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Irritable bowel syndrome symptoms among German students
Abstract
Irritable bowel syndrome (IBS) is a common disorder in the general population, and is linked to considerable impairments in daily functioning. Little is known about the prevalence of IBS symptoms among students. This study examined the prevalence and characteristics of IBS, sex differences, associations to other somatic complaints and sleep, quality of life (QoL), and childhood abdominal pain in a German university student population.
Using an Internet-based questionnaire, we assessed IBS criteria (according to Rome III), health complaints, health-related QoL (12-item short-form), healthcare-seeking behavior, absenteeism from classes, and subjective attributions in a sample of 2399 university students (mean age: 24.16 years; 1701 female and 696 male students).
The prevalence of IBS-like symptoms was 18.1% with a significant difference between male (15.2%) and female (21.0%) students. Logistic regression models showed that being long-term student doubles the risk for having IBS [adjusted Odds ratio (OR)=2.16], as did the presence of other health problems: recurrent backaches (adjusted OR=2.15), troubles falling asleep (adjusted OR=1.52), and recurrent abdominal pain during childhood (adjusted OR=2.01). The IBS group had significant impairment on 12-item short-form physical and mental dimensions compared with asymptomatic students. Approximately 60% of participants fulfilling IBS criteria never consulted a physician. Male students attributed their symptoms significantly more to nutrition than female students did, who attributed their symptoms significantly more often to stress and anxiety.
IBS is a common syndrome among German university students and goes along with impaired health-related QoL. According to our data, students reporting recurrent abdominal pain in childhood are especially at risk for IBS.
... Assessing data from eight Western European countries, Hungin et al reported that patients with IBS took a mean 5.5 sick days (versus 3.1 days for non-IBS patients) and cut short a mean 10.2 days (versus 4.8 days) per year.2 Productivity loss is not limited to employment; 13.5% of students affected by IBS missed a single day, 5.4% missed a full week, and 1.5% missed more than a week of school in the previous 4 weeks.3 ...
... Aside from its effects on health status, several studies from Western Europe have documented significant additional health care resource use attributed to IBS. Seven percent of European patients with IBS were hospitalized for their condition over a period of 12 months, 40% of patients with IBS had visited their physician at least once for their symptoms in the past 3 months, and 12% had visited their physician several times.2,3 ...
... Interestingly, the effects were generally stronger from a mental health status perspective than from the physical one, suggesting that patients suffer a profound emotional and psychological toll when dealing with IBS-C. Our results are generally consistent with other IBS studies in Western Europe.3–5 To put these results in a broader context, analyses of other conditions using the same NHWS data source suggest that the health status (as assessed using health utilities) of patients with IBS-C is worse than patients with diabetes,18 peripheral arterial disease,19 or gout.20 ...
Several studies have examined the effect of irritable bowel syndrome (IBS) on health outcomes in Western Europe, but less research has focused on the constipation subtype (IBS-C). The current study addresses this gap by comparing patients with IBS-C and matched controls for health status, work productivity, and resource utilization.
Data were obtained from the 2010 5EU National Health and Wellness Survey (NHWS), which includes respondents from France, Germany, Italy, Spain, and the UK. Only participants from France (n = 15,051), Italy (n = 7580), and the UK (n = 15,065) were included in the analyses. Respondents who reported a physician diagnosis of IBS and reported only constipation symptoms were compared with respondents who did not report being diagnosed with IBS using a propensity score-matching methodology (matching on sociodemographics, health behaviors, and comorbidities). Differences between patients with IBS-C and matched controls were examined on health status (Short Form Survey Instrument version 2), work productivity (Work Productivity and Activity Impairment questionnaire), and health care resource use in the past 6 months.
A total of 83 (0.55%), 109 (1.44%), and 204 (1.35%) respondents reported a diagnosis of IBS with only constipation symptoms in France, Italy, and the UK, respectively. Within each country, patients with IBS-C reported significantly worse health status compared with matched controls (all P < 0.05) and significantly more physician visits (all P < 0.05). More hospitalizations were also observed in the UK (P < 0.05). Among those who were employed, patients with IBS-C in France and the UK also reported significantly more presenteeism than matched controls (all P < 0.05).
These findings highlight the pervasive influence of IBS-C on the day-to-day functioning of sufferers, their ability to be productive at work, and their influence on the wider health care system. Significant unmet needs remain, and improved management of this condition could result in significant and clinically meaningful gains in health status as well as alleviating a societal cost burden.
... According to survey studies (Bailer et al., 2008;Fischer et al., 2013;Schlarb et al., 2017), 9.1-23.5% of European university students fulfill the criteria for the somatoform syndrome, characterized by multiple and distressing somatic symptoms (Kocalevent et al., 2013), which therefore represents one of the most common psychological syndromes in this population. Similarly, high prevalence rates have been reported for associated functional somatic syndromes (i.e., organic dys-functions without evidence of structural pathology) such as irritable bowel syndrome (Costanian et al., 2015;Gulewitsch et al., 2011) or tensiontype headache (Khil et al., 2012). Even when compared to other age groups, emerging adults have one of the highest rates of debilitating PSS (Leiknes et al., 2007;Schlarb et al., 2017). ...
... PSS not only represent a significant cause of healthcare utilization and costs (Barsky et al., 2005) but show a high risk for chronicity (van Westrienen et al., 2019) and comorbid mental disorders (Bailer et al., 2008;Fischer et al., 2013), which can significantly impede individuals during this vital period of life. However, only a few of those with PSS and associated mental health issues receive adequate psychological support (Auerbach et al., 2016;Gulewitsch et al., 2011). Internetbased interventions (IBIs) may provide emerging adults with low-threshold, widely accessible, flexible, and stigma-reducing treatment options, that seem to be well accepted in this target group (Dunbar et al., 2018). ...
Debilitating persistent somatic symptoms of varying etiology are very common in emerging adults. Internet-delivered interventions could help to prevent the burden and chronicity of persistent somatic symptoms. This study investigated the impact of therapist guidance on the effectiveness of a cognitive-behavioral Internet intervention for somatic symptom distress (iSOMA) in emerging adults, as a secondary analysis of a two-armed randomized controlled trial. We included 149 university students (83.2% female, 24.60 yrs) with varying degrees of somatic symptom distress who were either allocated to the eight-week intervention with regular, written therapeutic guidance (iSOMA guided) or to the control group (waitlist), which was afterwards crossed over to receive iSOMA with guidance-on-demand (iSOMA-GoD). Primary outcomes were somatic symptom distress (assessed by the PHQ-15) and psychobehavioral symptoms of the somatic symptom disorder (assessed by the SSD-12) at pre- and post-treatment. Secondary outcomes included depression, anxiety, and disability. Both treatments showed statistically significant pre-post improvements in primary (iSOMA-guided: d = 0.86 – 0.92, iSOMA-GoD: d = 0.55 – 0.63) and secondary outcomes. However, intention-to-treat analysis revealed non-significant between-group effects for all outcomes (ps ≥ .335), after controlling for confounding variables, and effect sizes were marginal (d = -0.06 – 0.12). Overall, our findings indicate that Internet-delivered cognitive behavioral therapy with regular guidance is not unequivocally superior to guidance-on-demand in alleviating somatic symptom distress and associated psychopathology in emerging adults. As a next step, non-inferiority studies are needed to test the robustness of these findings and their impact on clinical populations.
... According to European survey studies, 9.1%-23.5% of university students fulfill criteria for the somatoform syndrome (i.e., multiple, distressing somatic symptoms of unclear etiology), representing the most common psychological syndrome in this group (Bailer et al., 2008;Fischer et al., 2013;Schlarb et al., 2017). Similarly, related functional somatic syndromes such as irritable bowel syndrome are diagnosed in around 10%-20% of university students across various countries (Costanian et al., 2015;Gulewitsch et al., 2011;Hazlett-Stevens et al., 2003). Evidence suggests that emerging adults when compared to other age groups have one of the highest risks functional somatic syndromes and somatoform disorders (Leiknes et al., 2007;Petersen et al., 2020). ...
... As such, they have been associated with concurrent mental distress (e.g., depression, anxiety), college attrition, or worse functioning even beyond secondary education (Bigal et al., 2001;Breslau et al., 2008;Fischer et al., 2013). At the same time, access to adequate treatment is often difficult and delayed (Herzog et al., 2018) and only a fraction of emerging adults receive psychological treatment (Auerbach et al., 2016;Gulewitsch et al., 2011). Reasons for this treatment gap may include fear of stigmatization or unfavorable attitudes toward psychological treatments (Eisenberg et al., 2009;Schneider et al., 1990), as well as structurally limited treatment resources Xiao et al., 2017). ...
Objective:
Persistent somatic symptom distress is common in emerging adults and is associated with adverse health outcomes and impairment. Internet-based interventions could help to prevent burden and chronicity. This randomized controlled trial tested the efficacy of a guided, cognitive-behavioral internet intervention for somatic symptom distress (iSOMA) in emerging adults at risk for somatic symptom disorder compared to a waitlist control condition.
Method:
158 participants (N = 156 analyzed; 24.53 years, 83.3% female) with multiple somatic symptoms were recruited among German-speaking universities and randomly allocated to either receive the 8-week iSOMA intervention with psychologist support or the waitlist, both with access to treatment as usual. Primary outcomes were somatic symptom distress Patient Health Questionnaire, somatic symptom scale (PHQ-15) and psychobehavioral features of somatic symptom disorder-12 (SSD-12), assessed at baseline and 8-weeks postrandomization. Secondary outcomes included depression, anxiety, illness worries, functional impairment, and attitudes toward psychological treatment.
Results:
Participants in the iSOMA group showed significantly greater improvements (ps < .001) in primary outcomes (PHQ-15: d = 0.70 [0.36, 1.05], SSD-12: d = 0.65 [0.30, 0.99], and secondary outcomes (ps < .05; d = 0.41-0.52) compared to the waitlist, except for attitudes toward psychological treatment (p = .944). Satisfaction with iSOMA was high (91.0%), most participants (72.8%) completed at least 4 of 7 modules and negative treatment effects were infrequent (14.9%).
Conclusions:
Our intervention had a substantial positive impact on somatic symptom distress across a broad range of persistent physical symptoms in a vulnerable target group, opening up promising possibilities for indicative prevention and blended care for somatic symptom disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... The prevalence of IBS in the general population is estimated to be in the range between 10% and 20%12345. Our previous study has shown that the prevalence of Rome III IBS symptoms among German university students is 18.1% with a significant difference between males (15.2%) and females (21.0%) [6]. IBS, especially in a moderate or severe manifestation, has a considerable impact on health-related quality of life and daily functioning789. ...
... Both studies emphasized the impact of somatization and anxiety, which is in line with our results. As reported before [6] a proportion of 60.4% of surveyed students meeting IBS criteria never consulted a physician because of their GI symptoms. Only two students received an IBS diagnosis by their physician. ...
Aim. To investigate the degree of mental strain and chronic stress in a German community sample of students with IBS-like symptoms. Methods and Materials. Following an internet-based survey about stress, this study recruited 176 German university students (23.45 ± 2.48 years; 48.3% males) with IBS-like symptoms according to Rome III and 181 students without IBS (23.55 ± 2.82 years; 50.3% males) and compared them regarding current mental strain (SCL-90-R) and the extend of chronic stress. Beyond this, IBS subtypes, IBS severity, and health care utilization were assessed. Results. Students fulfilling IBS criteria showed significantly elevated values of mental strain and chronic stress. Nearly 40% of the IBS group (versus 20% of the controls) reached a clinically relevant value on the SCL-90-R global severity scale. IBS subtypes did not differ in terms of mental distress or chronic stress. Somatization, anxiety, and the chronic stressors "work overload," "social tension," and "dissatisfaction with job" were most closely connected to IBS symptom severity. Regarding health care utilization, our results show that consulting a physician frequently was not associated significantly with elevated mental strain or chronic stress but with IBS symptom severity. Conclusion. Our data contribute additional evidence to the distinct association between psychological stress and IBS in community samples.
... Research from 2014 found that more than a third of new patient referrals to a gastroenterology clinic were diagnosed with FGID, with inflammatory bowel syndrome (IBS) being the most common [2]. IBS is associated with significant impairments in daily functioning and reduced health-related quality of life [3]. It is characterized by abdominal pain, diarrhea and/or constipation, mucus passing along with stools, and changes in stool form [4]. Since IBS falls under the FGID umbrella, its etiology is not well established yet [1]. ...
Background
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder (FGID), with different subtypes based on symptoms. Psychological stress has been found to have a significant impact on intestinal function and is associated with self-reported IBS and gastrointestinal symptoms.
Aims
This study aimed to determine the prevalence of irritable bowel syndrome (IBS) among medical students at the University of Sharjah in the United Arab Emirates and to identify potential predictors of IBS.
Methods
A cross-sectional study was conducted in 2019 at the University of Sharjah. A multistage stratified random sampling technique was employed to recruit undergraduate students from medicine, dentistry, pharmacy, and health sciences colleges. A questionnaire consisting of 27 questions was administered to 471 medical students, which incorporated both standardized tools (Perceived Stress Scale (PSS-4), Hospital Anxiety and Depression Scale (HADS), and Rome IV criteria) and custom-developed sections (demographics and food frequency questionnaire). The data collected was analyzed using descriptive and bivariate statistics. The level of significance was set at 5% (p < 0.05).
Results
The research found that a moderate prevalence (17.3%) of IBS was present among medical students at UOS, with stress, anxiety, and smoking being the most significant predictors. No significant correlation was found between the occurrence of IBS and both gender and dietary factors.
Conclusion
The study identified a moderate prevalence (17.3%) of IBS among medical students, in which stress, anxiety, and smoking were the most significant predictors. Screening programs for IBS and psychological problems are recommended, along with stress coping strategies courses and raising awareness among the general population about IBS. The study also suggests conducting similar studies among the general population in the UAE to determine the prevalence of IBS and identify potential risk factors.
... associated mental distress receive adequate psychological treatment [8,13], and symptoms often remain untreated for years or even decades [14,15]. However, in previous clinical trials, the effects of psychological treatments, including cognitive-behavioral therapy (CBT) for various forms of PSS were only small to moderate [16,17]. ...
Objective
While studies mainly provide positive evidence for the efficacy of Internet-delivered cognitive-behavioral therapy (ICBT) for various persistent somatic symptoms, it remains largely unclear for whom these interventions work or not. This exploratory analysis aimed to identify moderators for the outcome between ICBT for somatic symptom distress and a waitlist control group (WL) in a vulnerable target group of emerging adults.
Methods
Based on data from a randomized controlled trial on 156 university students with varying degrees of distressing somatic symptoms who were allocated to either an eight-week, therapist guided ICBT (iSOMA) or to the WL, we examined pretreatment demographic characteristics, health-related variables (e.g., somatic symptom duration), mental distress (e.g., depression, anxiety) and cognitive-emotional factors (emotional reactivity, somatosensory amplification) as candidate moderators of the outcome, somatic symptom distress (assessed by the Patient Health Questionnaire, PHQ-15) from pre- to posttreatment.
Results
Somatosensory amplification (assessed by the Somatosensory Amplification Scale, SSAS) moderated the outcome in favor of iSOMA (B = −0.17, SE = 0.78, p = .031), i.e., higher pretreatment somatosensory amplification was associated with better outcome in the active compared to the control intervention. No significant moderation effects were found among demographic characteristics, health-related variables, or mental distress.
Conclusion
Our findings suggest that an Internet-delivered CBT for somatic symptom distress should be preferred over no active treatment particularly in individuals with moderate to high levels of somatosensory amplification, which as a next step should be tested against further active treatments and clinical populations.
Trial registration: German Clinical Trials Register (DRKS00014375).
... Three studies found that chronic pain (mixed chronic pain, IBS and nonspecific chronic low back pain) was associated with poorer overall quality of life and several quality of life domains/subscales. 46,51,52 A fourth study found a non-significant difference for overall quality of life but it found several significant differences on a number of quality of life domains/subscale; for example, students with chronic pain had more psychological discomfort than those without chronic pain. 40 ...
Objective:
Chronic pain is a prevalent health issue among young adults; however, there is limited understanding on how it affects university students. This is the first systematic review of evidence relating to the association between chronic pain and psychological, social and academic functioning in university students. Participants: Four databases were searched for relevant published studies. Data from 18 studies including 10,069 university students, of which 2895 reported having chronic pain, were included in the synthesis. Methods: Due to heterogeneity of data and methodologies, meta-analysis was not possible; therefore, data were synthesized narratively. Results: Our findings showed that students with chronic pain have poorer psychological, social and academic functioning and quality of life, compared to students without chronic pain. Conclusions: These findings suggest that chronic pain presents a challenge in university settings. Research is urgently needed to enable an understanding of how universities can support students who experience chronic pain.
... more than one week. 40 In our study, junior doctors had a tendency towards lower levels of absenteeism, suggesting either adaptation to their symptoms or a reluctance to take time off from work. ...
Background:
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which can have a strong impact on patients' quality of life including influence on various social aspects and psychological ramifications. The aim of the study was to assess the prevalence and consequences of IBS in medical students and junior doctors in Malta.
Method:
An online survey was sent out to all medical students enrolled at University of Malta and all doctors training with the Malta Foundation Programme.
Key results:
The prevalence of IBS was 17.7% (total number =192), with 6.2% being previously diagnosed with IBS and the rest (11.5%) having symptoms consistent with IBS according to the Rome IV criteria. There was no statistically significant difference in BMI and in activity level as determined by the Godin Leisure-Time Exercise Questionnaire between IBS and non-IBS group.Absenteeism was significantly commoner in students/ doctors with IBS (47.1%) than in those without IBS (9.5%; p=0.0001). Of those previously diagnosed with IBS, 66.7% self-medicated compared to 45.4% of those diagnosed through the questionnaire. 71.6% of those in the IBS group tried dietary modification as to control their symptoms.On the Kessler 6 Distress scale, 91.2% of the IBS group had a score >6, with 44.1% having a score >13. The mean Visceral Sensitivity Index Score was 40.1 (95% CI 33.6 - 46.6).
Conclusion:
IBS is prevalent, yet under-recognized, in medical students and junior doctors. Measures should be instituted for timely, confidential detection and management of IBS and its related psychological consequences.
... При этом в исследовании, проведенном в Индии, выявлена более высокая частота генетических нарушений у мужчин по сравнению с женщинами, что пока не нашло должного объяснения [19]. Исследование, проведенное у пациентов с СРК в Германии и Великобритании, показало, что частота генетических нарушений гена 5-HTTLPR у женщин и мужчин находится в соотношении 1,3-1,5:1 [20,21]. Низкая распространенность генотипа SS у пациентов с СРК отмечена в исследовании [22], особенно при варианте с диареей, однако в данное исследование были включены только мужчины (34 -с СРК и 30 -группы контроля). ...
Motility disorders of the upper and lower gastrointestinal tract encompass a very wide range of structurally different diseases. Functional dyspepsia and irritable bowel syndrome (IBS) are the most common functional gastrointestinal disorders in clinical practice. In spite of the considerable prevalence of these functional diseases, the knowledge of their development mechanisms is very scarce. Recent investigations of the impact of the motor and sensory components of the pathogenesis of these diseases have demonstrated that the development of IBS is associated with serotonin transporter gene (5-HTTLPR) impairment and that the patients with IBS show the inadequate response to nonselective cannabinoid receptor agonists, which is caused by cannabinoid receptor gene (CNR1) polymorphism. Most investigations (mainly trials with small sample sizes) dealing with the identification of pharmacogenetic features have indicated that there is a preponderance of patients with intermediary metabolism among those with functional gastrointestinal diseases. However, larger investigations are necessary for a more exact understanding of this aspect.
... The results of most of the current systematic review studies revealed that female medical students had a higher prevalence of IBS than males (2,3,5,7,8,10,12,13,15). Similar results were obtained among nursing students from Korea (22) and university students from Germany (25). Similarly, studies among the general populations also reported strong associations between female gender and IBS (21,23,(26)(27)(28)(29). Results from an Iranian systematic review showed that more than one-half of the reviewed researchers found that IBS was significantly associated with female gender (26). ...
Background/aims:
Irritable bowel syndrome (IBS) represents a great challenge to public health, particularly among medical students. The aim of the study was to determine the global prevalence and risk factors of IBS among medical students.
Materials and methods:
Data were obtained through searches in PubMed, Ovid, the Cochrane database, Embase, Google scholar, Institute for Scientific Information (ISI) "Web of Science," and Medline from 1990 to June 2015. The search terms included "Irritable Bowel Syndrome" and "Medical students" and "prevalence, risk factors". More than 100 articles were reviewed, scrutinized, and critically appraised for the eligibility criteria, and the relevant articles were selected.
Results:
Sixteen studies were identified, and the prevalence of IBS among medical students ranged from 9.3% to 35.5%. The relatively high prevalence among medical students may be attributed to their special stressful learning environment. Some studies found that female gender, family history of IBS, psychiatric stress, anxiety, depression, infections, dietary factors, and sleep disorders were associated with IBS.
Conclusion:
A relatively high prevalence of IBS was prevalent among medical students. Annual screening of IBS and introduction of stress management courses are recommended.
... Studies of patients with other chronic pain-related conditions show that CPM efficiency is influenced by report of stress or the introduction of stress in a laboratory setting as well as psychological variables including anxiety and depression (Johannesson, de Boussard, Brodda Jansen, & Bohm-Starke, 2007;Normand et al., 2011) or the presence of other painrelated conditions (Arendt-Nielsen, Sluka, & Nie, 2008;Williams & Clauw, 2009). As a group, patients with IBS report higher levels of anxiety and depression (Goncalves de Medeiros et al., 2012;Jones, Koloski, Boyce, & Talley, 2011;Orr, Crowell, Lin, Harnish, & Chen, 1997), stress and more co-morbid conditions (Gulewitsch, Enck, Hautzinger, & Schlarb, 2011) suggesting that CPM efficiency may be reduced. In addition, several studies found that IBS patients have dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis as evidenced by either hyper or hyposecretion of cortisol or dysregulation between ACTH and cortisol levels (Chang et al., 2009;Heitkemper et al., 2012). ...
Evidence suggests that patients with irritable bowel syndrome (IBS) are more vigilant to pain-associated stimuli. The aims of this study were to compare women with IBS (n = 20) to healthy control (HC, n = 20) women on pain sensitivity, conditioned pain modulation (CPM) efficiency, and salivary cortisol levels before and after the CPM test and to examine the relationship of CPM efficiency with gastrointestinal pain, somatic pain, psychological distress symptoms, and salivary cortisol levels in each group. Women, aged 20-42 years, gave consent, completed questionnaires, and kept a symptom diary for 2 weeks. CPM efficiency was tested with a heat test stimulus and cold water condition stimulus in a laboratory between 8 and 10 a.m. on a follicular phase day. Salivary cortisol samples were collected just before and after the experimental testing. Compared to the HC group, women with IBS reported more days with gastrointestinal and somatic pain/discomfort, psychological distress, fatigue, and feeling stressed. During the CPM baseline testing, women with IBS reported greater pain sensitivity compared to the HC group. There was no significant group difference in salivary cortisol levels nor in CPM efficiency, though a post-hoc analysis showed a higher prevalence of impaired CPM efficiency among IBS subjects with more severe lower-GI symptoms. In the IBS group, reduced CPM efficiency was associated with daily abdominal pain/discomfort and psychological distress. Overall, women with IBS exhibited an increased sensitivity to thermal stimuli. Impaired CPM was present in a subset of women with IBS.
... In Korea, a cross-sectional study of 715 college students observed that 65 % of the sample experienced >1 gastrointestinal symptom, and 31 % of students reported >3 gastrointestinal symptoms over the past 3 months (Lee et al. 2011). Equally, in Germany, in a sample of 2,399 university students, the prevalence of irritable bowel syndrome-like symptoms was 18.1 % (Gulewitsch et al. 2011). A third cluster of conditions encompasses a variety of psychological and mental health issues. ...
Aim
This research assessed the relationships between perceived stress and a range of self-reported symptoms and health complaints in a representative sample of students across UK universities.
Subjects and methods
The data comprised 3,706 students and was collected between 2007 and 2008 simultaneously at seven universities in three countries of the UK: England, Wales, and Republic of Northern Ireland. A self-administered questionnaire measured health complaints (22 symptoms) and Cohen’s Perceived Stress Scale. Sociodemographic and lifestyle data were also collected. Factor analysis developed four groups of health complaints: psychological, circulatory/breathing, gastro intestinal, and pains/aches.
Results
The symptoms most often reported as having occurred sometimes/very often in the last 12 months were fatigue (61.0 %), headache (59.5 %) and difficulties to concentrate (54.4 %), while back (43.3 %) and neck/shoulder pain (39.4 %) were also frequent. Multinominal logistic regression revealed a clear association and a linear trend between increasing level of stress and a higher frequency of psychological symptoms which remained significant after adjustment for many other factors. For circulatory/breathing symptoms and for pains/aches, associations with perceived stress were only significant at higher perceived stress levels. There was no association between perceived stress and gastrointestinal symptoms. For most symptoms, poor health was consistently associated with higher frequency of symptoms across all four symptom groups. Similarly, better quality of life was associated with lower frequency of psychological and circulatory/breathing symptoms, but not for the other two symptom groups.
Conclusions
The different profiles of reported complaints and their association with perceived stress, poor health and low quality of life should give rise to tailored interventions in this young population.
... It is common in Chinese people, representing approximately 11% of outpatient cases in gastroenterology departments [1] . Patients with IBS have long-term symptoms including abdominal pain or discomfort related to defecation, accompanied by emotional disorders such as anxiety or depression, and often have a poor quality of life (QoL) [2,3] . The abdominal symptoms of IBS may be related to changes of gastrointestinal motility, visceral sensitivity and other factors [4,5] , and affected by estrogen and progesterone levels and psychological factors [6][7][8] . ...
To explore age-related changes in symptoms and quality of life (QoL) of women with irritable bowel syndrome (IBS).
Two-hundred and fifty-four female adult outpatients with IBS attending the Department of Gastroenterology at the First Affiliated Hospital of Nanjing Medical University between January, 2008 and October, 2008 were approached. Patients with a history of abdominal surgery, mental illness or those who had recently taken psychotropic drugs were excluded. A physician obtained demographic and abdominal symptom data. All patients were asked to complete the Zung Self-Rated Anxiety and Depression Scale (SDS/SAS) and the IBS-specific QoL questionnaire. The patients were divided into six groups according to age, in 10-year increments: 18-27 years, 28-37 years, 38-47 years, 48-57 years, 58-67 years and 68-75 years (maximum 75 years). Age-related differences of abdominal pain or discomfort were analyzed using rank-sum tests. Differences in SDS/SAS and IBS-QoL scores between age groups were analyzed using one-way analysis of variance. Pearson's correlations evaluated potential associations between IBS symptoms, psychological factors and QoL in each age group.
There were no differences in the distribution of IBS subtypes between age groups (χ(2) = 20.516, P = 0.153). Differences in the severity of abdominal pain/discomfort with age were statistically significant (χ(2) = 25.638, P < 0.001); patients aged 48-57 years, 58-67 years or 68-75 years had milder abdominal pain/discomfort than those in the younger age groups. The severity of anxiety or depressive symptoms did not differ between age groups (SDS, χ(2) = 390.845, P = 0.110; SAS, χ(2) = 360.071, P = 0.220). Differences of IBS-QoL scores were statistically significant between age groups (χ(2) = 1098.458, P = 0.011). The scores of patients in the 48-57-year group were lower than those in the 18-27-year and 28-37-year groups (48-57-year group vs 18-27-year group, 74.88 ± 8.76 vs 79.76 ± 8.63, P = 0.021; 48-57-year group vs 28-37-year group, 74.88 ± 8.76 vs 79.04 ± 8.32, P = 0.014). The scores in the 68-75-year group were lower than those in the 18-27-year, 28-37-year and 38-47-year groups (68-75-year group vs 18-27-year group, 71.98 ± 9.83 vs 79.76 ± 8.63, P = 0.003; 68-75-year group vs 28-37-year group, 71.98 ± 9.83 vs 79.04 ± 8.32, P = 0.002; 68-75-year group vs 38-47-year group,71.98 ± 9.83 vs 76.44 ± 8.15, P = 0.039). Anxiety and depression were negatively correlated with QoL in all age groups (SDS and QoL: 18-27-year group, r = -0.562, P = 0.005; 28-37-year group, r = -0.540, P < 0.001; 38-47-year group, r = -0.775, P < 0.001; 48-57-year group, r = -0.445, P = 0.001; 58-67-year group, r = -0.692, P < 0.001; 68-75-year group, r = -0.732, P < 0.001. SAS and QoL: 18-27-year group, r = -0.600, P = 0.002; 28-37-year group, r = -0.511, P < 0.001; 38-47-year group, r = -0.675, P < 0.001; 48-57-year group, r = -0.558, 58-67-year group, P = 0.001; r = -0.588, P < 0.001; 68-75-year group, r = -0.811, P < 0.001). A negative correlation between abdominal pain severity and QoL was found in patients aged more than 58 years (58-67-year group, r = -0.366, P = 0.017; 68-75-year group, r = -0.448, P = 0.048 ), but not in younger patients (18-27-year group, r = 0.080, P = 0.716; 28-37-year group, r = -0.063, P = 0.679; 38-47-year group, r = -0.029, P = 0.812; 48-57-year group, r = -0.022, P = 0.876).
Factors affecting QoL should always be treated in IBS, especially emotional problems in young adults. Even mild abdominal pain should be controlled in elderly patients.
Emerging adulthood is a developmental phase marked by increased vulnerability to risky behaviors, including alcohol misuse. Pathological narcissism, particularly grandiose and vulnerable traits, has been identified as a key factor influencing alcohol misuse. The role of mentalized affectivity (namely, the ability to identify, express, and process emotions) may enhance these associations, along with potential gender differences in these dynamics.
A cross-sectional study was conducted with 1,075 emerging adults (M = 24.26, SD = 2.43; 71.2% assigned female at birth), using self-reports to measure pathological narcissism, mentalization difficulties, and alcohol misuse. Hierarchical regression models were used to examine the relationships between narcissistic traits, mentalized affectivity, and alcohol misuse.
Grandiose narcissism was associated with alcohol misuse in the total sample. Narcissistic vulnerability was a stronger predictor of alcohol misuse in female individuals, while difficulties in mentalization (identifying and expressing emotions) were significant predictors of alcohol misuse in males. Grandiose narcissism did not directly predict alcohol misuse in either gender, after controlling for Narcissistic vulnerability.
Vulnerable narcissism plays a significant role in alcohol misuse, especially in female individuals, with mentalization difficulties exacerbating these behaviors, particularly in male individuals. Gender differences highlight the need for gender-specific interventions in emerging adults.
Emerging adulthood represents a critical stage characterized by heightened risks for anxiety, depression, and somatization symptoms development. Research has shown that difficulties in emotional identification, expression, and processing, as well as dysfunctional parenting styles, may exacerbate symptoms in emerging adults. The present study aimed at examining the interplay between mentalized affectivity (i.e., emotional identification, processing, and expression), helicopter parenting, and psychopathological risk in 913 Italian cisgender emerging adults (M = 24.34, SD = 2.81; 71.20% assigned female at birth), using network analysis. The results indicated moderate to strong associations between psychopathological symptoms, with emotional processing difficulties significantly associated with general anxiety, depression, and, to a lesser extent, somatization. Additionally, increased degrees of helicopter parenting from mothers were linked to increased psychopathology and higher emotional processing difficulties. These findings emphasize the importance of addressing the interconnection between symptoms and emotional processing to prevent and treat psychopathological risks in emerging adults. Moreover, interventions targeting intrusive and overprotecting parenting behaviors may promote well-being among emerging adults.
Objective
Poor sleep quality is highly prevalent in patients with chronic diarrheal symptoms or inflammatory bowel disease (IBD). This study aimed to evaluate the associations of chronic diarrheal symptoms and IBD with sleep quality in the general US population.
Methods
14,696 adults (≥20 years) from the National Health and Nutrition Examination Survey (2005–2010) were included in the study. Chronic diarrheal symptoms and IBD were defined by self-reports. Sleep quality was assessed by sleep disorder, sleep trouble, and sleep duration. Multivariable logistic regression models were used to examine the associations.
Results
After adjustment of a series of covariates, we found that participants with chronic diarrheal symptoms or IBD had higher odds of sleep disorder [chronic diarrheal symptoms: odds ratio (OR) = 1.20, 95% confidence interval (CI) = 1.04–1.38; IBD: OR = 3.86, 95% CI = 1.92–7.77] and sleep trouble (chronic diarrheal symptoms: OR = 1.19, 95% CI = 1.09–1.30; IBD: OR = 2.32, 95% CI = 1.30–4.14), respectively. Sleep duration for participants with IBD was significantly shorter than that for those without IBD (β = −0.39, 95% CI = −0.78 to 0.01, P = 0.045). Subgroup analyses revealed that the associations of chronic diarrheal symptoms and IBD with sleep disorder and sleep trouble were more pronounced among women.
Conclusions
In this large sample of US adults, we found that chronic diarrheal symptoms and IBD were significantly associated with sleep quality, particularly in women. The findings highlight the importance of managing bowel health to promote high quality of sleep; and thus, improve quality of life in this subpopulation.
Background
Irritable bowel syndrome (IBS) has become a common public health issue among university students, impairing their physical and mental health. This meta-analysis aimed to examine the pooled prevalence of IBS and its associated factors among Chinese university students.
Methods
Databases of PubMed, EMBASE, MEDLINE (via EBSCO), CINAHL (via EBSCO), Wan Fang, CNKI and Weipu (via VIP) were systematically searched from inception date to May 31, 2021. Meta-analysis was performed using random-effects models. Meta-regression and subgroup analysis were used to detect the potential source of heterogeneity.
Key Results
A total of 22 cross-sectional studies (14 were in Chinese and 8 were in English) with 33,166 Chinese university students were included. The pooled prevalence of IBS was estimated as 11.89% (95% CI = 8.06%, 16.35%). The prevalence was 10.50% (95% CI = 6.80%, 15.87%) in Rome II criteria, 12.00% (95% CI = 8.23%, 17.17%) in Rome III criteria, and 3.66% (95% CI = 2.01%, 6.60%) in Rome IV criteria. The highest prevalence of IBS was 17.66% (95% CI = 7.37%, 36.64%) in North China, and the lowest was 3.18% (95% CI = 1.28%, 7.68%) in South China. Subgroup analyses indicated that gender, major, anxiety and depression symptoms, drinking and smoking behaviors were significantly associated with the prevalence of IBS. Meta-regression analyses suggested that region influenced prevalence estimates for IBS.
Conclusions and Inferences
This meta-analysis illustrated that IBS is very common in Chinese university students. Regular screening, effective prevention, and appropriate treatments should be implemented to reduce the risk of IBS in this population. More future studies should be conducted in Northeastern and Southwestern parts of China.
Much of the adult chronic pain literature addresses pain in typical pain cohorts of middle-aged to older individuals. To date, little research has focused on chronic pain in younger adults, who likely have a completely different pain experience. This scoping review aimed to address this gap by describing the emerging adult (18–29 years) chronic pain experience regarding prevalence, associated factors, outcomes, and pain management. Searches of primary electronic databases including PubMed, Embase, PsycINFO, and CINAHL were performed on February 26, 2020, restricting the publication date from database inception to December 31, 2019. The search strategy, conducted in English, covered search term combinations of “chronic pain” and “young adults.” A total of 6,612 records were considered—3,141 after removing duplicates. These records were screened by title and abstract; 871 through full-text screening. Of these, 78 articles covered the topic of emerging adults with chronic pain. Collectively, results indicated that between 5% and 30% of emerging adults experience chronic pain, depending on the sample and exact chronic pain definition. The most consistent associated factors were female sex, familial chronic pain, and previous experiences of chronic pain in childhood. Anxiety, depression, and sleep issues appeared associated both before and after the onset of chronic pain. Outcomes of pain included interruptions to study and work, poorer physical functioning, and pain-related interference to socializing. We observed that few pain treatments have been tested specifically in this cohort. A greater ongoing focus on chronic pain in emerging adults is required to improve long-lasting outcomes.
Very little research has assessed the physical activity (PA) of university students in in Finland, and their associations with self-reported health complaints (HCs), whilst simultaneously accounting for a range of other potential confounders. Students at the University of Turku (1177) completed an online health and wellbeing questionnaire that assessed 22 physical and somatic HCs, and students' achievement of the international guidelines of four forms of PA (moderate, vigorous, moderate-to-vigorous and muscle strengthening PA; MPA, VPA, MVPA, MSPA respectively). We also explored the associations between HCs and PA, controlling for sociodemographic and health confounders (age, sex, year of study, marital status, accommodation during semesters, health awareness). Factor analysis reduced the HCs into three factors (psychological, pains/aches, circulatory/breathing). Bivariate relationships (no controlling for confounders) between these 3 factors and four forms of PA guideline achievement showed significant effects of achieving the PA guidelines against various groups of HCs, where more strenuous PA was associated with significantly less HCs in a stepladder pattern. Multiple regression analyses (controlling for confounders) showed that achievement of PA guidelines was significantly independently associated with self-reported HCs scores in most cases. Psychological HCs were negatively associated with achieving any type of PA; pains/aches were negatively associated with achieving two types of PA or with achieving MSPA guidelines; and circulatory/breathing HCs were negatively associated with achieving the VPA guidelines only. This is the first study in Finland to examine such relationships, and highlights the critical role of PA for the health of these young adults. Programs and policies to strengthen and improve the PA of university students would be beneficial, recognizing the benefits of instilling lifelong PA habits among this group of young adults.
Background/aims:
We conducted this meta-analysis to evaluate the prevalence of sleep disorder in irritable bowel syndrome (IBS) patients and study the association between IBS and sleep disorder.
Materials and methods:
A systematic search was conducted by searching PubMed, Embase, and Cochrane library databases using the following search terms: "functional gastrointestinal disorders," "Sleep disturbance," "Sleep disorder," "insomnia," "Dysomnias," "irritable bowel syndrome," and "IBS." Studies evaluating the association between IBS and sleep disorder were identified. Data analysis was conducted using meta-analysis software Comprehensive Meta-Analysis (CMA) 2.0. Heterogeneity across studies was evaluated by χ2and I2statistics. Publication bias was evaluated by funnel plot, Begg's test, and Egger's test. Sensitivity analysis was also performed by removing each single study separately.
Results:
The bibliographical search yielded a total of 2866 studies. Finally, 36 studies including 63620 participants were identified. The prevalence of sleep disorder in IBS was 37.6% (95% CI: 31.4% to 44.3%) based on this meta-analysis. The pooled odds ratio was 2.618 (95% CI: 2.052% to 3.341). Publication bias was not determined. Regarding the sensitivity analysis, the outcome was stable regardless of which study was removed.
Conclusions:
The prevalence of sleep disorder was higher in IBS compared to healthy controls and may be associated with the pathogenesis of IBS. The prevalence of sleep disorder in IBS may differ according to different areas, age, gender, occupation, and IBS diagnostic criteria. Further studies are needed to investigate any possible causal relationship between sleep disorder and IBS.
Background:
Currently, a suitable questionnaire in German language is not available to monitor the progression and evaluate the severity of irritable bowel syndrome (IBS). Therefore, this study aimed to translate the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS) into German and to evaluate its psychometric qualities and factorial structure.
Methods:
This study is based on a total sample of 372 participants [62.6% female, mean age = 41 years (SD = 17 years)]. 17.5% of the participants had a diagnosis of IBS, 19.9% were receiving treatment for chronic inflammatory bowel disease, 12.1% of the participants were recruited from a psychosomatic clinic, and 50.5% belonged to a control group. All participants completed the German version of GSRS-IBS (called Reizdarm-Fragebogen, RDF), as well as the Gießen Subjective Complaints List (GBB-24) and the Hospital Anxiety and Depression Scale - German version (HADS-D).
Results:
The internal consistency of the RDF total scale was at least satisfactory in all subsamples (Cronbach's Alpha between .77 and .92), and for all subscales (Cronbach's Alpha between .79 and .91). The item difficulties (between .25 and .73) and the item-total correlations (between .48 and .83) were equally satisfactory. Principal axis analysis revealed a four-factorial structure of the RDF items, which mainly resembled the structure of the English original. Convergent validity was established based on substantial and significant correlations with the stomach-complaint scale of the GBB-24 (r = .71; p < .01) and the anxiety (r = .42; p < .01) and depression scales (r = .43; p < .01) of the HADS-D.
Conclusion:
The German version of the GSRS-IBS RDF proves to be an effective, reliable, and valid questionnaire for the assessment of symptom severity in IBS, which can be used in clinical practice as well as in clinical studies.
Background
Sleep problems are common among university students. Poor sleep is associated with impaired daily functioning, increased risk of psychiatric symptoms, and somatic complaints such as pain. Previous results suggest that poor sleep exacerbates pain, which in turn negatively affects sleep. The purpose of the present study was to determine prevalence rates, comorbidity, and role of depression as a factor of moderating the relationship between sleep and physical complaints in German university students.
Samples and methods
In total, 2443 German university students (65% women) completed a web survey. Self-report measures included the Pittsburg Sleep Quality Index, three modules of the Patient Health Questionnaire, and a questionnaire on the functional somatic syndromes (FSSs).
Results
More than one-third (36.9%) reported poor sleep as assessed by the Pittsburgh Sleep Quality Index. Somatoform syndrome was identified in 23.5%, and the prevalence of any FSS was 12.8%. Self-reported sleep quality, sleep onset latency, sleep disturbances, use of sleep medications, and daytime dysfunctioning were significant predictors of somatoform syndrome, whereas sleep efficiency and sleep duration influenced somatic complaints indirectly. Moderate correlations were found between stress, anxiety, somatoform syndrome, depression, and overall sleep quality. The effect of somatic complaints on sleep quality was associated with the severity of depression. Anxiety shows direct effects on somatization and depression but only indirect associations with sleep quality.
Functional gastrointestinal disorders (FGIDs) are highly prevalent in the USA and worldwide among children. These conditions can be broadly divided into those found in specific age groups as well as by symptom (e.g., nausea, vomiting, diarrhea, and abdominal pain). Collectively, these conditions account for a significant percentage of general and subspecialty practitioner visits. When unrecognized and/or untreated, these conditions can lead to significant morbidity including psychological and psychosocial disability for both patients and families. Furthermore, FGIDs are increasingly being recognized among patients with organic intestinal disorders such as Inflammatory Bowel Disease (IBD) and Celiac disease and affect disease-related management and utilization of healthcare resources. The Rome Foundation has identified key diagnostic criteria for these disorders. A majority of these disorders can be diagnosed on clinical grounds based on detailed and pertinent history and physical exam. Combined assessment of symptoms, illness experience, and psychosocial factors can be utilized to develop effective individualized treatment plans.
Irritable bowel syndrome (IBS) is a commonly encountered pediatric functional gastrointestinal disorder with varying clinical presentations. Multiple mechanisms likely contribute to its development and may include visceral hypersensitivity, altered gastrointestinal microbiota, mucosal immune activation, psychological disorders and cerebral activation, and altered gastrointestinal motility. The recently refined pediatric Rome (IV) criteria are more inclusive than adult criteria with respect to duration of symptoms and aid in diagnosis while avoiding exhaustive, low-yield medical testing. Although a myriad of therapeutic options are available for the treatment of IBS including medications, dietary manipulations, and behavioral and physical therapies, convincing evidence-based pediatric data to support any particular treatment modality are sparse. An effective management strategy is often multifaceted and should be individually tailored and symptom directed. Previous studies have demonstrated a particularly high placebo rate for the treatment of IBS, suggesting that with a strong physician–patient–family relationship, patients will improve regardless of the treatment approach. Future research in IBS will continue to focus on the pathophysiology of this disorder and on the discovery of more targeted therapies. Lastly, pediatric trials investigating the safety and effectiveness of current and emerging therapies approved in adult IBS are warranted.
In choir singing, the group factor is added to other aspects of singing. Choir singing is popular in many countries. In Sweden, singing in a choir at least once a week was reported by between 3 and 4 % of the adult population in the years 1982–2006. It has been more popular among women than among men. In the oldest category (75–84), the frequency increased during those years. An experiment on patients with irritable bowel syndrome (a gastrointestinal condition influenced by psychosomatic mechanisms) who started singing in a choir once a week during a year showed improvements in the endocrine and immune systems not seen in a control group of subjects who had group meetings without singing. An experiment performed with elderly who started choir singing for 2 years showed better health development than elderly in a control group.
Irritable bowel syndrome is a functional bowel disorder with gastrointestinal symptoms (e.g. abdominal pain, straining, urgency, incomplete evacuation, nausea, and bloating) that occur alongside bowel function alterations (i.e. constipation, diarrhea, or both). Patients with irritable bowel syndrome may also experience comorbid anxiety and depression. Irritable bowel syndrome is common, with a prevalence estimated between 3% and 28%, affecting patient health and quality of life. Patients with moderate or severe irritable bowel syndrome generally seek medical care, whereas those with milder symptoms may choose self-management. Most patients with irritable bowel syndrome receive outpatient care, but irritable bowel syndrome-related hospitalizations do occur. The pathophysiology of irritable bowel syndrome is multifactorial (i.e. genetics, immune components, changes in the gut microbiota, disturbances in physiologic stress response systems, and psychosocial factors). Management of irritable bowel syndrome can include lifestyle changes, dietary interventions, counseling, psychologic medication, and agents that affect gastrointestinal motility. A number of therapies have emerged in recent years with clinical trial data demonstrating efficacy and safety for patients with irritable bowel syndrome, including agents that target gastrointestinal motility (i.e. linaclotide), gastrointestinal opioid receptors (i.e. asimadoline, eluxadoline), and gut microbiota (i.e. rifaximin). Linaclotide has been shown to significantly improve stool frequency and abdominal pain compared with placebo in constipation-predominant irritable bowel syndrome (number needed to treat, 5.1). Asimadoline shows efficacy in patients with moderate-to-severe irritable bowel syndrome-related pain. Rifaximin provided adequate relief of global irritable bowel syndrome symptoms versus placebo for a significantly greater percentage of patients with diarrhea-predominant irritable bowel syndrome (p < 0.001). Management that encompasses all aspects of irritable bowel syndrome (gastrointestinal symptoms) and comorbid psychologic symptoms (e.g. anxiety or depression) is important for improving overall patient health and well-being.
Chronic visceral pain is an unresolved neurobiological, medical and socioeconomic challenge. Up to 20 % of the adult population suffer from chronic visceral pain and abdominal complaints constitute a prevalent symptom also in children and adolescents. Existing treatment approaches are often unsuccessful and patients typically suffer from multiple somatic and psychological symptoms. This complex situation requires integrative treatment approaches. This review summarizes current basic and clinical research on acute and chronic visceral pain with a focus on research groups in Germany. Despite significant clinical and scientific advances, a number of questions remain open calling for more funding to support research to elucidate the complex pathophysiology of chronic visceral pain and to develop and test new treatment approaches. Research support should focus on interdisciplinary concepts and methodology using expertise from multiple disciplines. The field would also benefit from a broader integration of visceral pain into teaching curricula in medicine and psychology and should aim to motivate young clinicians and scientists to strive for a career within this important and highly fascinating area.
Irritable bowel syndrome (IBS) is currently one of the most common disorders of the digestive system in the Western society. Almost 2 out of 10 people suffer from IBS with women being more affected than men. IBS is associated with abdominal pain, bloating and altered stool consistency and imposes a heavy burden for the affected patients.
The pathophysiology of IBS remains elusive although potential causes have been suggested, such as a deranged brain-gut signaling, hypersensitivity of visceral sensory afferent fibers, bacterial gastroenteritis, small intestinal bacterial overgrowth (SIBO), genetic alterations and food sensitivity. Targets for the pharmacotherapy of IBS include the serotonergic and opioidergic system, and the microbial population of the gut. Alternative therapies like traditional Chinese medicine have shown some success in the combat against IBS. Key Messages: Many therapeutics for the treatment of IBS have emerged in the past; however, only a few have met up with the expectations in larger clinical trials. Additionally, the multifactorial etiology of IBS and its variety of cardinal symptoms requires an individual set of therapeutics. This review provides a short overview of potential causes and current pharmacological therapeutics and of additional and alternative therapies for IBS. © 2015 S. Karger AG, Basel.
Background The National Health Service (NHS) is faced with increasing cost pressures that make the efficient use of resources paramount. Irritable bowel syndrome (IBS) places a large burden on the NHS as it has been estimated that at least 12% of the UK population is affected. However, poor clinical coding makes accurate assessment of this burden challenging.
Objective To calculate primary-care prescribing and both hospital outpatient and admission costs associated with the management of IBS in England.
Design and main outcome measures Hospital Episode Statistics data for 2012–2013 for all clinical commissioning groups in England were analysed to calculate the tariff cost of IBS. Prescribing analysis and cost tabulation (PACT) data for this period were also analysed.
Results In 2012–2013, there were 1 219 961 outpatient attendances in gastroenterology and colorectal surgery specialties. Despite this, only 1982 patients were recorded with IBS-specific codes, with a total estimated tariff cost of £812 336. In addition, 28 849 patients were recorded with IBS-related symptom codes at a cost of £11 002 874. In 2011–2012, there were 658 698 diagnostic lower gastrointestinal endoscopies at a tariff cost of £16 967 670 4. Of these, 323 752 (49%) had no further follow-up in secondary care over the subsequent 12 months. PACT data indicated that £44 977 959 and £25 582 752, respectively, were spent on selected laxatives and antispasmodics commonly used to treat IBS in primary care.
Conclusions Better diagnosing, through improved clinical coding and standardisation of diagnostic criteria, is required to more accurately assess the true burden and allow optimal management of IBS.
Background/aims:
Recent papers have highlighted the role of diet and lifestyle habits in irritable bowel syndrome (IBS), but very few population-based studies have evaluated this association in developing countries. The aim of this study was to evaluate the association between diet and lifestyle habits and IBS.
Methods:
A food frequency and lifestyle habits questionnaire was used to record the diet and lifestyle habits of 78 IBS subjects and 79 healthy subjects. Cross-tabulation analysis and logistic regression were used to reveal any association among lifestyle habits, eating habits, food consumption frequency, and other associated conditions.
Results:
The results from logistic regression analysis indicated that IBS was associated with irregular eating (odds ratio [OR], 3.257), physical inactivity (OR, 3.588), and good quality sleep (OR, 0.132). IBS subjects ate fruit (OR, 3.082) vegetables (OR, 3.778), and legumes (OR, 2.111) and drank tea (OR, 2.221) significantly more frequently than the control subjects. After adjusting for age and sex, irregular eating (OR, 3.963), physical inactivity (OR, 6.297), eating vegetables (OR, 7.904), legumes (OR, 2.674), drinking tea (OR, 3.421) and good quality sleep (OR, 0.054) were independent predictors of IBS.
Conclusions:
This study reveals a possible association between diet and lifestyle habits and IBS.
Unlabelled:
Widespread hyperalgesia is well documented among adult patients with irritable bowel syndrome (IBS), but little is known about pain sensitivity among adolescents with IBS. We examined pain sensitivity in 961 adolescents from the general population (mean age 16.1 years), including pain threshold and tolerance measurements of heat (forearm) and pressure pain (fingernail and shoulder) and cold pressor tolerance (hand). Adolescents with IBS symptoms (Rome III criteria) had lower heat pain thresholds compared to controls after adjustments for sex, comorbid pain, and psychological distress (mean difference = -.8 °C; 95% confidence interval [CI] = -1.6 to -.04). Similar results were found for pressure pain threshold at the shoulder (mean difference = -46 kPa; 95% CI = -78 to -13) and fingernail (mean difference = -62 kPa; 95% CI = -109 to -15), and for an aggregate of all 3 threshold measures (z-score difference = -.4; 95% CI = -.6 to -.2), though pressure pain threshold differences were nonsignificant after the final adjustments for psychological distress. No difference of pain tolerance was found between the IBS cases and controls. Our results indicate that adolescents in the general population with IBS symptoms, like adults, have widespread hyperalgesia.
Perspective:
This is the first report of widespread hyperalgesia among adolescents with IBS symptoms in the general population, with lower pain thresholds found to be independent of sex and comorbid pain. Our results suggest that central pain sensitization mechanisms in IBS may contribute to triggering and maintaining chronic pain symptoms.
Hintergrund
Funktionelle Bauchschmerzen gehören zu den häufigsten Schmerzsyndromen im Kindesalter und gehen mit erheblichen Alltagsbeeinträchtigungen bzw. einer ungünstigen Langzeitprognose einher. Psychotherapeutische Behandlungsansätze sind vielversprechend, allerdings im deutschsprachigen Raum nur wenig verbreitet. Das Konzept und die Akzeptanz eines multimodalen Kurzzeitinterventionsprogramms werden beschrieben und eine erste Untersuchung der Wirksamkeit durchgeführt.
Material und Methoden
An der hypnotherapeutisch-behavioralen Kurzintervention „Sonne im Bauch“ nahmen 21 Kinder zwischen 6 und 12 Jahren und deren Eltern teil. Erste Ergebnisse zur Wirksamkeit (Katamnese bis 3 Monate) werden berichtet.
Ergebnisse
Teilnehmende Kinder zeigten einen Rückgang der Schmerzhäufigkeit und Alltagsbeeinträchtigung bzw. eine Zunahme gesundheitsbezogener Lebensqualität. Mit den Schmerzen einhergehende psychische Auffälligkeiten konnten reduziert werden. Inhalte und Rahmenbedingungen wurden von Kindern und Eltern als hilfreich und sinnvoll beschrieben.
Schlussfolgerung
Vorläufige Ergebnisse weisen darauf hin, dass bereits kurze psychotherapeutische Interventionen helfen könnten, betroffene Kinder effektiv zu unterstützen und ihre Eltern zu entlasten. Weitere Untersuchungen im Kontrollgruppendesign an stärker belasteten Kindern sollten folgen, um aussagekräftige Schlussfolgerungen ziehen zu können.
Background:
Chronic diarrhea and functional abdominal pain (FAP) in childhood could be an early manifestation of adult irritable bowel syndrome (IBS). The aim of this study was to investigate the presence of chronic functional digestive symptoms in childhood, interviewing adult patients diagnosed with IBS, in an attempt to establish a relationship between them.
Methods:
By means of a questionnaire, the history of colic, chronic diarrhea, functional abdominal pain, constipation and migraine in childhood, was analyzed in patients diagnosed with IBS according to the current Rome III criteria, and in control patients without known chronic digestive disorders. Fisher's exact test was used for comparison of frequencies.
Results:
The IBS study group was made up of 40 patients (24 women; average age, 33.03 years), and the control group by 40 adults (22 women; average age, 29.62 years). IBS-diagnosed adults spoke about a significantly higher prevalence of chronic diarrhea (32.5/7.5%; odds ratio [OR], 7.01; 95% confidence interval [CI]: 26.84-1.80), and FAP (37.5/15%; OR, 4.30; 95%CI: 12.67-1.43) in their childhood, than the control group. There were no differences in the presence of other childhood functional symptoms. Interestingly, the present patients, when asked about the onset of symptoms that led to the diagnosis of IBS, referred to them mostly beginning in adulthood, not linking their current diagnosis of IBS with their background in childhood.
Conclusions:
In a proportion of adults with IBS the natural history of their symptoms probably began during their childhood.
Unlabelled:
Functional abdominal pain and irritable bowel syndrome are two prevalent disorders in childhood which are associated with recurrent or chronic abdominal pain, disabilities in daily functioning, and reduced quality of life. This study aimed to evaluate a brief hypnotherapeutic-behavioral intervention program in a prospective randomized controlled design. Thirty-eight children, 6 to 12 years of age, and their parents were randomly assigned to a standardized hypnotherapeutic-behavioral treatment (n = 20) or to a waiting list condition (n = 18). Both groups were reassessed 3 months after beginning. Primary outcome variables were child-completed pain measures and pain-related disability. Secondary outcome variables were parent-completed measures of their children's pain and pain-related disability. Health-related quality of life from both perspectives also served as a secondary outcome. In the treatment group, 11 of 20 children (55.0%) showed clinical remission (>80% improvement), whereas only one child (5.6%) in the waiting list condition was classified as responder. Children in the treatment group reported a significantly greater reduction of pain scores and pain-related disability than children of the waiting list condition. Parental ratings also showed a greater reduction of children's abdominal pain and pain-related disability. Health-related quality of life did not increase significantly.
Conclusions:
Hypnotherapeutic and behavioral interventions are effective in treating children with long-standing AP. Treatment success of this brief program should be further evaluated against active interventions with a longer follow-up.
The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominal pain, and also summarizes the primary related findings from the authors' research program. Specific areas discussed based on work within the authors' group include familial illness patterns, genetics, traits, and mechanisms or processes related to abdominal pain. Topics covered from research published in the past five years include prevalence and cost, longitudinal follow-up, overlap with other disorders, etiology and mechanisms behind functional abdominal pain and treatment studies. It is hoped that findings from this work in abdominal pain will be interpreted as a framework for understanding the processes by which other pain phenomena and, more broadly, reactions to any physical state, can be developed and maintained in children. The present article concludes with recommendations for clinical practice and research.
Background:
Although at least 20 different functional somatic syndromes (FSS) have been described, and overlaps between individual FSS and a high comorbidity with depressive and anxiety disorders have been suggested, barely any studies have examined a broad array of FSS within one study. Moreover, information on psychosocial risk factors gained from prospective studies is scarce.
Purpose:
This study aimed to determine prevalence rates, overlap, and comorbidity in 17 FSS and to estimate the influence of psychosocial risk factors on the development of FSS.
Methods:
In total, 3,054 students (73.4 % women) completed a Web survey containing questions on FSS, comorbidity, and psychosocial risk factors at baseline. Of these, 429 completed the survey again 6 months later.
Results:
The prevalence of any FSS was 9.5 %, with 227 (78.6 %) subjects fulfilling criteria for only one FSS, 49 (17.0 %) reporting two, and 12 (4.2 %) reporting three syndromes simultaneously. Only one person suffered from four FSS at the same time. "Major depressive syndrome" (15.6 %), "panic syndrome" (4.8 %), and "other anxiety syndromes" (19.7 %) frequently occurred among persons with FSS. Significant predictors of FSS were number of somatic symptoms (OR = 1.15), impairment in daily activities (OR = 3.17), depression (OR = 1.13), and somatization (OR = 1.15).
Conclusions:
Our findings indicate that FSS are common in nonclinical samples. The frequency of overlap and comorbidity in FSS was lower compared with previous research. A consideration of psychosocial risk factors is warranted in the prevention and management of FSS.
The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011.
The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies.
The diagnosis FMS in children and adolescents is not established. In so-called juvenile FMS (JFMS) multidimensional diagnostics with validated measures should be performed. Multimodal therapy is warranted. In the case of severe pain-related disability, therapy should be primarily performed on an inpatient basis. The English full-text version of this article is available at SpringerLink (under "Supplemental").
Recurrent abdominal pain is one of the most frequent pain syndromes in childhood and is accompanied by notable functional impairment and unfavourable long-term outcome. Psychotherapeutic approaches are promising, but not widely used in Germany. The concept of a multimodal short-term intervention and its acceptance are described and preliminary results are reported.
A total of 21 children aged 6-12 years and their parents participated in a hypnotherapeutic-behavioural short intervention program. Preliminary results on efficacy up to 3 months are reported.
Participating children showed a decrease in pain frequency and daily impairment. Health-related quality of life also increased and associated mental problems could be reduced. Content and conditions of the intervention were rated as helpful by children and parents.
Preliminary results indicate that even short psychotherapeutic interventions might help affected children effectively and lower the burden felt by parents. Further investigations using a randomized controlled trial design and focussing on children suffering more severely should follow to allow major conclusions.
To investigate the relationship between gender and symptomatology, psychological factors, and quality of life (QOL) in irritable bowel syndrome (IBS).
The diagnosis of IBS was made on the basis of the Rome III Criteria. A physician obtained demographic and symptom data, Zung Self-Rated Anxiety and Depression Scale scores (SAS/SDS), and IBS-specific quality-of-life ratings (IBS-QOL).
Of the 4015 patients approached, 452 patients were diagnosed with IBS. Age ranged from 14 to 79 years (44.05 ± 14.89 years) and the male to female ratio was 1 : 1.3. The gender composition between the four IBS subtypes differed significantly (P<0.01). Male and female patients differed in their rating of abdominal pain/discomfort in terms of severity and time (P<0.01). Groups did not differ with regard to attack frequency. Female patients more frequently reported headache, dizziness, backache, muscular soreness, inappetence, insomnia, and fatigue (P<0.01). In comparison with men, anxiety and depression scores were significantly higher in women (P<0.01). Severity, duration, and frequency of abdominal pain/discomfort did not correlate with IBS-QOL scores. Insomnia/fatigue was negatively correlated with IBS-QOL scores (P<0.01). SAS and SDS scores were negatively correlated with IBS-QOL (total score and each subscale; P<0.01).
There are significant gender differences in the symptoms, psychological rating, and QOL scores in IBS. Somatic symptoms, anxiety, and depression all contribute to the negative impact of IBS. Our findings suggest that gender differences should be recognized in IBS treatment.
Care of patients with functional gastrointestinal disorders (FGIDs) commonly includes offering guidance on diet, exercise, and other lifestyle factors, but there is little information available on the actual lifestyles of FGID sufferers.
An internet questionnaire survey of 15,000 adult members of the general public in Japan who were screened for functional dyspepsia (FD) and irritable bowel syndrome (IBS) using the Rome III adult FGID questionnaire was conducted.
The prevalence of FD and IBS was 6.5% and 14.0%, respectively, and 3.0% of the subjects met the criteria for both FD and IBS. The prevalence of both FD and IBS was higher in women than in men. The lifestyles of 2,547 subjects who met the Rome III criteria for FD, IBS, or both were compared with the lifestyles of 1,000 control subjects who did not meet the criteria for FD or the criteria for IBS. Compared to the control subjects, a significantly lower percentage of subjects with FD, IBS, or both exercised frequently, and a significantly higher percentage thought that their sleep was insufficient, ate meals irregularly, did not have an appetite, did not like meat, thought that their vegetable consumption was insufficient, felt stress in their daily lives, and regarded themselves as being highly susceptible to stress.
Persons with FGIDs are affected by impairment of sleep, eating habits, diet, exercise and other lifestyle factors, and feel excessive stress. This suggests that offering lifestyle guidance to FGID patients may be useful.
The objectives of this review are twofold. Our first objective is to evaluate the evidence supporting a role for genetics in irritable bowel syndrome (IBS). Specific examples of the associations of genetic variation and symptoms, syndromes, and intermediate phenotypes, including neurotransmitter (serotonergic, α(2)-adrenergic, and cannabinoid) mechanisms, inflammatory pathways (IL-10, TNFα, GNβ3, and susceptibility loci involved in Crohn's disease), and bile acid metabolism, are explored. The second objective is to review pharmacogenetics in IBS, with the focus on cytochrome P-450 metabolism of drugs used in IBS, modulation of motor and sensory responses to serotonergic agents based on the 5-hydroxytryptamine (5-HT) transporter-linked polymorphic region (5-HTTLPR) and 5-HT(3) genetic variants, responses to a nonselective cannabinoid agonist (dronabinol) based on cannabinoid receptor (CNR1) and fatty acid amide hydrolase (FAAH) variation, and responses to a bile acid (sodium chenodeoxycholate) and bile acid binding (colesevelam) based on klothoβ (KLB) and fibroblast growth factor receptor 4 (FGFR4) variation. Overall, there is limited evidence of a genetic association with IBS; the most frequently studied association is with 5-HTTLPR, and the most replicated association is with TNF superfamily member 15. Most of the pharmacogenetic associations are reported with intermediate phenotypes in relatively small trials, and confirmation in large clinical trials using validated clinical end points is still required. No published genome-wide association studies in functional gastrointestinal or motility disorders have been published.
Psychological Symptoms in Female University Students in East and West Germany: A Replication after 10 YearsBackground: After the German unification, several studies have focused on differences in the psychological health of people in East and West Germany. The current study is a replication of the Basten et al. study [Psychological wellbeing and health in a unified Germany: An East-West-comparison of two student samples. Verhaltenstherapie 1994;4:90–95] 10 years after the original research of 1991/1992. It investigated differences in depression, anxiety and bodily symptoms as well as problematic eating behaviour in female university students in Dresden (East Germany) and Marburg (West Germany). Subjects and Methods: From October 2001 to April 2002, we investigated psychological symptoms and eating behaviour in students of the universities of Dresden and Marburg. The current report includes data of 221 female students. We used the same standardized measures as had been used in the original research. Results: In contrast to the original study, students from West Germany did no longer exhibit higher depression scores. Instead, students from East Germany showed significantly increased anxiety symptoms. Furthermore, there was a trend towards a higher drive for thinness in East German students. In all, students from Dresden showed higher mean values in all measures than 10 years before. Discussion: This study corroborates results that there are only minor differences in psychological health between people in East and West Germany. However, our findings point out that during the past decade subtle changes might have occurred which have not been detected through lack of longitudinal investigations. The higher level of anxiety in East German students could be a result of socialisation.
Background Psychological distress among students is receiving growing attention in the scientific community as well as in the general public. There are counseling services available in student societies and universities which address psychological distress among students but scientific research in this area is rudimentary and poorly represented. Problem in question In order to present the prevalence, extent and type of psychological disorders in students and the alterations over time, an investigation was carried out to show which psychological complaints and disorders were present in students who consulted a psychotherapeutic counseling center. These data were compared with the psychological complaints of a student field study population. Furthermore, alterations in the psychological complaints and disorders of students over periods of 10 and 15 years will be presented. Methods The prevalence and change over time of psychological syndromes in students were identified by a comparison between an unselected sample of counseling center clients and several student field samples from the previous 15 years. The type of distress and severity of symptoms were measured with a Symptom Checklist (SCL-90-R), the Psychosocial Complaints List (PSB), the Satisfaction With Life And Studies Scale (LSZ), the diagnostic assessment according to International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), the Complaints Severity Score (BSS) and Global Assessment of Functioning (GAF). Results Previous results of investigations which showed that 20–25% of students suffer from psychological disorders could be confirmed in this study. However, 60–65% of the c l i e n t
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Background
Psychological distress among students is receiving growing attention in the scientific community as well as in the general public. There are counseling services available in student societies and universities which address psychological distress among students but scientific research in this area is rudimentary and poorly represented.
Problem in question
In order to present the prevalence, extent and type of psychological disorders in students and the alterations over time, an investigation was carried out to show which psychological complaints and disorders were present in students who consulted a psychotherapeutic counseling center. These data were compared with the psychological complaints of a student field study population. Furthermore, alterations in the psychological complaints and disorders of students over periods of 10 and 15 years will be presented.
Methods
The prevalence and change over time of psychological syndromes in students were identified by a comparison between an unselected sample of counseling center clients and several student field samples from the previous 15 years. The type of distress and severity of symptoms were measured with a Symptom Checklist (SCL-90-R), the Psychosocial Complaints List (PSB), the Satisfaction With Life And Studies Scale (LSZ), the diagnostic assessment according to International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), the Complaints Severity Score (BSS) and Global Assessment of Functioning (GAF).
Results
Previous results of investigations which showed that 20–25% of students suffer from psychological disorders could be confirmed in this study. However, 60–65% of the clients of a counseling center suffered from clinically relevant psychological disorders, which is significantly higher. The most common disorders were depressive moods, lack of self-confidence and exam anxiety, which can mostly be diagnostically assigned to adjustment, depression and anxiety disorders. The comparison with previous studies showed that the types and severity of psychological distress among students have remained stable over the last 15 years, with the exception of test anxiety which increased by 51% from 1993 to 2008. With respect to alcohol abuse, considerably less impairments were found than had been assumed based on the earlier investigations.
Conclusions
Psychological complaints and disorders are frequently found among students and they cause individual suffering as well as economic expenses. Noticeable was the obvious increase in clinically relevant exam anxiety. Psychological-psychotherapeutic counseling centers make an important contribution to screening, clinical assessment, primary health care and prevention of severe mental disorders among students and have shown a continuously increasing number of cases in recent years. Further studies especially in a process-outcome design of the mostly eclectic counseling centers are needed and possibilities will be presented.
It is hypothesized that adults who can recall abdominal pain as children are at risk of experiencing a functional gastrointestinal disorder (FGID), but this is not specific to any particular FGID. The aim of this study was to evaluate the association between recollecting abdominal pain as a child and experiencing a FGID.
A valid self-reported questionnaire of GI symptoms was mailed to a random population-based sample in Olmsted County, Minnesota. Logistic regression models adjusting for age, gender, body mass index (BMI), somatization, and other factors were used to estimate the odds ratios (ORs) for having a FGID in individuals recalling bouts of stomach or abdominal pain in childhood (before age 15).
Overall, 2298 (55%) of a total of 4194 eligible adult subjects returned a completed questionnaire. Of the respondents, 213 (9%) recalled experiencing abdominal pain as children. Adults who recalled experiencing abdominal pain in childhood had greater odds for reporting symptoms of a FGID (OR 1.9; 95% CI 1.4-2.7). Recalling abdominal pain in childhood was significantly associated with irritable bowel syndrome (IBS) (OR 2.5; 95% CI 1.7-3.6) but not gastroesophageal reflux, dyspepsia, constipation, or diarrhea, adjusting for age, gender, BMI, somatic symptoms, marital status, and education.
Recollection of childhood abdominal pain is specifically associated with IBS in adults. This suggests that a proportion of adults with IBS may have onset of symptoms of abdominal pain during childhood.
To assess symptoms of irritable bowel syndrome (IBS) in patients with recurrent abdominal pain (RAP) 5 years after their initial evaluation, to identify the relation of IBS symptoms to functional disability and health service use, and to determine the extent to which IBS symptoms are associated with life stress and poor psychosocial adjustment.
Patients with RAP (n = 76) and control subjects (n = 49) completed a telephone interview; measures included the Bowel Disease Questionnaire, the Functional Disability Inventory, the Life Events Questionnaire, the Family Inventory of Life Events, the Center for Epidemiological Studies Depression Scale, the Self-Perception Profile for Adolescents, and the Health Resources Inventory.
Five years after the initial evaluation, patients with RAP reported significantly more episodes of abdominal pain than did control subjects, as well as significantly higher levels of functional disability, school absence, and clinic visits for abdominal distress. Female patients with RAP were more likely than female control subjects to meet the Manning criteria for IBS. Among patients with RAP, higher levels of IBS symptoms were associated with significantly greater functional disability, more clinic visits, more life stress, higher levels of depression, and lower academic and social competence.
Female patients with a history of RAP may be at increased risk of IBS during adolescence and young adulthood. Among adolescents and young adults with a history of RAP, IBS symptoms are likely to be associated with high levels of disability and health service use.
To determine whether medically unexplained recurrent abdominal pain (RAP) in childhood predicts abdominal pain, irritable bowel syndrome (IBS), other somatic complaints, and psychiatric symptoms and disorders in young adulthood.
A sample of 28 young adults evaluated for RAP between the ages of 6 and 17 years were compared with 28 individually matched former childhood participants in a study of tonsillectomy and adenoidectomy. RAP caseness was established by structured retrospective chart review requiring agreement by 2 independent reviewers. Standardized assessments of abdominal pain, IBS, other somatic symptoms, psychopathology, perceived health, and history of maltreatment were performed an average of 11.1 years after the index visit.
Former RAP patients were significantly more likely than controls to endorse anxiety symptoms and disorders, hypochondriacal beliefs, greater perceived susceptibility to physical impairment, poorer social functioning, current treatment with psychoactive medication, and generalized anxiety in first degree relatives. There were trends suggesting associations between childhood RAP and lifetime psychiatric disorder, depression, migraine, and family history of depression, but group differences on abdominal pain, IBS, other somatic symptoms, and history of maltreatment were not statistically significant.
There is a strong and relatively specific association between childhood RAP and anxiety in young adulthood. Affected children may be at special risk to perceive physical symptoms as threatening, and should be evaluated for psychiatric disorder on initial presentation.
This study was carried out to investigate the presence of irritable bowel syndrome (IBS) in college students and compare its distribution in the non-medical college and medical college students.
We collected data from 508 students by inviting them to fill out a questionnaire based on Rome II criteria for the diagnosis of IBS from November 2001 to February 2004. Two major cities Karachi and Bahawalpur were selected and it was coordinated by the section of Gastroenterology, Department of Medicine, Aga Khan University Hospital and Quaide-Azam Medical College, Bahawalpur.
A total of 508 subjects with males 43% (220/508) and female 57 % (288/508) mean age 22 +/- 2.8 years responded to the questionnaire. The overall frequency of IBS among college students was 34% (171/508). There were 41% (107/263) non-medical college and 26 % (64/245) medical college students with IBS. Abdominal pain was present in 100% (171/171) with altered frequency of stool in 58% (100/171) (p< 0.001, OR 12.5, CI 7.9-20.0) of students with IBS. The medical advice was sought by 38% (65/171) in IBS group with 46% (30/65) non-medical college school and 54 % (35/65) medical student (p=0.001, OR 1.9, CI 1.3-2.8).
IBS is common in younger adult population of Pakistan. Its prevalence is higher in non-medical college students but health care seeking behavior was more common in medical students.
Background:
Students are an important part of the general population of Germany, but only limited information exists about the prevalence of common psychological syndromes among them.
Objective:
To provide prevalence rates for various psychological syndromes (affective, anxiety, somotoform, eating disorders, and alcohol associated problems) among German university students.
Methods:
A campus-wide survey including N = 1130 students at the University of Mannheim was conducted. Established assessment instruments were employed for this purpose: the German version of the Patient Health Questionnaire (PHQ), the German Version of the Whiteley-Index (WI), and the Chemical Odor Sensitivity Scale (COSS) to screen for idiopathic environmental intolerance (IEI).
Results:
PHQ criteria for at least one psychological disorder (apart from the alcohol abuse/dependence syndrome) were met by 22.7% of the students, more frequently by women than men (OR = 1.8). The alcohol syndrome (30.2%) was most frequent and the only syndrome which was more frequent in men than in women. The next frequent syndrome was the somatoform syndrome (9.1%), followed by other depressive syndromes (8.1 %), IEI (7.2%), major depression (6.0%) and hypochondriasis (4.2%). The presence of hypochondriasis increased greatly the risk for co-morbid disorders. All syndromes--with the exception of the alcohol syndrome and the binge eating disorder--were accompanied by functional impairments.
Conclusions:
We consider these results rather alarming, as they indicate a considerable need for both preventive and curative interventions in German students. However, further epidemiological studies are needed to prove the generalizability of our findings and to examine functional interrelations among and the course of these psychological syndromes.
Objective
Relationships between presence of irritable bowel syndrome (IBS) and generalized anxiety disorder (GAD), chronic worry, neuroticism, anxiety sensitivity and anxiety about visceral sensations were examined among university students.
Research on irritable bowel syndrome (IBS), a functional disorder of the gastrointestinal (GI) system, has linked GI symptoms to stress. This study examined the relationship between daily stress and GI symptoms across women and within woman in IBS patients (n = 26), IBS nonpatients (IBS-NP; n = 23), and controls (n = 26), controlling for menstrual cycle phase. Women (ages 20–45) completed daily health diaries for two cycles in which they monitored daily GI symptoms and stress levels. The Life Event Survey (LES) was used as a retrospective measure of self-reported stress. The across-women analyses showed higher mean GI symptoms and stress in the IBS and IBS-NP groups relative to controls but no group differences in LES scores. The within-woman analyses found a significant and positive relationship between daily stress and daily symptoms in both the IBS-NP and the IBS groups. Controlling for menstrual cycle had no substantial impact on the results.
In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0–100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.
To estimate the prevalence of irritable bowel syndrome (IBS) in college and university students of North China and certain related factors for IBS.
A total of 2500 students from Shandong University in North China were asked in February-March 2009 to complete questionnaires, including the Rome III questionnaire, hospital anxiety and depression scale, and IBS-quality of life questionnaire (IBS-QOL).
Among the 2126 students with complete data, the prevalence of IBS was 7.85% according to the Rome III criteria, with a female/male ratio of 1.78:1. Most students had the IBS-constipation subtype (36.5%), followed by IBS-diarrhea subtype (31.1%) and IBS-mixed subtype (23.9%). The students with IBS had a higher anxiety and depression score than those without IBS. Low exercise level and anxiety indicated a high risk for IBS. The mean score of IBS patients was 74.2 +/- 4.242 on the IBS-QOL.
The prevalence of IBS is 7.85% in Chinese college and university students according to the Rome III criteria. Low exercise level and anxiety may be the risk factors for IBS.
The implications of the Rome III recommendations to change the irritable bowel syndrome (IBS) subtype criteria for stool pattern are unknown.
(1) Determine the level of agreement between Rome II and Rome III subtypes and (2) compare the behaviors of Rome II and Rome III subtypes over time.
Female patients (n=148) with Rome II defined IBS were prospectively tracked over 5 consecutive 3-month periods. At baseline, bowel habit reports on questionnaires were used to subclassify patients into Rome II and Rome III subtypes. Over the subsequent 15 months, bowel habit reports on diary cards were used to subclassify patients based on previously derived surrogate criteria into Rome II and Rome III IBS subtypes.
The level of agreement between Rome II and Rome III subtype assignments was quite high (86.5%; kappa 0.79). The behavior of Rome II and Rome III subtypes over time was also similar in terms of subtype prevalence, subtype stability, and the proportion of subjects who met criteria for alternating irritable bowel syndrome.
Rome II and Rome III IBS subtypes are in high agreement and behave similarly over time. Therefore, studies that used Rome II subtype criteria and studies that will use Rome III criteria will define comparable populations.
Because the prevalence of the irritable bowel syndrome (IBS) in the general population is unknown, a questionnaire of intestinal symptoms was administered to a stratified random sample of 1058 women and 838 men. Subjects were asked if they had consulted a physician about such symptoms. One or more symptoms occurred frequently in 47% of women and 27% of men. Diagnosable IBS, defined as three or more symptoms, was present in 13% of women and 5% of men. Abdominal pain was the most common symptom, and recurrent intestinal pain was reported by 20% of women and 10% of men. All symptoms were more common in women except runny or watery stools. Most symptoms including pain were unrelated to age. Only half the people with diagnosable IBS had consulted a physician about it. The likelihood of consulting a physician was directly proportional to the number of symptoms and was similar in men and women after controlling for the number of symptoms. Of individual symptoms, the one most strongly associated with consulting was abdominal pain, especially in men. It is concluded that IBS is prevalent at all ages, especially in women, that it is nearly always painful, and that people with multiple symptoms are more likely to consult a physician.
United States estimates of the frequency of visits to physicians and patterns of medical care for the diagnosis of the irritable bowel syndrome were derived from the 1975, 1980-1981, and 1985 National Ambulatory Medical Care Surveys. These surveys of office-based physicians allow national estimates of various aspects of ambulatory care. The overall rate of visits with the diagnosis of irritable bowel syndrome in 1980-1981 and 1985 were 10.6 per thousand U.S. population. Women had 2.4 times the rate of visits by men and rates rose in both sexes until middle-age. Irritable bowel syndrome was the leading digestive disease diagnosis among gastroenterologists but only the seventh leading diagnosis among all physicians. Gastrointestinal symptoms, association with mental disorders, prescriptions, and disposition were also examined in patients with visits for irritable bowel syndrome. Among records with digestive tract symptoms and a first listed diagnosis of irritable bowel syndrome, stomach or abdominal pain was listed on only about one half of records and disorders of bowel function were listed on fewer than 40%. In 1975 and 1985, irritable bowel syndrome was noted approximately twice as often as other digestive diseases at visits with mental disorder symptoms and diagnosis, although mental disorder symptoms and diagnoses were noted at fewer than 15% of visits with irritable bowel syndrome. Medications were prescribed at approximately 75% of visits for irritable bowel syndrome; the most common were gastrointestinal medications followed by combination gastrointestinal-psychoactive medications. Subsequent appointments were scheduled following at least 50% of the visits of patients with irritable bowel syndrome.
The clinical relevance of subdividing the irritable bowel syndrome (IBS) into subgroups based on bowel habit is largely unknown. We therefore obtained an age- and sex-stratified random sample of Olmsted County, Minnesota, residents aged 20-95 years. All subjects were mailed a valid self-report questionnaire during the years 1988-1993; the response rate was 74% (n = 3,022). Among subjects with IBS (n = 536), four symptom-based subgroups of similar size were identified: constipation predominant, diarrhea predominant, alternating constipation and diarrhea, and neither. The prevalence of IBS was significantly greater in females, primarily because of a higher prevalence of constipation-predominant IBS in women. Of persons > or = 60 years of age, 23% reported the initial onset of IBS in the previous year compared with 10% in younger subjects; the age at onset of IBS was similar among the subgroups. Marital status, education level, smoking, and alcohol use were not significantly different among the subgroups. Of those with IBS, 25% reported visiting a physician for abdominal pain or disturbed defecation in the prior year compared with only 8% of persons without IBS. Female sex, an increased number of Manning's symptom criteria, and the individual IBS subgroups were not associated with higher rates of physician visits. We conclude that the onset of IBS may not be limited to early adulthood and that subgroups of IBS based on bowel patterns may not identify clinically distinct entities.
Standardized assessment of health status by diagnosis (functional vs. organic) and the relative influence of abuse history on health status have not been studied previously. The aim of this study was to estimate the health status and abuse history for gastrointestinal diagnoses among patients seen in a tertiary-care gastroenterology clinic and to evaluate the relative predictive effects of diagnosis and abuse history on health status.
Standardized measures of sexual and physical abuse history and six health status measures were estimated for the patients by diagnosis. Analysis of covariance was performed to determine the relative contributions of diagnosis type and abuse history on the health status measures.
Patients with functional gastrointestinal diagnoses had poorer health status and a higher frequency of severe types of abuse than patients with structural diagnoses. Independent of abuse history, functional diagnosis was significantly associated with greater pain severity and psychological distress and poorer daily function. Independent of diagnosis, abuse history significantly contributed to greater pain severity, more days in bed, more psychological distress, and poorer daily function.
The type of diagnosis and abuse history independently contributed to the health status of this population. Therefore, medical symptoms alone may not be sufficient to understand patients' health status. Attention must also be paid to contributing psychosocial factors.
Synopsis
We compared 71 patients with irritable bowel syndrome (IBS) and 40 patients with inflammatory bowel disease (IBD) using structured interviews for psychiatric, gastrointestinal and sexual/physical victimization histories, as well as self-reported measures of personality, functional disability and dissociation. IBS patients had significantly higher lifetime prevalence rates of major depression, current panic disorder, and childhood sexual abuse. Despite the absence of organic pathology, IBS patients had significantly higher numbers of medically unexplained physical symptoms and disability ratings equal to, or greater than, those of patients with severe organic gastrointestinal disease.
Dyspepsia and irritable bowel syndrome (IBS) share aetiopathogenic factors, and may therefore be part of a single disorder. This study was intended to determine their prevalence in the general population, and the degree of overlap between these two digestive disorders.
Descriptive study.
A sample of 264 subjects chosen randomly from the population census of a city in Spain, and considered representative of the general population in this city, was surveyed by questionnaire.
The prevalence of dyspepsia was 23.9%, and that of IBS was 13.6%. Of the subjects with dyspepsia, 31.6% had IBS, and of the subjects with IBS, 55.6% reported symptoms of dyspepsia. The prevalence of IBS was higher among subjects with dyspepsia (31.7%) than among those who reported no symptoms of dyspepsia (7.9%; P < 0.05). Moreover, the prevalence of IBS was similar in three subgroups identified according to the type of dyspepsia described (ulcer-like, reflux-like or dysmotility-like). When we compared subjects with both dyspepsia and IBS and those with dyspepsia alone, we found no significant differences in clinical characteristics except for abdominal pain and fear of cancer, which were more frequent in the former. Of the entire sample, 27.7% of the subjects sought medical attention for IBS and 17% missed work because of IBS.
Our findings suggest that functional dyspepsia and IBS are two manifestations of a single, more extensive digestive system disorder.
Irritable bowel syndrome (IBS) is commonly thought to be associated with psychologic distress. However, in some studies only persons who had sought medical care for IBS (IBS patients) showed an increased frequency of psychiatric symptoms, and nonpatients did not differ significantly from normal subjects. Our aims were 1) to estimate the prevalence of IBS in the population aged 18-45 years, 2) to find the proportion seeking medical care for IBS, and 3) to compare IBS subjects with normals, and IBS patients with IBS nonpatients with regard to mental health.
Questionnaires on IBS symptoms and the General Health Questionnaire (GHQ) were mailed to 5000 randomly sampled persons aged 18-45 years. The response rate was 58%.
IBS was found in 7.4% of the men and 13.3% of the women. Those who had sought medical attention had more severe symptoms. The Likert mean score on the GHQ was 4.7 (95% confidence interval, 4.4-5.0) points higher for the IBS group than for normals (P < 0.001). There was no difference in GHQ scores between IBS patients and nonpatients.
The results indicate that IBS per se is associated with more psychiatric distress, regardless of medical care-seeking. Seeking medical care is associated with more severe IBS symptoms.
Few data are available to evaluate health-related quality of life (HRQOL) of people with irritable bowel syndrome (IBS). We evaluated and compared the impact of IBS on HRQOL using previously reported HRQOL data for the U.S. general population and for people with selected chronic diseases.
Using the SF-36 Health Survey, we compared the HRQOL of IBS patients (n = 877) with previously reported SF-36 data for the general U.S. population and for patients with gastroesophageal reflux disease (GERD), diabetes mellitus, depression, and dialysis-dependent end-stage renal disease (ESRD).
On all 8 SF-36 scales, IBS patients had significantly worse HRQOL than the U.S. general population (P < 0. 001). Compared with GERD patients, IBS patients scored significantly lower on all SF-36 scales (P < 0.001) except physical functioning. Similarly, IBS patients had significantly worse HRQOL on selected SF-36 scales than patients with diabetes mellitus and ESRD. IBS patients had significantly better mental health SF-36 scale scores than patients with depression (P < 0.001).
IBS patients experience significant impairment in HRQOL. Decrements in HRQOL are most pronounced in energy/fatigue, role limitations caused by physical health problems, bodily pain, and general health perceptions. These data offer further insight into the impact of IBS on patient functional status and well-being.
Despite the rapidly growing body of literature on health-related quality of life (HRQoL). placing the results in a context that is meaningful to clinicians and patients is often overlooked.
This study sought to quantify the impact of irritable bowel syndrome (IBS) on HRQoL by comparing the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) scores of IBS patients with normative US data and with the scores of patients having other chronic gastrointestinal (GI) and non-GI disorders.
Two IBS reference groups were identified from the published literature: a largely untreated community sample of health maintenance organization (HMO) members (N = 92) and a sample of patients with IBS recruited through clinics and in the community (N = 140). SF-36 scores for these groups were compared with published US population norms (N = 2474) and with published scores for 3 other IBS samples (N = 464); a sample with other chronic GI disorders (dyspepsia [N = 126], gastroesophageal reflux disease [GERD] [N = 516]); and samples with other chronic episodic disorders (asthma [N = 375], migraine [N = 303], panic disorder [N = 73], rheumatoid arthritis [N = 693]).
The scores of patients in both IBS reference groups were significantly lower on several SF-36 domains than those of the US normative population (P < 0.003). Scores on several SF-36 scales were also significantly lower in the IBS reference groups compared with the GERD, asthma, and migraine samples (P < 0.003). Depending on the IBS sample used, scores did not differ or were higher compared with those in the sample with dyspepsia. Relative to the samples with panic disorder and rheumatoid arthritis, the IBS groups had significantly higher scores on most SF-36 domains (P < 0.003). Scores for the HMO reference group were generally higher than those for the clinic/community reference group.
Based on the results of this analysis, IBS is associated with impairment of HRQoL relative to US population norms and to populations with GERD, asthma, or migraine. HRQoL appears to be greater in patients with IBS than in those with panic disorder or rheumatoid arthritis, although the relative symptom severity in these samples was not known.
To perform a systematic review of the literature with three objectives: (1) to compare the health related quality of life (HRQoL) of patients with irritable bowel syndrome with that of healthy controls; (2) to compare the HRQoL of irritable bowel syndrome patients to those with other diseases; and (3) to examine therapy-associated changes in HRQoL of irritable bowel syndrome patients.
Searches of all English and non-English articles from 1980 to 2001 were performed in Medline and Embase, and two investigators performed independent data abstraction.
Seventeen articles met our selection criteria. 13 studies addressed objective no. 1; 11 showed a significant reduction in HRQoL among irritable bowel syndrome patients. Of these, only one study was considered of high quality. Four studies addressed objective no. 2, none of which was considered to be high quality in addressing this objective. Four trials (three of high quality) addressed objective no. 3. One showed that symptomatic improvement with Leupron compared to placebo was accompanied an improvement only in the comparative health domain of the HRQoL. The second study reported significant positive changes in HRQoL after 12 weeks of cognitive behavioural therapy. The third report of two placebo-controlled studies indicated significant improvement with alosetron on most domains of Irritable Bowel Syndrome Quality of Life Questionnaire.
(i) There is reasonable evidence for a decrease in HRQoL in patients with moderate to severe irritable bowel syndrome; however, the data are conflicting regarding the impact of irritable bowel syndrome on HRQoL in population-based studies of nonconsulters. (ii) HRQoL in irritable bowel syndrome patients is impaired to a degree comparable to other chronic disorders such as GERD and depression. (iii) A therapeutic response in irritable bowel syndrome-related pain has a corresponding improvement in HRQoL. (iv) Limitations of the literature include focusing on moderate-severe irritable bowel syndrome in referral centres, and lack of appropriate controls
The aim of this study was to systematically review published literature about the prevalence, incidence, and natural history of irritable bowel syndrome (IBS) in North America.
A computer-assisted search of MEDLINE, EMBASE, and Current Contents/Science Edition databases was performed independently by two investigators. Study selection criteria included: 1) North American population-based sample of adults; 2) objective diagnostic criteria for IBS (i.e., Rome or Manning criteria); and 3) publication in full manuscript form in English. Eligible articles were reviewed in a duplicate and independent manner. Data extracted were converted into individual tables and presented in descriptive form.
The prevalence of IBS in North America ranges from 3% to 20%, with most prevalence estimates ranging from 10% to 15%. The prevalences of diarrhea-predominant and constipation-predominant IBS are both approximately 5%. Published prevalence estimates by gender range from 2:1 female predominance to a ratio of 1:1. Constipation-predominant IBS is more common in female individuals. The prevalence of IBS varies minimally with age. No true population-based incidence studies or natural history studies were found. In one cohort surveyed on two occasions 1 yr apart, 9% of subjects who were free of IBS at baseline reported IBS at follow-up producing an onset rate of 67 per 1000 person-years. In all, 38% of patients meeting criteria for IBS did not meet IBS criteria at 1-yr follow-up.
Approximately 30 million people in North America meet the diagnostic criteria for IBS. However, data about the natural history of IBS is quite sparse and renewed efforts should be focused at developing appropriately designed trials of the epidemiology of IBS.
A low health-related quality of life (HRQL) was reported in subjects with functional bowel disorders (FBD). The aim of the present study was to investigate the association between HRQL and FBD within a three year period in a population-based sample in Germany.
A panel-study based on an age- and sex-stratified random sample of subjects aged 21 - 80 years in Düsseldorf, Germany (about 500,000 population).
The presence of FBD, in particular lower abdominal pain, was assessed annually over a three year period using a postal questionnaire. With the last questionning, HRQL was assessed using the Medical Outcome Short Form (SF36) in 305 subjects responding all three questionnaires (49 % males, mean age (SD) 54 (15) years). HRQL was analyzed based on SF36 scores and component summary scores, adjusted for age and sex using regression models.
Twenty-eight percent (28 %; 95 % confidence interval 23 - 33 %) of the respondents reported FBD in at least one year of the study period. HRQL was significantly lower in study subjects with FBD in all scores compared to subjects without any FBD during observation time and compared to the German general population. No significant differences between subjects with persistent and those with intermittent FBD could be evaluated.
Subjects with FBD within a three-year period had impaired HRQL compared to subjects without FBD and the general population in Germany. HRQL seemed to be less impaired than in subjects with IBS from the UK and the US.
The irritable bowel syndrome (IBS) is part of the larger group of functional gastrointestinal (GI) disorders that, despite differences in location and symptom patterns, share common features with regard to their motor and sensory physiology, central nervous system (CNS) relationships, and the approach to patient care.¹ IBS is a functional bowel disorder characterized by symptoms of abdominal pain or discomfort that is associated with disturbed defecation.² This disorder is highly prevalent and can be associated with significant emotional distress, impaired health-related quality of life (HRQL), disability, and high health care costs. Psychosocial factors, although not part of IBS per se, have an important role in modulating the illness experience and its clinical outcome.³
GASTROENTEROLOGY 2002;123:2108-2131
Although stress is often presumed to cause sleep disturbances, little research has documented the role of stressful life events in primary insomnia. The present study examined the relationship of stress and coping skills, and the potential mediating role of presleep arousal, to sleep patterns in good sleepers and insomnia sufferers.
The sample was composed of 67 participants (38 women, 29 men; mean age, 39.6 years), 40 individuals with insomnia and 27 good sleepers. Subjects completed prospective, daily measures of stressful events, presleep arousal, and sleep for 21 consecutive days. In addition, they completed several retrospective and global measures of depression, anxiety, stressful life events, and coping skills.
The results showed that poor and good sleepers reported equivalent numbers of minor stressful life events. However, insomniacs rated both the impact of daily minor stressors and the intensity of major negative life events higher than did good sleepers. In addition, insomniacs perceived their lives as more stressful, relied more on emotion-oriented coping strategies, and reported greater presleep arousal than good sleepers. Prospective daily data showed significant relationships between daytime stress and nighttime sleep, but presleep arousal and coping skills played an important mediating role.
The findings suggest that the appraisal of stressors and the perceived lack of control over stressful events, rather than the number of stressful events per se, enhance the vulnerability to insomnia. Arousal and coping skills play an important mediating role between stress and sleep. The main implication of these results is that insomnia treatments should incorporate clinical methods designed to teach effective stress appraisal and coping skills.
Relationships between presence of irritable bowel syndrome (IBS) and generalized anxiety disorder (GAD), chronic worry, neuroticism, anxiety sensitivity and anxiety about visceral sensations were examined among university students.
College student participants were administered self-report diagnostic measures of IBS and GAD, the Penn State Worry Questionnaire (PSWQ), the Neuroticism subscale of the Eysenck Personality Questionnaire, the Anxiety Sensitivity Index (ASI) and five additional items designed to measure visceral anxiety.
The prevalence of IBS and its associated characteristics among students were similar to previous community survey studies, with the exception of lower symptom severity in the university sample. IBS was associated with a higher frequency of GAD and greater worry, neuroticism, anxiety sensitivity and visceral anxiety. Logistic regression analyses further showed that the measure of anxiety specific to visceral sensations was the strongest predictor of IBS diagnostic status.
While various aspects of anxiety appear related to IBS, specific anxiety about visceral sensations appears to be the most significant factor. Implications of the associations between anxiety-related variables, particularly anxiety about visceral sensations, are discussed.
Irritable bowel syndrome (IBS) is a common functional bowel disease in the West. Information on the prevalence of IBS in the Asian population is relatively scanty. The aims of the present study were to determine the prevalence of IBS and to assess the symptom subgroups based on the predominant bowel habit in a young adult population of Asian origin.
Basic demographic data and symptoms of IBS using the Rome I criteria were sought using a questionnaire administered to all apparently healthy students in a medical school. Other questions asked related to alcohol intake, smoking, chili consumption, dietary fiber intake, and to psychological and psychosomatic symptoms of anxiety, depression, insomnia, headache, and backache. The health-care seeking behavior of the subjects was also analyzed.
Of the 610 questionnaires administered, 533 complete responses were received (response rate of 87.4%). The responders comprised 229 men (43.0%) and 304 (57.0%) women with a mean age of 22 +/- 1.8 years. The ethnic distribution was Malays 278 (52.2%), Chinese 179 (33.6%), Indians 46 (8.6%), and others 30 (5.6%). Eighty-four (15.8%) reported symptoms consistent with the diagnosis of IBS, predominantly women. Sixty-five (77.4%) and six (7.1%) were of the constipation-predominant and diarrhea-predominant IBS subgroups, respectively. Thirteen (15.5%) subjects fell into the non-specific IBS subgroup. The self-reported psychological and psychosomatic symptoms of anxiety (P = 0.02), depression (P = 0.002), insomnia (P = 0.006), headache (P = 0.04), and backache (P = 0.006) were encountered more frequently in the subjects with IBS. Only 13.1% of the IBS group had consulted their health-care practitioner, and 20.2% reported self-medication.
Symptoms supportive of the diagnosis of IBS were common among young Malaysians, with a prevalence rate of 15.8%. There were significantly more women with IBS than men. Within the IBS population, the majority (77.4%) was of the constipation-predominant IBS subgroup. A significantly higher prevalence of psychological and psychosomatic symptoms was found in individuals with IBS. Only a minority sought medical advice for their symptoms.
Background and aims:
Irritable bowel syndrome (IBS) is considered to be prevalent in the general population, but there are little data on bowel habits and IBS in Korea. Because nurses are frequently called on to help this patient population with IBS and help manage their symptoms, it is very necessary to get some practical information about patients' experiences and to outline a multifaceted approach to the practical management of patient with IBS. So this study aims to describe the bowel habits and the prevalence of IBS in young university students in Korea and to investigate the influence of lifestyle factors, including dietary habits, on IBS prevalence. Finally, we discuss the nursing needs for an holistic approach.
Methods:
A cross-sectional study, using the self-reported questionnaire based on previous studies done abroad and the Rome alpha criteria was applied with 1717 young university students.
Results:
The answers of 747 men and 970 women were included in the study. The prevalence of IBS, as defined by the Rome alpha criteria, was 5.7% of the subjects. The proportion of women (70.7%) was significantly higher than the proportion of men in the IBS group as compared to that in the non-IBS group (odds ratio 2.07, 95% CI 1.2-3.7). Residential type (odds ratio 1.27, 95% 1.06-1.5) and frequency of meals (odds ratio 1.69, 95% CI 1.2-2.5) significantly differed between the IBS group and non-IBS group. There was a trend towards the higher prevalence of IBS with fewer hours of exercise (odds ratio 0.99, 95% CI 0.95-1.04). 90.6% of respondents reported stool frequencies between three times per day and three times per week. Characteristics of defecation differed significantly between men and women (p<0.05, to p<0.0001).
Conclusion:
The prevalence of IBS in healthy young people of Korea was lower compared with those reported in the West. This study shows that proportionately more women suffered from IBS than men and dietary factors and lifestyle were significantly related to IBS. From our study results, we found that there are multifaceted nursing aspects required to reduce symptoms, such as dietary education and encouragement to change lifestyle aimed at controlling stress.
Irritable bowel syndrome (IBS) is a widely recognized disorder accounting for up to 50% of referrals to gastroenterologists in the Western world. Existing literature had suggested that its prevalence is low among native Africans. The objective [corrected] is to document the prevalence of IBS in this environment. A cross-sectional study of clinical students at the Jos University Medical School and the School of Medical Laboratory Technology in Jos University were cohorted. Questionnaires based on the Rome II criteria were administered to 330 students (221 males and 109 females). Irritable bowel syndrome was present in 86 (26.1%) of the subjects, being present in 58 (26.4%) of the males and 28 (25.7%) of the females respectively (OR 0.97, 95% CI 0.57-1.63, p = 0.89). The mean age of subjects with IBS was 26.3 +/- 4.0 years and that of subjects without IBS was 26.5 +/- 3.8 years, p = 0.6. The majority (54.8%) of the subjects did not consider their symptoms as illness and therefore did not seek any form of care. More males sought medical care compared to females (19.6% vs. 3.6% respectively, p = 0.02). Depressive symptoms were present in 21 (24.4%) of subjects with IBS compared to 36 (14.8%) of those without (p = 0.06). Irritable bowel syndrome is a common disorder in the student population of a medical school in Northern Nigeria.
To assess the impact of irritable bowel syndrome (IBS) on patient-reported health-related quality of life (HRQOL).
Two HRQOL instruments were administered by telephone interviews to a sample of 253 IBS French patients recruited from the general population. IBS was diagnosed according to the Manning, Rome I and Rome II criteria. Patients with organic diseases were excluded from the study. A generic instrument, the Short Form 36 (SF-36), and an IBS disease-specific instrument, the IBSQOL, were used.
Patients with IBS had statistically significant (P<0.05) lower scores for all SF-36 QOL domains compared with the general French population. Women (N=192) reported significantly (P<0.05) poorer HRQOL on both the SF-36 and the IBSQOL scores than men (N=61) for all domains except energy on the SF36 and the sleep on the IBSQOL. HRQOL deteriorated with time since onset of IBS symptoms for some domains such as diet. For both instruments, a positive correlation was observed between low scores and intensity of pain and discomfort. IBS patients with a predominance of diarrhea (N=72) exhibited significantly greater impairment of HRQOL in the emotional domain than IBS persons with constipation predominance (N=65) (P<or=0.05).
IBS has a significant impact on HRQOL of patients. In addition, specific characteristics such as gender, symptom severity and time since onset of symptoms are predictive of more impaired health-related quality of life.
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.
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.
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.
There was a strong relationship between IBS-C and female sex, and food sensitivity seemed to be an exacerbating factor for IBS-D.
We wished to determine the value of an open-access internet questionnaire for assessment of upper and lower gastrointestinal symptoms and health-related quality of life.
Between January 2002 and June 2005, a symptom scale for upper gastrointestinal and lower gastrointestinal symptoms was placed on a genuine website (www.gesundheits-umfrage.de) and linked to the website of the German irritable bowel syndrome patient group (www.Reizdarmselbsthilfe.de). Patients were asked to report gastrointestinal symptoms that had occurred during the last month. Patients who finished this symptoms questionnaire and acknowledged more than two of a total of eight upper gastrointestinal symptoms and/or more than two of 16 lower gastrointestinal symptoms were immediately offered the assessment of their health-related quality of life by a validated general quality of life scale--the patient general well-being inventory--a 22-item scale with six subscales (anxiety, depression, general well-being, self-control, health, and vitality) and a global scale. Total patient general well-being inventory scores and subscale values were correlated to upper gastrointestinal and lower gastrointestinal symptom scores including the Rome I definition of the irritable bowel syndrome, and to social variables.
Five thousand two hundred and fifty-six individuals completed symptom assessment. Out of these, 4431 had three or more upper gastrointestinal symptoms, the mean number of upper gastrointestinal symptoms reported was 3.2+/-2.0; 4456 had three or more lower gastrointestinal symptoms (mean: 10.3+/-3.3), and 3187 met the Rome I criteria for irritable bowel syndrome. A total of 3316 individuals completed the patient general well-being inventory assessment (1156 men, 2160 women, mean age: 37.7+/-12.3 years). Upper gastrointestinal, lower gastrointestinal, and total symptom score were higher in women than in men (P < 0.001), and significantly correlated to the global quality of life assessment. Family status affected the symptom scores (higher in singles) and quality of life scores (lower in people living in partnership for health, but higher for vitality and depression). Age correlated negatively with upper gastrointestinal, lower gastrointestinal, and with total symptom scores as well as with some patient general well-being inventory scores.
Symptom and quality of life assessment using an open internet questionnaire is feasible and generates data which are, in large, comparable to those from other sources of assessment, despite the fact that the population addressed is, on average, moderately younger than previously studied cohorts.
Revisions of the diagnostic criteria for irritable bowel syndrome have led to varying prevalence estimates. The Rome III criteria require a lower symptom frequency than Rome II (at least 10% of the time for Rome III, compared with at least 25% of the time for Rome II). In an epidemiological survey of a representative sample of Israeli adults using Rome II, we reported the prevalence for irritable bowel syndrome as 2.9%. The official Rome II integrative questionnaire, used for that study, enables a close approximation of Rome III rates, facilitating a retrospective comparison of these criteria.
A representative sample of 1000 adults was interviewed with a validated Hebrew version of the official Rome II integrative questionnaire. The data were re-evaluated retrospectively to compare the Rome II results with a close approximation of the new Rome III criteria.
The prevalence rates for irritable bowel syndrome were 2.9 and 11.4%, respectively, for Rome II and Rome III. The corresponding consultation rates were 57.1 and 41.7%, indicating that the more strict Rome II criteria may select out a group of patients with more severe disease or greater psychosocial problems. Women made up 71.4% of irritable bowel syndrome by Rome II and 62.5% by Rome III.
In the present retrospective study, the prevalence rate for irritable bowel syndrome in our population is significantly higher by Rome III compared with Rome II. Rome III may more closely reflect the socioeconomic burden of irritable bowel syndrome compared with the overly strict Rome II. Prospective comparative studies should be conducted to confirm these results.
Assessing health related quality of life (HRQOL) is becoming more important in research and clinical care. However, little information is available on the performance of HRQOL questionnaires for the functional bowel disorders (FBD). The aims of this study were to (a) understand the performance of the Sickness Impact Profile (SIP) and IBS-QOL for the functional bowel disorders at baseline and after treatment, (b) determine which HRQOL subscales best improve with treatment, (c) determine clinically meaningful improvement, and (d) determine the predictors of HRQOL at baseline and in response to treatment.
Women with moderate to severe FBD were evaluated using both medical (desipramine vs placebo) and psychological (cognitive-behavioral therapy vs education) treatments. Clinical and psychosocial questionnaires along with the SIP and IBS-QOL were given at baseline and after 12-wk treatment.
(a) Patients with FBD experience functional limitations in social interactions, home management, and recreational activities, respond emotionally to the pain, feel helpless, out of control, depressed, and irritable, and perceive restrictions in lifestyle relating to toilet accessibility, and eating; (b) HRQOL is not different among the FBD diagnoses or IBS subgroups; (c) the IBS-QOL is more responsive to treatment than the SIP; (d) meaningful clinical improvement is 2.8 points for SIP and 14 for IBS-QOL; and (e) improvement is demonstrated primarily in psychosocial rather than physical domains. In addition, we found that expectation of benefit is greater for taking a pill over a psychological intervention, and the predictive effects of abuse history and pain on outcome is mediated by psychosocial factors.
The data support the value of the IBS-QOL over the SIP, and provide new information on the profile of impairment in FBD, and the ways in which medical and psychological treatments produce improvement in HRQOL.
The agreement between subtyping irritable bowel syndrome (IBS) patients based on Rome II criteria versus Rome III criteria is unknown.
To compare IBS subtyping based on Rome II versus III criteria.
The Rome II Modular Questionnaire and the Bristol Stool Form Scale (one-week diary cards) were completed by 249 IBS patients. Based on the Rome II criteria, patients were defined as having diarrhoea- or constipation-predominant IBS, or alternating IBS. Based on the Rome III criteria, patients were divided into IBS with constipation, IBS with diarrhoea, mixed IBS or unsubtyped IBS. Agreement between Rome II and Rome III was assessed with kappa statistics.
Based on Rome II there were 92 diarrhoea-predominant IBS, 45 constipation-predominant IBS and 112 alternating IBS, and based on Rome III 97 IBS with diarrhoea, 77 IBS with constipation, 16 mixed IBS and 59 unsubtyped IBS. The agreement between Rome II and Rome III subgroups was 46% (kappa = 0.19). Changes from the constipation to the diarrhoea subgroups and vice versa were uncommon (8% of patients). The majority of changes occurred from/to the alternating IBS, mixed IBS and unsubtyped IBS subgroups.
There is poor agreement between subtyping of IBS patients based on Rome II versus Rome III criteria.
Students are an important part of the general population of Germany, but only limited information exists about the prevalence of common psychological syndromes among them.
To provide prevalence rates for various psychological syndromes (affective, anxiety, somotoform, eating disorders, and alcohol associated problems) among German university students.
A campus-wide survey including N = 1130 students at the University of Mannheim was conducted. Established assessment instruments were employed for this purpose: the German version of the Patient Health Questionnaire (PHQ), the German Version of the Whiteley-Index (WI), and the Chemical Odor Sensitivity Scale (COSS) to screen for idiopathic environmental intolerance (IEI).
PHQ criteria for at least one psychological disorder (apart from the alcohol abuse/dependence syndrome) were met by 22.7% of the students, more frequently by women than men (OR = 1.8). The alcohol syndrome (30.2%) was most frequent and the only syndrome which was more frequent in men than in women. The next frequent syndrome was the somatoform syndrome (9.1%), followed by other depressive syndromes (8.1 %), IEI (7.2%), major depression (6.0%) and hypochondriasis (4.2%). The presence of hypochondriasis increased greatly the risk for co-morbid disorders. All syndromes--with the exception of the alcohol syndrome and the binge eating disorder--were accompanied by functional impairments.
We consider these results rather alarming, as they indicate a considerable need for both preventive and curative interventions in German students. However, further epidemiological studies are needed to prove the generalizability of our findings and to examine functional interrelations among and the course of these psychological syndromes.
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.
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.
All the undergraduate student participants were administered self-report diagnostic measures for irritable bowel syndrome.
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.
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.
A large number of irritable bowel syndrome (IBS) patients are additionally afflicted with other somatic intestinal and/or extraintestinal comorbidities. The occurrence of one or more comorbidities is correlated with enhanced medical help seeking, worse prognosis, and higher rates of anxiety and depression-all resulting in a reduced quality of life. The aims of this study were, firstly, to review the literature on comorbidities of IBS and to assess gastrointestinal and extraintestinal comorbidities, and, secondly, to evaluate explanatory hypotheses and possible common pathophysiological mechanisms.
We systematically reviewed the scientific literature in the past 25 years, as cited in MEDLINE.
IBS patients present with a twofold increase in somatic comorbidities compared to controls, possibly caused by common pathophysiological mechanisms. Nevertheless, to date, there has been no convincing evidence for a consolidated underlying pathophysiology or somatization. Gastrointestinal disorders, such as functional dyspepsia, gastroesophageal reflux disease, functional constipation, and anal incontinence, occur in almost half of the patients. In a broad variety of extraintestinal comorbidities, fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain are best documented and appear in up to 65%.
The knowledge and structured assessment of comorbid somatic symptoms might allow to identify subgroups of IBS patients with special characteristics and lead to adaptation of the therapeutic concept.