previous history of IBS or serious bowel conditions were recruited into this prospective study (n = 620). Participants completed a questionnaire at the time of infection, which included standardised measures of mood, perceived stress, perfectionism, negative illness beliefs and illness behaviours. Participants completed follow-up questionnaires designed to determine whether they met the Rome criteria for IBS 3 and 6 months after initial infection. RESULTS: A total of 49 participants met the criteria for IBS at both follow-up points. Logistic regressions indicated that those who developed IBS had significantly higher levels of perceived stress (1.10, 95% CI 1.02 to-1.15), anxiety (1.14, 95% CI 1.05 to 1.23), somatisation (1.17, 95% CI 1.02 to 1.35) and negative illness beliefs (1.14, 95% CI 1.03 to 1.27) at the time of infection than those who did not develop IBS. Patients with IBS were also significantly more likely to remain active in the face of their acute symptoms until they felt forced to rest (all-or-nothing behaviour) (1.09, 95% CI 1.03 to 1.16), and significantly less likely to initially rest in response to their acute illness (0.93, 95% CI 0.88 to 0.97). Depression and perfectionism were not associated with the onset of IBS. CONCLUSIONS: Results suggest that patients with high stress and anxiety levels are more prone to develop IBS after a bout of gastroenteritis. Additional risk factors include a tendency to interpret illness in a pessimistic fashion and to respond to symptoms in an all-or-nothing manner.     

睡眠质量与社区人群肠易激综合征相关性分析

目的 探讨上海市社区人群睡眠质量与肠易激综合征(IBS)患病率及两者之间的关系.方法 采用随机分层整群抽样方法,对上海市嘉定区江桥镇常住人群成年居民进行面访式问卷调查,回收有效调查问卷11 569份.采用罗马Ⅲ标准诊断IBS,阿森斯睡眠障碍量表进行自我评估,分析睡眠障碍与IBS之间的关系.结果 睡眠障碍在社区总人群、IBS患者及非IBS患者中发生率分别为21.00%、33.02%和18.74%.IBS组存在睡眠障碍比例高于非IBS组,两组间差异有统计学意义(P=0.004,OR=2.14,95%CI:1.92～2.39),即存在睡眠障碍的人群患IBS的危险性是无睡眠障碍人群的2.14倍.在IBS组,女性患者存在睡眠障碍的比例(37.24%)显著高于男性患者(28.41%),两组间差异有统计学意义(P=0.000,OR=1.50,95%CI:1.23～1.82),提示存在睡眠障碍的女性更易于患IBS.Logistic回归分析显示睡眠障碍是IBS的危险因素之一(OR=2.11,95%CI:1.89～2.36).结论 IBS患者常存在睡眠障碍,尤其是女性患者.     

Prevalence of abdominal and pelvic surgeries in patients with irritable bowel syndrome: comparison between Caucasian and African Americans

BACKGROUND: Although controversial, studies suggest that irritable bowel syndrome (IBS) is associated with an increased risk of abdominal and pelvic surgeries. However, the role of race in this interaction has not been defined. We studied the prevalence of appendectomy, cholecystectomy, and hysterectomy among African American patients with IBS among the population at large and compared it with the Caucasians residing in same area. METHODS: A total of 990 adults from 9 different sites in the Jackson, Mississippi, metropolitan area (670 African Americans and 320 Caucasians), completed self-administered questionnaires providing sociodemographic information and details regarding bowel habits and associated symptoms for diagnosing the IBS, based on ROME II criteria. We recorded the patient's name, age, sex, race, history of smoking, and history of surgeries. Subjects with a history of IBD and gastrointestinal cancer were excluded. The prevalence of appendectomy and hysterectomy was compared between IBS patients and non-IBS control subjects. RESULTS: One thousand ninety-nine, or 84%, of those distributed were returned. On checking the exclusion and inclusion criteria, we eliminated 109 subjects. The reasons for elimination of 109 subjects included incomplete questionnaires and incorrect marking of questionnaires that resulted in invalid data. Overall, there was significantly higher prevalence of appendectomy (15.3% vs 5.1%) and cholecystectomy (6.6% vs 3.4%) but not hysterectomy (21.1% vs 17.6%; P = NS) among Caucasian Americans as compared with African Americans. The prevalence of appendectomy among IBS patients (n = 95) versus non-IBS subjects (n = 895) was not statistically significant (10.5% vs 8.2%; OR, 1.3; 95% CI, 0.7 to 2.7; P = 0.43). The prevalence of cholecystectomy in the 2 groups was also similar (5.3% vs 4.4%). Likewise, there was no statistically significant difference for the prevalence of hysterectomy among females IBS patients versus non-IBS females (23.3% vs 18.2%; OR, 1.4; 95% CI, 0.8 to 2.4; P = 0.29). Comparing the prevalence of these surgeries in with IBS patients (African Americans versus Caucasian Americans), we found significant difference in the prevalence of appendectomy to be 1.9% vs 21.4% (P < 0.01). In contrast, there was no difference in the prevalence of cholecystectomy or hysterectomy. Logistical regression suggested that race but not IBS was a significant factor in the prevalence of various surgeries. CONCLUSIONS: Based on responses to ROME II criteria questionnaire administered to community at large, IBS is not associated with greater prevalence of abdominal and pelvic surgeries. Caucasians are more likely to have these surgeries irrespective of whether they have IBS or not. Our study does not exclude the possibility that there may indeed be association between IBS and surgeries if only the IBS patients seeking health care are considered.     

Dyspepsia and irritable bowel syndrome after a Salmonella gastroenteritis outbreak: one-year follow-up cohort study

BACKGROUND & AIMS: It has been reported that some patients develop functional digestive disorders, particularly irritable bowel syndrome (IBS), after acute gastroenteritis (AGE). However, the presence of dyspepsia has not been specifically addressed. We prospectively evaluated development of dyspepsia and IBS during a 1-year follow-up in a cohort of adult patients affected by a Salmonella enteritidis AGE outbreak. METHODS: Questionnaires were sent to 1878 potential participants at baseline and 3, 6, and 12 months; 677 had experienced a Salmonella enteritidis AGE on June 23, 2002, and 1201 had not (randomly selected controls, matched for village of residence, age, and sex). At 12 months, 271 patients and 335 controls returned the questionnaires. Data permitted the establishment of dyspepsia and IBS diagnosis by Rome II criteria. RESULTS: Before the AGE outbreak, the prevalence of dyspepsia was similar in cases and controls (2.5% vs 3.8%); the prevalence of IBS was also similar (2.9% vs 2.3%). At 3, 6, and 12 months, the prevalence of both dyspepsia and IBS had increased significantly in exposed compared with unexposed subjects. Overlap between dyspepsia and IBS was frequent. At 1 year, the relative risk for development of dyspepsia was 5.2 (95% confidence interval, 2.7-9.8) and for IBS was 7.8 (95% confidence interval, 3.1-19.7). Prolonged abdominal pain and vomiting during AGE were positive predictors of dyspepsia. No predictive factors for IBS were found. CONCLUSIONS: Salmonella gastroenteritis is a significant risk factor not only for IBS but also for dyspepsia; at 1 year of follow-up, 1 in 7 and 1 in 10 subjects developed dyspepsia or IBS, respectively.     

The Incidence of Irritable Bowel Syndrome Among Community Subjects With Previous Acute Enteric Infection

The purpose of this study was to determine the incidence of postinfectious irritable bowel syndrome (IBS) among community subjects with positive stool studies. This was a prospective cohort study whereby all individuals with stool-positive acute enteric infection (AEI) were recruited from 3 health regions in Ontario, Canada. Each person completed questionnaires regarding preinfectious bowel habit and their bowel habit 3 months postinfection. Manning and Rome I criteria were used to diagnose irritable bowel syndrome. Two hundred thirty-one patients participated. Forty had preexisting IBS and were excluded. Of the remaining 191 patients, 7 developed irritable bowel syndrome, for an incidence of 3.7% (95% confidence interval: 1.0–6.3%). Fever during AEI was the only identifiable risk factor for developing postinfectious IBS (odds ratio, 11.96; P = .02). The incidence of postinfectious IBS in community subjects is 3.7%. Fever during the AEI may be an important risk factor for this condition.     

A Survey about Irritable Bowel Syndrome in South Korea

The aims of the present study were: (1) to assess the prevalence of symptom-based irritable bowel syndrome (IBS) in Korean adults, (2) to assess several organic abnormalities which can be found in IBS patients, and (3) to analyze the risk or associated factors that influence the presence of IBS. Adult health examinees were requested to fill out a questionnaire. The prevalence of IBS was calculated using Rome II criteria. Using several tests, several organic abnormalities were identified in the IBS group. Risk factors were analyzed by comparing the IBS and normal groups. The prevalence value for IBS according to Rome II criteria was 16.8%. Mucosal hyperplasia, lymphocyte aggregation, and increased eosinophil counts were relatively common microscopic findings in IBS group. Female gender, self-consciousness of IBS, and irregular defecation were expressed as significantly independent risk or associated factors for IBS. Several colonic microscopic findings mentioned above may be helpful in accurate diagnosis of IBS. Therefore a more-precise and large population study about these findings is necessary to reach a definitive conclusion.     

Is Rectal Biopsy Necessary in Irritable Bowel Syndrome?

Many physicians obtain a rectal biopsy from patients with irritable bowel syndrome (IBS) in order to exclude melanosis coli and collagenous or microscopic colitis. To determine the value of routine rectal biopsy in IBS, 89 patients and 59 controls were administered a bowel questionnaire, and a rectal biopsy was obtained at sigmoidoscopy. IBS patients were 82% female and averaged 44 yr. Eighty-nine percent fulfilled three or more Manning criteria, and 84% fulfilled the Rome criteria for IBS. The 59 control subjects were 37% female, and averaged 57 yr. Only 15% fulfilled three or more Manning criteria, and 5% the Rome criteria. The 148 rectal biopsies were examined histologically by a pathologist whose methods were validated by a second pathologist. Although minor changes previously reported with phosphate enemas were observed, not a single subject had melanosis coli or fulfilled criteria for microscopic or collagenous colitis. Thus, patients with an endoscopically normal colon and a diagnosis of IBS made by established criteria are unlikely to have histologic abnormalities in the rectum. Rectal biopsies are costly and unnecessary in the investigation of IBS.     

Post-infectious irritable bowel syndrome in patients with Shigella infection

BACKGROUND AND AIMS: Bacterial gastroenteritis has been known as a risk factor of irritable bowel syndrome (IBS). Several risk factors of post-infectious IBS (PI-IBS) have been documented. The aims of this study were to verify the role of bacterial gastroenteritis in the development of IBS and the risk factors for the development of PI-IBS. The clinical course of PI-IBS was also investigated. METHODS: We recruited 143 patients with shigellosis during its outbreak and 113 controls. Both groups were followed up for 12 months. Bowel symptoms were evaluated by use of questionnaires at 3, 6 and 12 months after the initial recruitment. RESULTS: Complete data were obtained from 101 patients (70.6%) and 102 healthy controls (90.3%). At 12 months, 15 patients and six controls had IBS (adjusted OR; 2.9, 95% CI; 1.1-7.9). Of the 15 patients, five had IBS symptoms consistently for 12 months, three did not have IBS symptoms initially and seven had fluctuating bowel symptoms. The duration of diarrhea was an independent risk factor of PI-IBS. CONCLUSIONS: Bacterial gastroenteritis is a risk factor of IBS and the duration of diarrhea as the index of severity of initial illness is an independent risk factor of PI-IBS. The clinical course of PI-IBS is variable over the 1 year of follow-up.     

Epidemiology of irritable bowel syndrome among African Americans as compared with whites: a population-based study.

BACKGROUND & AIMS: We studied the prevalence as well as the sociodemographic characteristics and quality of life of African American patients with irritable bowel syndrome (IBS) among the population at large and compared them with those of whites. METHODS: A total of 990 adults from 9 different sites in the Jackson, Mississippi metropolitan area (670 African Americans and 320 whites) completed self-administered questionnaires providing sociodemographic information and details regarding bowel habits and associated symptoms for diagnosing IBS on the basis of Rome II criteria. Quality of life was assessed by the SF-12 questionnaire. RESULTS: Ninety-five of the 990 participants had IBS, giving a total sample prevalence of 9.6% (African Americans, 7.9%; whites, 13.1%). Adjusting for other risk factors in a reduced logistic regression model, we found race (P = .0004) and education (P = .0049) to be important correlates of IBS prevalence. The household income showed a trend toward statistical significance (P = .0845). With the adjusted odds ratio as an estimate of relative risk, whites were 2.5 (95% confidence interval, 1.5-4.0) more likely than African Americans to have IBS. In terms of an index for quality of life (possible score, 1-44), the adjusted mean score was lower for adults with IBS compared with non-IBS adults (IBS mean, 29.8; no IBS, 34.2; P < .0001), but the racial difference was not significant. CONCLUSIONS: IBS occurs less frequently among African Americans. Although IBS affects quality of life among both ethnicities, the degree of impairment is similar.     

Postinfectious Irritable Bowel Syndrome—A Meta-Analysis

OBJECTIVES:  Irritable bowel syndrome (IBS) is a heterogeneous disorder affecting 12% of the population worldwide. Several studies identify IBS as a sequela of infectious gastroenteritis (IGE) with reported prevalence ranging from 4% to 31% and relative risk from 2.5 to 11.9. This meta-analysis was conducted to explore the differences between reported rates and provide a pooled estimate of risk for postinfectious irritable bowel syndrome (PI-IBS).
DATA SOURCES:  Electronic databases (MEDLINE, OLDMEDLINE, EMBASE, Cochrane database of clinical trials) and pertinent reference lists (including other review articles).
REVIEW METHODS:  Data were abstracted from included studies by two independent investigators; study quality, heterogeneity, and publication bias were assessed; sensitivity analysis was performed; and a summative effect estimate was calculated for risk of PI-IBS.
RESULTS:  Eight studies were included for analysis and all reported elevated risk of IBS following IGE. Median prevalence of IBS in the IGE groups was 9.8% (IQR 4.0–13.3) and 1.2% in control groups (IQR 0.4–1.8) (sign-rank test, p = 0.01). The pooled odds ratio was 7.3 (95% CI, 4.7–11.1) without significant heterogeneity (χ² heterogeneity statistic, p = 0.41). Subgroup analysis revealed an association between PI-IBS risk and IGE definition used.
CONCLUSIONS:  This study provides supporting evidence for PI-IBS as a sequela of IGE and a pooled risk estimate revealing a sevenfold increase in the odds of developing IBS following IGE. The results suggest that the long-term benefit of reduced PI-IBS may be gained from primary prevention of IGE.     

Management of irritable bowel syndrome

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. The prevalence rate is 10-20% and women have a higher prevalence. IBS adversely affects quality of life and is associated with health care use and costs. IBS comprises a group of functional bowel disorders in which abdominal discomfort or pain is associated with defecation or a change in bowel habit, and with features of disordered defecation. The consensus definition and criteria for IBS have been formalized in the "Rome II criteria". Food, psychiatric disorders, and gastroenteritis are risk factors for developing IBS. The mechanism in IBS involves biopsychosocial disorders; psychosocial factors, altered motility, and heightened sensory function. Brain-gut interaction is the most important in understanding the pathophysiology of IBS. Effective management requires an effective physician-patient relationship. Dietary treatment, lifestyle therapy, behavioral therapy, and pharmacologic therapy play a major role in treating IBS. Calcium polycarbophil can benefit IBS patients with constipation or alternating diarrhea and constipation.     

Irritable Bowel Syndrome on Inflammatory Bowel Disease in Deep Remission: No Relation with Remission Deepening and Inflammation

Background: The aim of the study was to establish the frequency of irritable bowel syndrome (IBS) in patients with inflammatory bowel disease (IBD) in clinical, endoscopic, and histologic remission and in relation to both the depth of remission and inflammation markers. Methods: Patients with ulcerative colitis (UC) and with Crohn’s disease (CD) in clinical remission for at least 6 months were enrolled in the study. All of the patients underwent colonoscopy, and biopsy specimens were taken to evaluate endoscopic and histopathologic remission. Patients were evaluated according to Rome III criteria for IBS. Fecal calprotectin level and blood samples for C-reactive protein (CRP), sedimentation rate, and fibrinogen levels were studied.Results: IBS frequency was 20.9% in UC cases and 28.9% in CD cases in clinical remission. Rates with and without endoscopic remission in UC (20.5% vs. 22.2%, P = .727) and CD (25% vs. 33.3%, P = .837, respectively) were not different. Similarly, rates with and without histopathologic remission in UC (15.7% vs. 26.6%, P = .723), and CD (21.4% vs. 33.3%, P = .999) were not statistically different. Also, it was not related to inflammation markers.Conclusion: IBS frequency among IBD patients with remission was in a substantial rate; these rates kept up with the process of deep remission and even complete mucosal healing and were irrelevant to inflammation.     

Abnormal Vagal Cholinergic Function and Psychological Behaviors in Irritable Bowel Syndrome Patients A Hospital-Based Oriental Study

Irritable bowel syndrome (IBS) patients inWestern countries usually manifest autonomic nervedysfunctions and abnormal psychological behaviors. Thepurpose of this study was to assess whether Oriental IBS patients with predominant bowel symptomsalso exhibited similar abnormalities. We enrolled 40 IBSpatients from the outpatient clinic and 20 controls withnormal daily bowel habit for study. The IBS patients were further divided according totheir predominant bowel habit: 20 wereconstipation-predominant and 20 werediarrheapredominant. Sympathetic function was evaluatedby sympathetic skin response (SSR) while vagal cholinergic function wasdetermined by measuring R-R interval variation (RRIV) inelectrocardiography during rest and deep breathing.Psychological parameters were assessed by scales of the Minnesota Multiphasic Personality Inventory(MMPI) and the Hopkins Symptom Checklist (HSCL-90). IBSpatients, despite their bowel habit, showed normal SSRresponse. RRIV during deep breathing was significantly lower in constipation-predominant IBS patientsthan in controls or diarrhea-predominant IBS patients(16.5 ± 3.1% vs 20.5 ± 4.8% and 21.5± 4.6%, P < 0.001). IBS patients alsoexhibited abnormal MMPI measuring scores on depression, hysteria,paranoia, and masculinity/femininity scales. Inaddition, they also had more severe psychologicaldistress in the items of HSCL-90 measurement. Inconclusion, vagal dysfunction characterizes Orientalconstipation-predominant IBS patients seeking medicalhelp. Abnormal psychoneurotic profiles also exist inthese IBS patients, irrespective of their bowelhabits.     

Functional Bowel Disorders in Iranian Population using Rome III Criteria

Background/Aim:

To study the prevalence and risk factors of functional bowel disorders (FBD) in Iranian community using Rome III criteria.

Materials and Methods:

This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran, including 18,180 participants who were selected randomly and interviewed face-to-face by a validated questionnaire based on Rome III criteria.

Results:

In all, 1.1% met the Rome III criteria for irritable bowel syndrome (IBS), 2.4% for functional constipation (FC), and 10.9% of the participants had any type of FBD. Among participants with functional dyspepsia, 83.8% had FBD; the majority cases were unspecified functional bowel disorder (U-FBD). Of the subjects fulfilling the IBS criteria, IBS with constipation (52%) was the most frequent subtype. In the multivariate analysis, women had a higher risk of any FBDs than men, except for functional diarrhea (FD). The prevalence of FBD, FC and FD increased and IBS decreased with increasing age. Marital status was only associated with a decrease in the risk of FBD and FD, respectively. IBS subtypes compared with FC and FD. There was no significant difference between FC and IBS with constipation (IBS-C), except for self-reported constipation; while, IBS with diarrhea (IBS-D) had more symptoms than FD.

Conclusion:

This study revealed a low rate of FBDs among the urban population of Tehran province. The ROME III criteria itself, and the problems with interpretation of the data collection tool may have contributed in underestimating the prevalence of FBD. In addition the reliability of recall over 6 months in Rome III criteria is questionable for our population.     

Prevalence of Irritable Bowel Syndrome and Depression in Fibromyalgia

The purpose of this study was to determine the point prevalence of depressive symptoms, using the PRIME-MD questionnaire, and irritable bowel syndrome (IBS), while comparing the Rome II to the Rome I criteria, in patients with fibromyalgia (FM) and rheumatologic controls in an outpatient setting. The prevalence of IBS in FM patients (n = 105) was 63% by Rome I and 81% by Rome II criteria. The prevalence of IBS in controls (n = 62) was 15% by Rome I and 24% by Rome II criteria (FM vs. control; P < 0.001). Depressive symptoms were met in 40% of FM patients and 8% of controls (P < 0.001). The coexistence of IBS and depressive symptoms in the FM patients was 31% (Rome I) and 34% (Rome II). The prevalence of IBS and depressive symptoms was higher in FM patients compared to the control population. Identification of IBS and depressive symptoms in FM patients might enable clinicians to better meet the needs of this patient population. The views expressed in this article are those of the authors and do not reflect the official policy or practice of the Department of the Navy, Department of Defense, or the United States Government. This research was performed at outpatient private rheumatology clinics. No financial support was received for the research