Factor analysis of bowel symptoms in US and Italian populations.

BACKGROUND AND AIMS: Functional gastrointestinal disorders are diagnosed by the presence of a characteristic set of symptoms. Aims of this study were to validate the Rome symptom criteria by factor analysis and to determine whether symptoms cluster in the same way in different cultures. METHODS: One thousand forty-one gastroenterology clinic patients in the US (response rate 53%) and 228 family members accompanying clinic patients in Italy (84%) completed a previously validated symptom questionnaire. Factor analysis identified clusters of symptoms which are highly correlated with each other, and these were compared to the Rome diagnostic criteria. RESULTS: In the US, 13 factors were identified. The irritable bowel factor was composed of three core symptoms corresponding to the Rome II classification system. Two dyspepsia factors were identified which correspond to the ulcer- and motility-like subtypes proposed in the Rome I classification system. All symptoms of constipation formed a single cluster as proposed in the Rome II classification system. Symptom clusters in the US agreed well with symptom clusters identified in Italian subjects. CONCLUSIONS: Empirically derived symptom clusters agree in most respects with the Rome II classification system and support their validity. These symptom clusters are independent of cultural differences in diet and behaviour.

Anxiety but not depression determines health care-seeking behaviour in Chinese patients with dyspepsia and irritable bowel syndrome: a population-based study.

AIMS: To study the prevalence of dyspepsia and irritable bowel syndrome and the effects of co-existing anxiety and depression on health care utilization by a population survey in Chinese. METHODS: Ethnic Chinese households were invited to participate in a telephone survey using a validated bowel symptom questionnaire and the hospital anxiety and depression scale. Gastrointestinal symptoms were classified as dyspepsia and irritable bowel syndrome according to the Rome I criteria and gastro-oesophageal reflux disease by the presence of weekly heartburn or acid regurgitation. The anxiety and depression scores were compared between patients who sought medical attention and those who did not, using multiple logistic regression analysis. RESULTS: One thousand, six hundred and forty-nine subjects completed the interview (response rate, 62%). The population prevalences of dyspepsia, irritable bowel syndrome and gastro-oesophageal reflux disease were 18.4%, 4.1% and 4.8%, respectively. Dyspepsia and irritable bowel syndrome were associated with anxiety, depression, medical consultation, sick leave and adverse effects on social life. The degree of anxiety was an independent factor associated with health care-seeking behaviour in both dyspeptics (P = 0.003) and irritable bowel syndrome patients (P = 0.036). CONCLUSIONS: Irritable bowel syndrome and dyspepsia are associated with anxiety, depression, significant social morbidity, health care utilization and days off work. Anxiety is an independent factor in determining health care utilization in patients with dyspepsia and irritable bowel syndrome.

Epidemiology of irritable bowel syndrome in Croatia.

This epidemiological study of irritable bowel syndrome (IBS) was the first one of the type in Croatia. The aim of the study was to determine prevalence and association between IBS and gender, age, education and urban/rural living. Study design included a questionnaire based on Rome criteria, which was send to 500 study subjects by post. Study population matched the adult population of Croatia according last census. Study result showed a high prevalence of IBS: i.e. 28% (10% of males and 18% of females). Age, education and urban/rural type of living were not related to the prevalence of IBS. Logistic regression gave gender-body mass index (BMI) model for IBS determination: the relative risk for getting IBS in females was by 165% higher than in males and BMI increase of 5 kg/m2 increased the risk of IBS by 36%. BMI was indicated as a possible new factor of IBS prevalence.

Dolor abdominal recurrente: un trastorno somatomorfo / Recurrent abdominal pain: a somatomorf disorder

El dolor abdominal recurrente es un problema común en pediatría. La etiología es desconocida, aunque se relaciona con un origen psicosomático. En este trabajo analizamos el dolor abdominal recurrente como trastorno somatomorfo indiferenciado, según los criterios del DSM-IV, y estudiamos los factores psicológicos asociados a la etiología, fisiopatología, diagnóstico y tratamiento (AU)

Prevalence of gastrointestinal symptoms in a multiracial Asian population, with particular reference to reflux-type symptoms.

OBJECTIVE: Data on the epidemiology of chronic gastrointestinal symptoms in the East are limited. The aims of this study were to estimate the prevalence of chronic gastrointestinal symptoms in Singapore and to determine whether ethnic differences in the prevalence of these symptoms exist. METHODS: A cross-sectional survey, using a reliable and valid questionnaire, was carried out in a race-stratified random sample of residents aged 21-95 yr (mean+/-SD, 40+/-1 yr) in a Singaporean town; 93% responded (n=696). RESULTS: The ethnic-adjusted prevalence of chronic abdominal pain, frequent dyspepsia, irritable bowel syndrome, chronic constipation, chronic diarrhea, and frequent reflux were 5.7% (95% confidence interval [CI], 3.3-8.1), 7.9% (95% CI, 5.0-10.8), 2.3% (95% CI, 0.8-3.9), 3.9% (95% CI, 1.9-5.9), 4.5% (95% CI, 2.3-6.7), and 1.6% (95% CI, 0.6-2.6), respectively. There were no ethnic differences in the prevalence of any of these symptom categories except for reflux-type symptoms, which were more common among Indians (7.5%; 95% CI, 4.4-11.7) than Chinese (0.8%; 95% CI, 0.1-3.0) or Malays (3.0%; 95% CI, 1.26.1). CONCLUSION: The prevalence of all types of chronic gastrointestinal symptoms in the general population of Singapore was low compared with those in the West. Chronic gastrointestinal symptoms were equally prevalent in the three major ethnic groups except for reflux-type symptoms, which were more common among Indians than Chinese or Malays.

Abnormal vagal cholinergic function and psychological behaviors in irritable bowel syndrome patients: a hospital-based Oriental study.

Irritable bowel syndrome (IBS) patients in Western countries usually manifest autonomic nerve dysfunctions and abnormal psychological behaviors. The purpose of this study was to assess whether Oriental IBS patients with predominant bowel symptoms also exhibited similar abnormalities. We enrolled 40 IBS patients from the outpatient clinic and 20 controls with normal daily bowel habit for study. The IBS patients were further divided according to their predominant bowel habit: 20 were constipation-predominant and 20 were diarrhea-predominant. Sympathetic function was evaluated by sympathetic skin response (SSR) while vagal cholinergic function was determined by measuring R-R interval variation (RRIV) in electrocardiography 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). IBS patients, despite their bowel habit, showed normal SSR response. RRIV during deep breathing was significantly lower in constipation-predominant IBS patients than 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 also exhibited abnormal MMPI measuring scores on depression, hysteria, paranoia, and masculinity/femininity scales. In addition, they also had more severe psychological distress in the items of HSCL-90 measurement. In conclusion, vagal dysfunction characterizes Oriental constipation-predominant IBS patients seeking medical help. Abnormal psychoneurotic profiles also exist in these IBS patients, irrespective of their bowel habits.

Characteristics of small bowel motility in patients with irritable bowel syndrome and normal humans: an Oriental study.

1. Small bowel dysmotility may be one of the clinical manifestations in Occidental patients with irritable bowel syndrome. Here we studied the characteristics of small bowel motility in Oriental patients with irritable bowel syndrome and identified the factors responsible for disturbed small bowel motility. 2. We enrolled 90 patients with irritable bowel syndrome and 45 healthy controls to the study. The patients with irritable bowel syndrome were further divided according to their predominant bowel habits. Of those, 45 were constipation-predominant and 45 were diarrhoea-predominant. Small bowel transit was measured by the non-invasive hydrogen breath test in the fasting state. 3. The transit times obtained in constipation-predominant and diarrhoea-predominant patients with irritable bowel syndrome and in controls were 108.4+/-34.3, 67. 4+/-19.6 and 85.3+/-37.3 min respectively (P<0.05). Delayed transit characterized constipation-predominant patients with irritable bowel syndrome, whereas accelerated transit was observed in diarrhoea-predominant patients with irritable bowel syndrome. The ages of constipation-predominant and diarrhoea-predominant patients with irritable bowel syndrome and of controls displayed a significant positive correlation with their small bowel transit times (r=0.34, 0.31 and 0.39 respectively; P<0.05) and body mass indexes also demonstrated a positive correlation (r=0.31, 0.41 and 0. 30 respectively; P<0.05). Other demographic characteristics did not influence the small bowel transit times. 4. Accelerated or delayed small intestinal transit is exhibited in Oriental patients with irritable bowel syndrome showing either diarrhoea-predominant or constipation-predominant symptoms. Age and body mass index must be taken into consideration to study patients with suspected small intestinal dysmotility.

Health-care-seeking behaviors related to bowel complaints. Hispanics versus non-Hispanic whites.

Health-care-seeking behaviors related to bowel complaints may vary between ethnic groups. A survey of a nonpatient population in El Paso, Texas, was conducted in order to examine differences in health care behavior related to bowel dysfunction, and in the perception of health and bowel function, in Hispanics and non-Hispanic whites. Data from 905 subjects who were either Hispanic (580) or non-Hispanic white (325) given a forced-choice, self-report questionnaire were used for analysis. Data on health care behavior variables were studied using logistic regression, in ethnic and gender groups, controlling for age and socioeconomic status. A log-linear analysis was applied to health perception variables in ethnic and gender groups. Hispanics were less likely than non-Hispanic whites to have seen a physician for bowel symptoms (P < 0.02). Of the subjects with symptoms compatible with irritable bowel syndrome, Hispanics were less likely to have seen a physician (P < 0.05). More Hispanics reported buying folk remedies (P < 0.001), and herbal teas were taken more often to maintain good bowel function (P < 0.02) and to treat bowel problems (P < 0.005). Additionally, Hispanics had a poorer perception of their health in general (P < 0.001), reported more concern about their health (P < 0.02), more concern about bowel function (P < 0.001), and more time spent attending to bowel function (P < 0.001). Therefore, data on health-care-seeking behaviors related to bowel dysfunction showed that Hispanics were less likely than non-Hispanic whites to seek health care for bowel complaints and that Hispanics were more likely to self-medicate with folk remedies to maintain good bowel function. The perception of health and bowel function is in part determined by ethnic differences.

Irritable bowel syndrome defined by factor analysis. Gender and race comparisons.

To examine the applicability across subgroups of the Manning criteria commonly used to diagnose the irritable bowel syndrome, a 22-item symptom questionnaire was administered to male and female African-American and Caucasian adults (N = 1344). Principal components factor analysis with varimax rotation was used to identify symptom clusters. Consistent with the findings of a previous factor analytic study, three of the six Manning symptoms (loose stools and more frequent bowel movement with onset of pain, pain relieved by defecation) formed a cluster corresponding to the irritable bowel syndrome in all subgroups. It is concluded that: (1) The three core Manning symptoms have equal applicability to both genders and to African-Americans as well as to Caucasians. They useful symptom criteria for the diagnosis of IBS when used in conjunction with medical evaluation. (2) Three of the six Manning symptoms rarely correlate with the others; if confirmed in patient samples, this would indicate that these three symptoms are not useful for making a diagnosis of the irritable bowel syndrome.

A study of irritable bowel syndrome diagnosed by Manning criteria in an African population.

Symptoms of irritable bowel syndrome (IBS) using the Manning Criteria were sought by a questionnaire administered to 400 (male-female ratio 3:1) apparently healthy medical students. With a response rate of 84%, 230 (65.5%) reported more than six episodes of abdominal pain in the preceding year (1992-1993). Contrary to expectation, 100 (43.5%) reported symptoms consistent with the diagnosis of IBS. The one-year period prevalence of the syndrome was 30% overall, with prevalence figures of 24% for males and 48% for females (P < 0.01). There was no difference in the type of diet (mainly high-fiber diets) consumed by subjects with and without IBS. About two thirds of the subjects with IBS had sought medical advice during the study period; the consultation behavior was influenced by factors such as the presence of other symptoms. This is the first detailed evidence in a random sample of an African population showing symptoms consistent with a diagnosis of IBS to be very common. It casts doubt on the assumption generated by other workers that IBS is rare among native Africans.