Prevalence of irritable bowel syndrome in Hong Kong

BACKGROUND AND AIMS: As part of a public education program, the Hong Kong Society of Gastrointestinal Motility studied the prevalence of irritable bowel syndrome (IBS) in the community, which was based on the recently published Rome II criteria. The distribution of diarrhea or constipation-predominant IBS subtypes, the prevalence of bowel symptoms and the predictors of health-care seeking were also studied. METHODS: Among 1797 randomly selected respondents, 1000 successful telephone interviews (56%) were conducted from August 2000 to December 2000, using a validated questionnaire in Chinese that looked into demographic data and various bowel symptoms during the past year. RESULTS: The 12-month prevalence of IBS as defined by the Rome II criteria in Hong Kong was 6.6%. The female to male ratio was 1.3:1, but this ratio was the same in the control group. The distribution of IBS patients into diarrhea predominant, constipation predominant, and non-specific subtypes was 27, 17 and 56%, respectively. The predominant symptom in the IBS group was pain (54.5%), followed by urgency (15%), abdominal distension (15%) and diarrhea (11%). Forty-seven percent of IBS patients sought medical attention and only 21% of them knew that they had IBS. Moderate to severe pain severity (odds ratio 3.7, 95% CI 1.02-13) and mucus in stool (odds ratio 3.57, 95% CI 1.18-10.7) were associated with health-care seeking in univariate analysis. The prevalence of bowel symptoms such as urgency, straining, feeling of incomplete defecation, mucus in stool and abdominal distension ranged from 11 to 41%. CONCLUSION: The prevalence of IBS in Hong Kong was 6.6%, and the female to male ratio was similar to the control group. The majority was of non-specific IBS subtype. Gross underdiagnosis (21%) by Western practitioners was noted.     

Epidemiological features of irritable bowel syndrome in a Turkish urban society

BACKGROUND AND AIM: Irritable bowel syndrome (IBS) is a widespread functional bowel disorder and its prevalence in Western societies ranges from 3-20%. The present study aimed to determine the prevalence of IBS in eastern Turkey, particularly in urban parts of Elazig where 250 000 people live. METHODS: Of the 18 primary care centers, four were randomly selected for this study. All individuals (aged >17 years) living around the service area of these health centers were included. A total of 1900 subjects were randomly selected using the personal health records from the primary care centers. The total number of subjects that could be contacted was 1766. A questionnaire with multiple choice questions was applied to the subjects by medical students using the face-to-face technique. Prevalence of IBS and distribution of symptoms were evaluated by the Rome II criteria. RESULTS: Of the 1766 subjects, 45.4% were male and 54.6% were female. Prevalence of IBS was 5% in males, 7.4% in females and 6.3% overall. The percentage of subjects with IBS in the 17-30 years age group was 26.2%; 52.3% in the 30-50 years age group and 21.6% in the above 50 years age group. Prevalence of IBS was highest (10.2%) in persons who were illiterate and lowest (3.0%) in university graduates. A positive correlation was determined between low economical status and prevalence of IBS (P < 0.05). CONCLUSION: Although IBS is widely present in Turkey, its prevalence is lower than that reported in Western communities. In the region where this study was carried out, IBS was more prevalent in females and in individuals with low educational and economical status.     

Prevalence of irritable bowel syndrome in Korea: population-based survey using the Rome II criteria

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder in the West. But information on the prevalence of IBS in Asia is still lacking, especially in Korea. Therefore, the aims of the present study were to estimate the prevalence of IBS in the general population of Korea and also to investigate characteristics of IBS and health-care-seeking behavior of IBS patients. METHODS: Telephone interview survey was conducted by Gallup, Korea using a validated questionnaire based on the Rome II criteria. The response rate of the telephone interview survey was 25.2% (n = 1066, 535 male and 531 female responders). A random sample of gender and age (between 18 and 60 years), based on a per capita ratio was obtained. RESULTS: Among 1066 subjects, the prevalence of IBS was 6.6% (70 subjects; 7.1%, male; 6.0%, female). The difference in IBS prevalence by gender was not significant. The prevalence was higher among those in their 20s (P = 0.036). Among 70 subjects with IBS, 10/20 IBS subjects sought health care due to abdominal pain. Among the risk factors of IBS, marital status had a significant difference; the following risk factors are arranged in descending order: age (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 0.85-2.25), alcohol intake (OR: 1.38, 95%CI: 0.81-2.35), gender (OR: 1.19, 95%CI: 0.73-1.94), demographics (OR: 1.09, 95%CI: 0.53-2.25), income (OR: 0.88, 95%CI: 0.54-1.45), education level (OR: 0.81, 95%CI: 0.46-1.40), smoking (OR: 0.64, 95%CI: 0.37-1.12), and marital status (OR: 0.59, 95%CI: 0.35-0.99). CONCLUSIONS: The prevalence of IBS in the Korean population is 6.6%, and the male:female ratio is similar. Also, IBS is more frequent in younger subjects. Irritable bowel syndrome subjects visited a physician mostly due to abdominal pain.     

Rome III survey of irritable bowel syndrome among ethnic Malays

AIM: To survey irritable bowel syndrome (IBS) using Rome III criteria among Malays from the north-eastern region of Peninsular Malaysia.METHODS: A previously validated Malay language Rome III IBS diagnostic questionnaire was used in the current study. A prospective sample of 232 Malay subjects (80% power) was initially screened. Using a stratified random sampling strategy, a total of 221 Malay subjects (112 subjects in a “full time job” and 109 subjects in “no full time job”) were recruited. Subjects were visitors (friends and relatives) within the hospital compound and were representative of the local community. Red flags and psychosocial alarm symptoms were also assessed in the current study using previously translated and validated questionnaires. Subjects with IBS were sub-typed into constipation-predominant, diarrhea-predominant, mixed type and un-subtyped. Univariable and multivariable analyses were used to test for association between socioeconomic factors and presence of red flags and psychosocial alarm features among the Malays with IBS.RESULTS: IBS was present in 10.9% (24/221), red flags in 22.2% (49/221) and psychosocial alarm features in 9.0% (20/221). Red flags were more commonly reported in subjects with IBS (83.3%) than psychosocial alarm features (20.8%, P < 0.001). Subjects with IBS were older (mean age 41.4 years vs 36.9 years, P = 0.08), but no difference in gender was noted (P = 0.4). Using univariable analysis, IBS was significantly associated with a tertiary education, high individual income above RM1000, married status, ex-smoker and the presence of red flags (all P < 0.05). In multiple logistic regression analysis, only the presence of red flags was significantly associated with IBS (odds ratio: 0.02, 95%CI: 0.004-0.1, P < 0.001). The commonest IBS sub-type was mixed type (58.3%), followed by constipation-predominant (20.8%), diarrhea-predominant (16.7%) and un-subtyped (4.2%). Four of 13 Malay females (30.8%) with IBS also had menstrual pain. Most subjects with IBS had at least one red flag (70.8%), 12.5% had two red flags and 16.7% with no red flags. The commonest red flag was a bowel habit change in subjects > 50 years old and this was reported by 16.7% of subjects with IBS.CONCLUSION: Using the Rome III criteria, IBS was common among ethnic Malays from the north-eastern region of Peninsular Malaysia.     

Comorbidity and use of health-care services among irritable bowel syndrome sufferers

Objective. Patients suffering from irritable bowel syndrome (IBS) have more somatic and psychiatric comorbidity and use more health-care services for comorbid conditions than do other patients. Little is known about the frequency of comorbid symptoms among IBS sufferers in the general population and their influence on use of health-care facilities. The objective of this study was to compare the frequency of somatic and psychiatric symptoms between IBS sufferers and controls in the general population, and to study how comorbidity rates are distributed among consulters and non-consulters and how they predict the use of health care-services. Material and methods. By means of a questionnaire sent to 5000 randomly selected adults IBS was identified according to the Rome II criteria. The questionnaire also covered upper GI symptoms, non-GI somatic symptoms, depression and anxiety. A logistic regression analysis with 26 variables was carried out to determine the independent predictors of health-care seeking for GI and non-GI complaints. Results. The response rate was 73% and prevalence of IBS 5.1% (95% CI 4.4–5.8%). Dyspeptic symptoms, somatic extra-GI symptoms and psychiatric symptoms were reported by 45%, 69% and 51% of IBS sufferers, respectively, and 6%, 35% and 27%, of controls, respectively. Visiting a physician because of GI complaints was associated with disturbing abdominal symptoms, but not with depression or anxiety. Of the present GI conditions, only dyspeptic symptoms were associated with an increased consultation rate also for non-GI complaints. Conclusions. In the general population, both IBS consulters and non-consulters demonstrate high rates of comorbidity. Seeking health care for abdominal complaints is associated with abdominal symptoms rather than psychiatric comorbidity.     

Sex differences in irritable bowel syndrome in Japanese university students

Background Epidemiological studies of irritable bowel syndrome (IBS) among young adults are few, especially in Asian countries. Our aim was to examine the prevalence of IBS, whether there was a sex difference, and whether allergic diseases were important risk factors for IBS in young adults. Methods Newly enrolled university students completed health survey questionnaires regarding general health. Those with gastrointestinal symptoms completed the Gastrointestinal Symptom Rating Scale (GSRS) and an additional questionnaire covering the presence of allergic manifestations. IBS was diagnosed based on the Rome II criteria. Results IBS was diagnosed in 268 of 2495 students [10.7%; constipation-predominant type (IBS-C), 128; diarrhea-predominant type (IBS-D), 117; unclassified, 23]. IBS-C was associated with female sex (odds ratio, 6.4; 95% confidence interval, 4.1–9.7; P < 0.001), whereas there was no sex difference in IBS-D. The proportions of subjects with food sensitivity were significantly different among the three groups (4.0%, subjects without IBS; 8.6%, IBS-C group; and 15.4%, IBS-D group) (P < 0.001). The median GSRS scores for pain (1.67 vs 1, P = 0.001), indigestion (1.75 vs 1.5, P < 0.001), and constipation (2.0 vs 1.33, P < 0.001) were higher, and the median diarrhea score was lower (1.33 vs 1.67) (P < 0.001), in women than in men. The median score for diarrhea (2.33 vs 1.67, P = 0.001) was significantly higher in subjects with food sensitivity than in those without. Conclusions There was a strong relationship between IBS-C and female sex, and food sensitivity seemed to be an exacerbating factor for IBS-D. There is no conflict of interest.     

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

Background and Aims: Although irritable bowel syndrome (IBS) is a common disorder in the West, information on the prevalence of IBS in university students is relatively scant, especially in Asia. The aims of the present study were to investigate the prevalence and pattern of symptoms of IBS and its relationship with psychological stress status in Chinese university students. Methods: Basic demographic data and IBS symptoms were sought using the Rome II criteria and a validated bowel symptom questionnaire. Another questionnaire used related to psychosomatic symptoms of depression and anxiety. Results: In total, 491 of the 530 students in the trial met the selected criteria, which included 241 men. The participants were medical college students (313/491) and non‐medical college students (178/491). The apparent prevalence of IBS was 15.7%, with a prevalence of 14.5% in men and 16.8% in women. The most common symptom was abdominal pain associated with change in the consistency of stool (36.9%), followed by altered stool frequency (16.3%), and abdominal pain relieved by defecation (12.4%), predominantly in women. The self‐reported psychological and psychosomatic symptoms of anxiety (P < 0.001) and depression (P < 0.001) were encountered more frequently in participants with IBS. The depression (P = 0.03) and anxiety measures (P = 0.02) significantly predicted IBS status. Conclusion: The prevalence of IBS in Chinese university students is often compared with university students in developed countries and the general Chinese population. Depression and anxiety could potentially induce IBS. Medical education should be considered when aiming to reduce stress of university students who are susceptible to IBS.     

Comorbid irritable bowel syndrome symptoms and headache have greater association with anxiety than depression: Annual health check-up survey results

High rates of co-existing irritable bowel syndrome (IBS) and headache have been reported in western countries. We investigated that comorbidity in individuals in Japan, along with anxiety and depression in subjects with and without IBS symptoms and/or headache.This cross-sectional study was performed from April 2012 to January 2013 at the Matsue Seikyo General Hospital Health Check Center. Questionnaires concerning symptoms related to IBS (Rome III) and headache, as well as anxiety/depression score were sent to individuals scheduled to undergo an annual health check-up, then returned during the visit and analyzed in a blinded manner.A total of 2885 individuals returned completed questionnaires and were enrolled, of whom 218 (7.6%) met the IBS criteria. The rates of co-existing headache in subjects with and without IBS symptoms were 44.0% (96/218) and 22.9% (611/2667), respectively, indicating a significantly higher rate of co-existing headache in subjects with as compared to without IBS (odds ratio [OR] 2.65, P < .001). Furthermore, the percentage of subjects with anxiety along with comorbid IBS symptoms and headache was significantly greater as compared to those with IBS (OR 3.01, P = .001) or headache (OR 2.41, P < .001) alone. Unlike anxiety, the percentage of subjects with depression was not significantly different among the IBS/non-headache, non-IBS/headache, and IBS/headache groups.Subjects with IBS symptoms had a higher rate of co-existing headache as compared to those without IBS. Furthermore, those with comorbid IBS symptoms and headache had a greater association with anxiety than with depression, as compared to those with only IBS or headache.     

Diagnosing irritable bowel syndrome: poor agreement between general practitioners and the Rome II criteria

Background: The new guidelines for diagnosing irritable bowel syndrome (IBS) in clinical practice recommend the use of the Rome II criteria. In this study the agreement between general practitioners (GPs) and the Rome II criteria for diagnosing of IBS and functional bowel disorders (FBD) is examined. Methods: Consecutive patients in general practice were asked to report on abdominal complaints, for which they had consulted or wanted to consult a GP. Patients with such complaints completed a questionnaire based on the Rome II criteria for FBD. After consultations, the GPs reported their diagnoses on the abdominal complaints. Results: Of 3097 screened patients, 553 patients were diagnosed by their GP and had complete data in the questionnaire. Of these patients, 107 had IBS according to the GPs and 209 had IBS according to the Rome II criteria (agreement 58%, kappa 0.01 (CI: ?0.06; 0.09)). Agreement on IBS and FBD in patients without organic disease, without reflux or dyspepsia and in patients with a verified diagnosis was 45%–58%, with kappa values from ?0.02 to 0.13. IBS and FBD cases were diagnosed by the Rome II criteria more often than by the GPs in all these groups of patients (P?Conclusions: This study shows poor agreement in the diagnosis of IBS between GPs and the Rome II criteria. Therefore, current knowledge about IBS based on strict criteria is not necessarily transferable to patients with IBS in general practice.     

Subtypes of irritable bowel syndrome on Rome III criteria: a multicenter study

Background and Aim: The aim of this study was to explore the distribution and clinical characteristics of four subtypes of irritable bowel syndrome (IBS) based on Rome III criteria in Chinese. Methods: A total of 754 consecutive IBS outpatients from three tertiary hospitals in China were included. Diagnostic criteria were based on Rome II or Rome III. Results: Among 754 outpatients, 510 (67.6%) patients met the Rome II criteria, 735 (97.5%) patients met the Rome III criteria and 492 (65.3%) patients met both sets of criteria. Among 735 patients who met the Rome III criteria, 66.3% had IBS with diarrhea (IBS‐D), 14.7% had IBS with constipation (IBS‐C), 4.2% had mixed IBS (IBS‐M) and 14.8% had unsubtyped IBS (IBS‐U). Most of the IBS‐D, IBS‐C and IBS‐M patients based on the Rome III criteria matched the diarrhea‐predominant IBS, constipation‐predominant IBS and alternating IBS based on the Rome II criteria, respectively. Among IBS‐U patients, 57.0%, 33.3% and 9.7% had constipation‐predominant IBS, diarrhea‐predominant IBS and alternating IBS, respectively. For IBS‐M, the frequencies of bowel movements were stable in 48.4% patients and variable in 51.6% patients. Defecation urgency and straining were most frequent in IBS‐M and least frequent in IBS‐U patients than other subtypes. About 77.2% of IBS‐U patients had abnormal stool frequency (< 3 times/week or > 3 times/day). Conclusion: The Rome III criteria are more sensitive and practical in diagnosing IBS. IBS‐D is the most frequent subtype, which is followed by IBS‐U, IBS‐C and IBS‐M. IBS‐U is a new subtype, which warrants further studies.     

Efficacy of dioctahedral smectite in treating patients of diarrhea-predominant irritable bowel syndrome

BACKGROUND AND AIM: Dioctahedral smectite (DS) is natural adsorbent clay useful in treating acute diarrhea. The aim of this study was to determine DS efficacy on patients with diarrhea-predominant irritable bowel syndrome (D-IBS in a phase III-, 8-week-randomized, double-blind, placebo-controlled trial. METHODS: The 104 patients who met the D-IBS Rome II criteria were randomized to receive either DS (n = 52) or placebo (n = 52) treatment for 8 weeks (three sachets daily). The primary efficacy endpoint was the changes of the visual analog scale (VAS) score of IBS overall disorder and pain/discomfort-related symptoms after treatment on days 28 and 56, respectively. Other outcome measures included improvement of bowel movement disorders. The therapeutic global response was assessed by the patients and investigators at each visit, as was drug safety. RESULTS: Both treatments diminished overall disorder at each visit (P < 0.01), with respect to primary efficacy. This effect was further observed in DS-treated patients on day 56 (P = 0.0167). Placebo had no effect on the VAS score of pain/discomfort at any visit, whereas DS improved this score on days 28 and 56, respectively (P < 0.05). DS and placebo similarly diminished bowel disorders at each visit; however, only DS improved abdominal bloating (P < 0.01). The global therapeutic responses evaluated by the patients and investigators were similarly distributed. The study drug was well tolerated during the 8-week period. CONCLUSION: DS seems acceptable to treat D-IBS patients, particularly for pain-related symptoms.     

Prevalence of irritable bowel syndrome among undergraduates in Southeast China

BACKGROUND: There is a wide range in reported prevalence of irritable bowel syndrome worldwide. From the data appeared recently in medical literatures in China, it seems that the incidence of irritable bowel syndrome in young adults is not dissimilar to the one in the Western countries. AIMS: To explore the prevalence and epidemiological variations of irritable bowel syndrome in an undergraduate student population in Southeast China on the basis of the Rome II and Rome III criteria. METHODS: All the undergraduate student participants were administered self-report diagnostic measures for irritable bowel syndrome. RESULTS: The sex-adjusted prevalence rate of irritable bowel syndrome was 4.7% (Rome II) and 10.4% (Rome III), respectively. When we combined irritable bowel syndrome mixed and irritable bowel syndrome unsubtyped in the Rome III subgroups into one group considering the counterpart in the Rome II subgroups was alternative irritable bowel syndrome, the agreement between the two ways to subdivide these 54 patients who were identified with irritable bowel syndrome by both the two criteria was 81%, with a kappa value of 0.67. By the Rome III criteria, we found a female predominance which was especially attributed to the subtypes of irritable bowel syndrome with constipation and unsubtyped. CONCLUSIONS: Our study suggests that, in young adults in Southeast China, changing diagnostic criteria for irritable bowel syndrome from Rome II to Rome III may affect women more than men on not only the overall prevalence rate but also the sex-difference present or not, especially in irritable bowel syndrome with constipation and irritable bowel syndrome unsubtyped subgroups.     

Psychological comorbidity and complexity of gastrointestinal symptoms in clinically diagnosed irritable bowel syndrome patients

Background and Aim:  The prevalence of psychological disorders is high in patients with irritable bowel syndrome (IBS) but their role in symptom reporting is uncertain. It is thus interesting whether the number of functional gastrointestinal disorders (FGID) determines the load of psychological comorbidity. The Rome III criteria have not been used to evaluate such a relationship as yet. Moreover, not many studies have examined the sensitivity of the Rome III criteria in detecting IBS. Our aims were therefore: (i) to determine whether those IBS participants with more FGID had a tendency to greater psychological comorbidity than those with fewer FGID; and (ii) to assess the performance of the Rome III criteria in detecting IBS versus the diagnosis of the gastroenterologist.
Methods:  A cross-sectional survey of 32 consecutive outpatients with clinically diagnosed IBS was performed. The Hospital Anxiety and Depression Scale (HADS), the Short Form 12 Health Survey (SF-12), and the Rome III criteria questionnaire (BDQ-6) were administered. Multiple linear regression was conducted to detect associations among FGID, anxiety, depression and quality of life.
Results:  Overall, 50% of participants were anxious and 12% were depressed. Forty-four percent of participants had >two FGID; however, the number of FGID did not correlate with scores for anxiety, depression or quality of life. Amazingly, only 50% (CI: 33–67) of participants clinically diagnosed with IBS met Rome III criteria for IBS.
Conclusion:  Contrary to our expectations, a greater load of FGID did not correlate with a greater load of psychological comorbidity. Surprisingly, the Rome III criteria detected only 50% of clinical cases of IBS.     

Prevalence and health/social impacts of functional dyspepsia in Taiwan: A study based on the Rome Criteria Questionnaire Survey assisted by endoscopic exclusion among a physical check-up population

Objective Until now, the epidemiology of functional dyspepsia (FD) and its social impact on Asians have been rarely studied. The aims of this study were to determine the prevalence, social impact, and health-seeking behaviors of FD in an apparently healthy Chinese population in Taiwan. Material and methods Based on the questionnaire provided by the Rome II working team, a survey was administered to a Taiwanese population receiving paid physical check-up (n=2865). Esophagoduodenoscopy was performed in each subject to exclude organic dyspepsia. Finally, diagnoses of functional gastrointestinal disorders were obtained by means of a computer-generated algorithm. Results The FD prevalences were 23.8% and 11.8% according to the Rome I and -II criteria, respectively. Nearly 60% of Rome I-defined FD subjects and 18.9% of Rome II-defined FD subjects had overlapping irritable bowel syndrome (IBS). Irrespective of any Rome definition, FD subjects had excessive physician visits, absenteeism, and sleep disturbances compared to dyspepsia-free controls (p<0.01). Moreover, over half of the Rome II FD subjects were “consulters” showing excessive physician visits, absenteeism, and sleep disturbances than “non-consulters”. The dysmotility-like subgroup (74.5%) comprised the majority of FD subjects and showed no differences to their ulcer-like counterparts in terms of major demographic data and social and health impacts. Conclusions FD is a common complaint in Taiwan and also bears an obvious social and medical burden to society. Over half of our FD subjects sought medical help, which may be due to the readily accessible medical care in Taiwan. The newly defined Rome II criteria diminish the chance of co-existence of FD and IBS. Further FD classification by the main symptoms appears of limited clinical usefulness.     

Epidemiology of irritable bowel syndrome in Chinese

Irritable bowel syndrome (IBS) is common in Caucasians and Japanese, but its epidemiology has not been studied in urbanized Chinese populations. Our aim was to compare diagnostic criteria and study the epidemiology of IBS in Hong Kong Chinese. In all, 964 subjects from public housing and 334 subjects from private housing were recruited for face-to-face interviews in Shatin, Hong Kong. A structured questionnaire was used to measure the prevalence of IBS according to the Manning, Rome I, and Rome II criteria. The SF-36 scale was used to measure quality of life (QOL) in subjects with IBS and in normal controls. The results were compared by the analysis of covariance (ANCOVA). Relevant medical consultations and absence from work were recorded. There was fair agreement between the Manning and Rome II criteria ( = 0.23; P < 0.001), but good agreement between the Rome I and Rome II criteria ( = 0.5; P < 0.001). The prevalence of IBS, based on the Rome II criteria, was 3.6% (95% CI = 2.0–5.2) in men and 3.8% (95% CI = 2.5–5.2) in women. Men with IBS had significantly lower vitality scores on the SF-36 scale than the controls (P < 0.05 by ANCOVA), and women with IBS had significantly lower mental health scores than controls (P < 0.05 by ANCOVA). In conclusion, IBS is quite prevalent in Hong Kong Chinese, and the QOL of subjects with IBS was significantly affected.     

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.     

Prevalence and factors associated with irritable bowel syndrome among university students in Lebanon:Findings from a cross-sectional study

AIM: To describe the bowel habits and the prevalence of irritable bowel syndrome(IBS) and to investigate the influence of health behavior and social factors on IBS prevalence in university students. METHODS: This cross-sectional study was conducted at five major universities in Greater Beirut and its suburbs, between February and June 2014. Using a convenience sample, a total of 813 students aged 18 years old and above participated in this study. Participants were asked to complete a comprehensive anonymous questionnaire which detailed characteristics on socio-demographic, health-related, and lifestyle factors, as well as IBS. The ROME Ⅲ criteria were used as a tool to ascertain IBS. A χ2 test was used to determine differences between categorical variables; stepwise logistic regression was used to measure the association between IBS and its risk factors.RESULTS: An overall prevalence of IBS of 20% was recorded among university students. The bivariate analysis showed that females were significantly more likely to report having IBS than males(29.1% vs 18.2%, P < 0.01). Those living at the school dormitory or in a private residence(39.5%) were more likely to have IBS than those living with their families(16.3%)(P < 0.01). The multivariate analysis showed that those who had a relatively high family income level(US$ > 2000) were almost 6 times more likely to report havingIBS than their counterparts.CONCLUSION: This is the first study to describe the nature of IBS among young adults in Lebanon. The prevalence of IBS among university students in our sample was higher than that reported in the West.     

Latent structure of irritable bowel syndrome symptom severity

AIM: To investigate the latent structure of an irritable bowel syndrome(IBS) symptom severity scale in a population of healthy adults.METHODS: The Birmingham IBS symptom questionnaire which consists of three symptom specific scales(diarrhea,constipation,pain) was evaluated by meansof structural equation modeling.We compared the original 3-factor solution to a general factor model and a bifactor solution in a large internet sample of college students(n = 875).Statistical comparisons of competing models were conducted by means of χ2 difference tests.Regarding the evaluation of model fit,we examined the comparative fit index(CFI) and the Root Mean Square Error of Approximation(RMSEA).RESULTS: Results clearly favored a bifactor model of IBS symptom severity(CFI = 0.99,RMSEA = 0.05) which consisted of a strong general IBS somatization factor and three symptom specific factors(diarrhea,constipation,pain) based on the subscales of the Birmingham IBS symptom questionnaire.The fit indices of the competing one factor model(CFI = 0.85,RMSEA = 0.17) and three factor model(CFI = 0.97,RMSEA = 0.08) were clearly inferior.χ2 difference tests showed that the differences between the models were indeed significant in favor of the bifactor model(P 0.001).Correlations of the four latent factors with measures of pain sensitivity,somatoform dissociation,fatigue severity,and demographic variables support the validity of our bifactor model of IBS specific symptom severity.CONCLUSION: The findings suggest that IBS symptom severity might best be understood as a continuous and multidimensional construct which can be reliably and validly assessed with the B-IBS.     

A prospective assessment of bowel habit in irritable bowel syndrome in women: defining an alternator

BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is subtyped as IBS with diarrhea (IBS-D) or IBS with constipation (IBS-C) based on Rome II guidelines. The remaining group is considered as having mixed IBS (IBS-M). There is no standard definition of an alternator (IBS-A), in which bowel habit changes over time. Our aim was to use Rome II criteria to prospectively assess change in bowel habit for more than 1 year to understand IBS-A. METHODS: Female patients (n=317) with IBS entering a National Institutes of Health treatment trial were studied at baseline with questionnaires and 2-week daily diary cards of pain and stool frequency and consistency. Studies were repeated at the end of treatment (3 months) and at four 3-month intervals for one more year. Algorithms to classify subjects into IBS-D, IBS-C, and IBS-M groups used diary card information and modified Rome II definitions. Changes in bowel habit at 3-month intervals were then assessed using these surrogate diary card measures. RESULTS: At baseline, 36% had IBS-D, 31% IBS-M, and 34% IBS-C. Except for stool frequency, there were no differences between groups. While the proportion of subjects in each subgroup remained the same over the year, most individuals (more than 75%) changed to either of the other 2 subtypes at least once. IBS-M was the least stable (50% changed out by 12 weeks). Patients were more likely to transition between IBS-M and IBS-C than between IBS-D and IBS-M. Notably, only 29% switched between the IBS-D and IBS-C subtypes over the year. CONCLUSIONS: While the proportion of subjects in each of the IBS subtypes stays the same, individuals commonly transition between subtypes, particularly between IBS-M and IBS-C. We recommend that IBS-A be defined as at least one change between IBS-D and IBS-C by Rome II criteria over a 1-year period.