Prevalence and impact of upper gastrointestinal symptoms in the Canadian population: findings from the DIGEST study

OBJECTIVE: The prevalence and impact of upper gastrointestinal (GI) symptoms in the general population are poorly defined. Most data are obtained from selected samples derived from patients presenting to health care providers. As part of a larger international effort (The DIGEST study), we examined the prevalence of upper GI symptoms among the general Canadian population, as well as their psychosocial and economic impact. METHODS: A sample of 1036 adults was studied, its demographic characteristics closely matching those of the general Canadian population. A validated detailed questionnaire measured the prevalence, severity, and frequency of 15 digestive symptoms, as well as demographic information, use of medication and medical resources, other illnesses, and dietary habits. The Psychological General Well-Being Index, a self-administered questionnaire, assessed the individual's subjective sense of well-being. RESULTS: Of the sample population, 28.6% reported substantial symptoms in the preceding 3 months, the majority (111/153 subjects) for >1 yr; 34.1% reported having never experienced significant GI symptoms.The most bothersome symptoms were primarily related to dysmotility-like symptoms in 54.9% of those with chronic symptoms, ulcer-like symptoms in 12.4%, and related to heartburn in 42.5%. Chronic upper GI symptoms were associated with a highly significant (p < 0.001) decrease in all facets of the Psychological General Well Being Index. CONCLUSIONS: Upper GI symptoms are very prevalent in the general Canadian population and substantially affect the quality-of-life and psychological well-being of those affected. Dysmotility-like symptoms, rather than heartburn, are the most common chronic upper gastrointestinal symptoms in the general population.     

Peripheral neuropathy in inflammatory bowel disease patients: A prospective cohort study

Abstract

Introduction. Survival of upper gastrointestinal (GI) cancer depends on early stage diagnosis. Symptom-based guidelines and fast-track referral systems have been implemented for use in general practice. To improve diagnosis of upper GI cancer, knowledge on prevalence of alarm symptoms in the general population and subsequent healthcare-seeking is needed. Material and methods. A nationwide study of 100,000 adults, who were randomly selected from the general population were invited to participate in an internet-based survey. People aged ≥45 years were included in this study. Items regarding experience of specific and nonspecific alarm symptoms of upper GI cancer within the preceding 4 weeks and contact to general practitioner (GP) were included. Results. Of the 60,562 subjects aged ≥45 years, 33,040 (54.6%) completed the questionnaire. The prevalence of the specific alarm symptoms ranged between 1.1% (“repeated vomiting”) and 3.4% (“difficulty swallowing”). Women had higher odds of experiencing “repeated vomiting” and “persistent and recent-onset abdominal pain”, but lower odds of experiencing “upper GI bleeding”. The proportion of people contacting their GP with each of the four specific alarm symptoms ranged from 24.3% (“upper GI bleeding”) to 39.9% (“repeated vomiting”). For each combination of two specific alarm symptoms, at least 52% contacted their GP. Conclusion. The specific alarm symptoms of upper GI cancer are not very prevalent in the general population. The proportion of GP contacts with each of the four specific symptoms varied between 24.3% and 39.9%. The proportion of GP contacts was higher in the older age and with combinations of two symptoms.     

Obesity and chronic gastrointestinal tract symptoms in young adults: a birth cohort study

BACKGROUND: An unexplained epidemic of obesity is occurring but the relationship between obesity and gastrointestinal (GI) tract function is unclear. We aimed to evaluate the association between body mass index (BMI) and specific GI symptoms. METHODS: A birth cohort in Dunedin, New Zealand, aged 26 yr (n = 980, 94% of total original sample) was evaluated using a validated GI symptom questionnaire. Categories of GI symptom complexes were defined a priori. The association of reported GI symptoms with BMI (kg/m(2)) was assessed adjusting for gender. RESULTS: The prevalence of obesity (BMI > or = 30 kg/m(2)) was 12%; 30% were overweight. There was a significant univariate positive association between increased BMI and diarrhea (>3 stools/day, loose stools, or urgency); the sex adjusted odds ratio for obese versus normal weight was 1.8 (95% CI 1.1, 2.9; p= 0.02). Abdominal pain associated with nausea or vomiting was positively associated with increased BMI (OR 2.0, 95% CI 1.0, 2.9; p= 0.04). Being overweight was negatively associated with abdominal pain and constipation (OR 0.4, 95% CI 0.2, 0.9; p= 0.02). Irritable bowel syndrome and reflux symptoms were not significantly associated with increased BMI. Waist-to-hip ratios were not significantly associated with GI symptoms. No study members were taking antiobesity medications. Hemoglobin A1c levels were not associated with any of the GI symptoms. CONCLUSIONS: In a general population sample of young adults, increasing BMI was associated with diarrhea and abdominal pain with nausea/vomiting.     

Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population: the Kalixanda study

BACKGROUND: Upper oesophagogastroduodenoscopy is considered to be the gold standard for upper gastrointestinal disease assessment, but is currently seldom used in epidemiological studies. One concern is that the procedure may bias sampling among volunteers in a general adult population. The aim of this study was to explore whether the procedure affects symptom reporting. METHODS: A random sample of 3000 adults aged 20-81 years (mean age 50.4), from two Swedish municipalities (n=21,610) was surveyed using a validated postal questionnaire (the Abdominal Symptom Questionnaire) assessing gastrointestinal symptoms. A subsample of the responders was invited, in random order, to undergo an upper endoscopy and repeated symptom reporting using the same questionnaire, as well as a serology test for Helicobacter pylori. RESULTS: The response rate to the initial questionnaire was 74.2% and the participation rate for those eligible for the upper endoscopy was 73.3% (n = 1001, mean age 54.0 years, 48.8% male). No major social or symptom sampling error was encountered from the selection process, with the exception of an excess of symptom reporters among the youngest subjects. The prevalence of reflux symptoms, dyspeptic symptoms and irritable bowel symptoms was 40%, 37.6% and 29.6%, respectively, which is relatively high, but in no way extreme. CONCLUSIONS: The upper endoscopy survey strategy was successful. The response rate was high and there was no major selection bias of clinical relevance. The cohort selected for this study appears to be representative of the general Swedish adult population.     

Gastrointestinal symptoms in long-distance runners, cyclists, and triathletes: prevalence, medication, and etiology

OBJECTIVE: The aim of this study was to determine the prevalence of exercise-related gastrointestinal (GI) symptoms and the use of medication for these symptoms among long-distance runners, cyclists, and triathletes, and to determine the relationship of different variables to GI symptoms. METHODS: A mail questionnaire covering the preceding 12 months was sent to 606 well-trained endurance type athletes: 199 runners (114 men and 85 women), 197 cyclists (98 men and 99 women), and 210 triathletes (110 men and 100 women) and sent back by 93%, 88%, and 71% of these groups, respectively. Symptoms were evaluated with respect to the upper (nausea, vomiting, belching, heartburn, chest pain) or lower part of the GI tract (bloating, GI cramps, side ache, urge to defecate, defecation, diarrhea). For statistical analysis, Mann-Whitney U test, Fisher exact test, or Student t test were used. RESULTS: Runners experienced more lower (prevalence 71%) than upper (36%) GI symptoms during exercise. Cyclists experienced both upper (67%) and lower (64%) symptoms. Triathletes experienced during cycling both upper (52%) and lower (45%) symptoms, and during running more lower (79%) than upper (54%) symptoms. Bloating, diarrhea, and flatulence occurred more at rest than during exercise among all subjects. In general, exercise-related GI symptoms were significantly related to the occurrence of GI symptoms during nonexercise periods, age, gender, diet, and years of training. The prevalence of medication for exercise-related GI symptoms was 5%, 6%, and 3% for runners, cyclists, and triathletes, respectively. CONCLUSIONS: Long-distance running is mainly associated with lower GI symptoms, whereas cycling is associated with both upper and lower symptoms. Triathletes confirm this pattern during cycling and running. The prevalence of medication for exercise-related GI symptoms is lower in the Netherlands in comparison with other countries, in which a prevalence of 10-18% was reported. More research on the possible predisposition of athletes for GI symptoms during exercise is needed.     

GI symptoms in diabetes mellitus are associated with both poor glycemic control and diabetic complications

OBJECTIVE: Diabetes mellitus is associated with an increased prevalence of GI symptoms, but the mechanisms underlying symptoms are poorly defined and controversial. We aimed to determine whether there is a relationship between GI symptoms and both diabetic complications and glycemic control. METHODS: We performed a cross-sectional questionnaire study of 1101 subjects with diabetes mellitus recruited from outpatient clinics (n = 209) and the community (n = 892). Data on eight GI symptom groups, complications of diabetes (retinopathy, neuropathy, nephropathy), and self-reported glycemic control were obtained from a validated questionnaire. Glycated hemoglobin was measured in 463 of the subjects, The association between diabetic complications, glycemic control, and GI symptoms was assessed using logistic regression analysis, adjusted for demographic and clinical factors. RESULTS: Of the 1101 subjects, 57% reported at least one complication. Diabetic complications were independently associated with both symptom complexity (number of symptom groups reported) (adjusted odds ratio = 1.92 per symptom group [95% CI = 1.51-2.45]) and seven of the eight GI symptom groups. For all symptom groups, the association was explained by self-reported symptoms of peripheral neuropathy. Poor glycemic control measured by both self-report and Hb A1c was an independent risk factor for upper GI symptoms, whereas other potential risk indicators, including duration and type of diabetes, were not significant. CONCLUSIONS: GI symptoms in diabetes mellitus may be linked to diabetic complications, particularly peripheral neuropathy, and to poor glycemic control.     

Prevalence of functional gastrointestinal disorders in a population of subjects consulting for gastroesophageal reflux disease in general practice

AIMS: To establish the prevalence of functional gastrointestinal (GI) disorders in adult patients with symptoms of gastroesophageal reflux disease (GERD) and to assess the impact of GERD treatment on functional GI disorders in medical practice in France. METHODS: 3318 patients with GERD symptoms (mean age 53 yr; 1726 women and 1592 men) were involved in the survey. A questionnaire on demographic data, GERD features, presence of functional GI disorders and their features, and impact of GERD treatment on functional GI disorders was performed by the physician. The size of the different groups was compared using either a chi2 test or a Mantel-Haenszel analysis, on a case by case basis. RESULTS: Seventy-two percent of patients with GERD had associated functional GI disorders, with a mean of 4.1 +/- 1.9 functional digestive symptoms per patient. Gas, flatulence, transit disorders and abdominal distension were the most commonly reported symptoms. Among patients with functional GI symptoms, 27% had symptoms suggestive of irritable bowel syndrome (IBS), 16% were suggestive of dyspepsia while 57% had both upper and lower functional digestive symptoms. According to the patients, GERD treatment had a positive impact (significant to complete improvement) on their functional GI disorders in about one-third of patients particularly in those with dyspeptic-type symptoms. CONCLUSIONS: Functional GI disorders are particularly common in adult patients suffering from GERD, with a three times higher prevalence than in the general population.     

Initial validation of a bowel symptom questionnaire* and measurement of chronic gastrointestinal symptoms in Australians

Background: Chronic gastrointestinal (GI) symptoms are believed to be common in the general population, but Australian data are lacking. A valid instrument is required to assess GI symptoms adequately and determine their prevalence in the community. Aims: To test the feasibility, reliability and concurrent validity of a self-report Bowel Symptom Questionnaire (BSQ) as a measure of GI symptoms, and obtain preliminary data on the prevalence of symptoms in an Australian population-based sample. Methods: Outpatients (n= 63), volunteers (n= 163) and a random sample (n= 99) of the Penrith population, Sydney, completed the BSQ. Feasibility was evaluated in 264 subjects. Reliability was measured by a test-retest procedure (n= 43), while concurrent validity was documented by comparing self-report data with an independent interview (n= 20). The response rate in the population mail survey was 68%. Prevalence data on bowel symptoms in the community sample (n= 99) were age and gender standardised to the Australian population. Results: The majority of subjects found the BSQ easy to complete (97%) and understand (97%); 90% completed the questionnaire in half an hour or less. Reliability (median kappa 0.70, interquartile range 0.20) and concurrent validity (median kappa 0.79, interquartile range 0.26) of GI symptoms were both very acceptable. The internal consistency of all GI symptom scales was good (Cronbach's Alpha range 0.51-0.74). The prevalence of the irritable bowel syndrome (defined as abdominal pain and disturbed defaecation based on two or more of the Manning criteria) was 17.2% (95% CI: 10–25%). Conclusions: The BSQ was well accepted and easy to understand; it provided reliable and valid data on GI symptoms and should prove useful in large scale epidemiological studies in Australia. (Aust NZ J Med 1995; 25: 302–308.)     

Sleep disturbances in clinic patients with functional bowel disorders

OBJECTIVE: Sleep deprivation can lower visceral perception thresholds and nonregenerative sleep has been implicated as an etiological factor in chronic hyperalgesia syndromes. The aims of our study were to quantify the self-reported prevalence and type of sleep disturbances in patients with different functional bowel disorders (FBD) and to determine if this prevalence is related to involvement of the upper or lower gastrointestinal (GI) tract, perceived disease severity, or psychological comorbidity. METHODS: We enrolled 505 new FBD patients from an academic referral center specializing in functional GI disorders and 247 community based healthy controls. All patients and controls were prospectively evaluated by validated bowel symptom and sleep questionnaires. A psychological profile was obtained by SCL-90R. RESULTS: We found that 68% of functional dyspepsia (FD), 71.2% of irritable bowel syndrome (IBS)+FD, 50.2% of IBS, and 55.1% of the normal subjects reported having sleep disturbances. Waking up repeatedly during the night and waking up in the morning feeling tired or not rested were the most commonly reported sleep patterns; 57.2% of the patients reported that their abdominal ache awakened them from sleep during the night. Self-reported sleep disturbance was directly related to the perceived intensity of GI symptoms. Self-reported sleep disturbances were equally common in both male (57%) and female (58.4%) FBD patients. There was no significant difference between the mean anxiety and depression scores between patients with and without sleep dysfunction. CONCLUSIONS: FD patients, but not IBS patients, reported sleep disturbances more frequently than healthy control subjects. Abdominal pain or discomfort that awaken FBD patients from sleep during the night were common, and thus a poor discriminating factor between organic and functional disorders.     

Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors

OBJECTIVES: Quality of life is reduced in inflammatory bowel disease (IBD). Whether or not this is true in IBD patients in long-standing remission is unclear. Symptoms compatible with irritable bowel syndrome (IBS) are common in IBD patients in remission. The importance of psychological factors in this process is a matter of controversy. METHODS: Forty-three patients with ulcerative colitis (UC) and 40 with Crohn's disease (CD), who had been in remission for at least 1 yr according to laboratory parameters and clinical and endoscopical appearance, were included. These patients completed four different self-administered questionnaires, evaluating GI symptoms, anxiety, depression, and psychological general well-being. The two patient groups were compared with the general population, and within-group comparisons in psychometric scores were made between patients with and without IBS-like symptoms. RESULTS: The psychological well-being in IBD patients in long-standing remission was similar to that of the general population, despite the presence of more severe GI symptoms. CD patients reported more psychosocial dysfunction, reduced well-being, and GI symptoms than UC patients. Thirty-three percent of UC patients and 57% of CD patients had IBS-like symptoms. The group with IBS-like symptoms (both UC and CD) had higher levels of anxiety and depression and more reduced well-being than those without. Anxiety and reduced vitality were found to be independent predictors for IBS-like symptoms in these patients. CONCLUSION: The prevalence of IBS-like symptoms in IBD patients in long-standing remission is two to three times higher than that in the normal population. Psychological factors seem to be of importance in this process. However, as a group IBD patients in remission demonstrate psychological well-being comparable to that of the general population.     

Prevalence of self-reported peripheral joint pain and swelling in an Italian population: the Chiavari study

OBJECTIVE: To evaluate the prevalence of self-reported joint pain and swelling in the peripheral joints of subjects from an Italian general population. To correlate the result with demographic data and physical activity. METHODS: A total of 4,456 subjects aged 16 years or more listed in four general practices were invited to participate in the study and to fill out the ARC questionnaire. The 3,294 responders were asked to report: (a) any past occurrence of joint swelling lasting more than 4 weeks and the distribution of the swollen joints on a mannequin; (b) any joint pain lasting more than 4 weeks; (c) current joint pain or swelling; (d) morning stiffness; (e) whether they had been previously told by a doctor they had arthritis; and (f) their physical activity according to a three-class scale. RESULTS: Joint pain was reported by 889 (27%) subjects and joint swelling was reported by 463 (14%) subjects. Women reported joint pain and swelling more frequently than men, except for the younger age classes. The prevalence of joint pain and swelling increased with age in both sexes until age 55-64, when a plateau was observed. Age was involved in the determination of joint pain and swelling. Physical activity was involved only marginally. CONCLUSIONS: We found high levels of prevalence of pain and swelling in the peripheral joints in a general Italian population. Prevalence was higher in Italian subjects than in subjects from China and Pakistan studied using the same questionnaire. These differences may reflect cultural and social diversity in the perception of disease, as well as true differences in the prevalence of rheumatic symptoms across the world.     

Factors influencing the diagnosis of chronic fatigue syndrome

BACKGROUND: Most of what is believed about chronic fatigue syndrome (CFS) is based on clinic-based studies. These studies may not reflect CFS cases in the population. METHODS: We used data from a population-based study of CFS to identify factors associated with receiving a CFS diagnosis. Wichita, Kan, residents were screened by random-digit dialing. Eligible individuals completed a telephone interview. Respondents meeting CFS criteria were invited for a clinical evaluation to confirm CFS. We analyzed all persons with confirmed CFS. The main outcomes of this study, prevalence and incidence of CFS, are published elsewhere. Herein, we present an exploratory analysis with previous CFS diagnosis as the outcome, predicted by demographic and symptom characteristics. RESULTS: We confirmed CFS in 90 subjects; 14 (16%) had been previously diagnosed as having CFS. Persons in the middle- vs the higher-income group were more likely to have been diagnosed as having CFS (9 [29%] of 31 subjects vs 3 [8%] of 39 subjects; P = .03), as were those with sudden vs gradual fatigue onset (7 [41%] of 17 subjects vs 4 [6%] of 64 subjects; P < .01), those reporting tender lymph nodes (7 [33%] of 21 subjects vs 7 [10%] of 69 subjects; P = .02), and those reporting a sore throat (6 [35%] of 17 subjects vs 8 [11%] of 73 subjects; P = .02). Only 17 (21%) of 81 subjects had sudden fatigue onset, and tender lymph nodes (reported in 21 [23%] of 90 subjects) and a sore throat (reported in 17 [19%] of 90 subjects) were the least common symptoms. CONCLUSION: Most cases of CFS in the population are unrecognized by the medical community; persons diagnosed as having CFS may be different from persons with CFS in the general population.     

Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population: the Kalixanda study

Background: Upper oesophagogastroduodenoscopy is considered to be the gold standard for upper gastrointestinal disease assessment, but is currently seldom used in epidemiological studies. One concern is that the procedure may bias sampling among volunteers in a general adult population. The aim of this study was to explore whether the procedure affects symptom reporting. Methods: A random sample of 3000 adults aged 20-81 years (mean age 50.4), from two Swedish municipalities (n?=?21,610) was surveyed using a validated postal questionnaire (the Abdominal Symptom Questionnaire) assessing gastrointestinal symptoms. A subsample of the responders was invited, in random order, to undergo an upper endoscopy and repeated symptom reporting using the same questionnaire, as well as a serology test for Helicobacter pylori. Results: The response rate to the initial questionnaire was 74.2% and the participation rate for those eligible for the upper endoscopy was 73.3% (n?=?1001, mean age 54.0 years, 48.8% male). No major social or symptom sampling error was encountered from the selection process, with the exception of an excess of symptom reporters among the youngest subjects. The prevalence of reflux symptoms, dyspeptic symptoms and irritable bowel symptoms was 40%, 37.6% and 29.6%, respectively, which is relatively high, but in no way extreme. Conclusions: The upper endoscopy survey strategy was successful. The response rate was high and there was no major selection bias of clinical relevance. The cohort selected for this study appears to be representative of the general Swedish adult population.     

Epidemiology and health care seeking in the functional GI disorders: a population-based study

OBJECTIVES: Functional GI disorders (FGIDs) are common in clinical practice, but little is known about the epidemiology of these disorders in the general population. We aimed to determine the prevalence, association with psychological morbidity, and health care seeking behavior of FGIDs in the population. METHODS: A random sample of subjects (n = 4500) aged > or = 18 yr and representative of the Australian population were mailed a validated questionnaire. For these subjects we measured all Rome I GI symptoms and physician visits over the past 12 months, as well as neuroticism, anxiety, depression, and somatic distress. RESULTS: The response rate for the study was 72%. The prevalence of any FGID was 34.6%, and 62.1% of these subjects had consulted a physician. There was considerable overlap of the FGIDs (19.2% had more than two disorders). Independent predictors for an FGID diagnosis were neuroticism, somatic distress, anxiety, bowel habit disturbance, abdominal pain frequency, and increasing age. However, psychological morbidity did not independently discriminate between consulters and nonconsulters with an FGID. CONCLUSIONS: More than one third of the general population have one or more FGIDs. There seems to be a modest link between psychological morbidity and FGIDs, although other unknown factors seem to be more important in explaining health care seeking for these disorders.     

Estimating the prevalence of delayed median nerve conduction in the general population

The objectives of this study were to determine the point prevalence of neurophysiologically defined median nerve compression and associated carpal tunnel syndrome in a random sample of the general population. The design was a two-stage screening study: (i) a cross-sectional survey to estimate the point prevalence of current hand symptoms; (ii) nerve conduction testing of the median nerve in weighted samples of the survey respondents. The target study population was a random sample of 1000 adults aged between 18 and 75 yr registered with a family practice in the UK. A mailed questionnaire enquired about hand symptoms on the day and included various demographic questions. Weighted random samples were taken based on the hand symptoms reported, and the subjects were invited to attend for motor and sensory median nerve conduction testing. A neurophysiological diagnosis of median nerve compression was made based on a number of different cut-offs using published criteria. Of those receiving a questionnaire, 79% responded. A total of 250 responders were invited to attend for nerve conduction testing, of whom 155 (62%) attended. Non-response to the questionnaire and non- attendance for nerve conduction testing may have biased the prevalence estimates. After adjustment for such biases, a prevalence estimate of between 7 and 16% was obtained, varying with the different cut-offs used to define delayed median nerve conduction. Subjects over 54 yr of age had a higher prevalence than younger participants. There was no difference in prevalence estimates between men and women. The conclusion reached was that carpal tunnel syndrome, as assessed by delayed median nerve conduction, is common in the general population.      

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.     

Prevalence and impact of musculoskeletal disorders of the upper limb in the general population

OBJECTIVE: To determine the prevalence, interrelation, and impact of musculoskeletal disorders of the upper limb in the general population. METHODS: A total of 9,696 randomly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening questionnaire and a standardized physical examination in symptomatic subjects. Age- and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs. The overlap and impact on daily activities and healthcare utilization were explored. RESULTS: Among 6,038 first-stage responders, 3,152 reported upper limb symptoms and 1,960 were subsequently examined. Of subjects with pain, 44.8% had 1 or more specific soft-tissue disorders. Site-specific prevalence rates were as follows: shoulder tendinitis 4.5% among men and 6.1% among women; adhesive capsulitis 8.2% among men and 10.1% among women; lateral epicondylitis 1.3% among men and 1.1% among women; de Quervain's disease 0.5% among men and 1.3% among women; other tenosynovitis of the hand or wrist, 1.1% among men and 2.2% among women. Specific disorders tended to cluster (P < 0.001) in individuals, with particular overlap at the shoulder. Compared with subjects with nonspecific pain, those with specific disorders more often reported inability to perform everyday tasks (P < 0.05), consultation with a doctor (P < 0.05), and use of prescribed medication (P < 0.05). CONCLUSION: Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders. These disorders have a substantial impact on physical function and use of health care.