Irritable bowel syndrome in Asia: Pathogenesis, natural history, epidemiology, and management

Abstract

Historically, the epidemiology of gastrointestinal diseases in Asia was different from that in Western countries. Early studies suggested a low prevalence of irritable bowel syndrome (IBS) in Asia. As the diagnosis of IBS is symptom-based and as symptom perception, expression, and interpretation are influenced by sociocultural perspectives including language, the presentation of IBS is expected to vary in different communities. Furthermore, the pathogenesis is multifactorial with psychosocial (stress, illness, behavior, and diet) and biological (infection, gut microbiota, and immune activation) variables interacting, and so, the present study can anticipate that the development of IBS will vary in different environments. In recognition of this aspect of functional gastrointestinal disorders, the recently published Rome IV documents have provided greater focus on cross-cultural factors. In this review, the present study seeks to highlight Asian perspectives by identifying historical trends and recent publications from the region and comparing these with the observations from Western societies.

Review article: the incidence and risk factors for irritable bowel syndrome in population‐based studies

“…[45][46][47] Younger age is a risk factor in the West whereas older age predicts onset in Taiwan. Female sex is a clear risk factor in the West but this is not found in Taiwan in line with previous reports of prevalent IBS.…”

“…Female sex is a clear risk factor in the West but this is not found in Taiwan in line with previous reports of prevalent IBS. [45][46][47] Younger age is a risk factor in the West whereas older age predicts onset in Taiwan.…”

Marshall and Warren Lecture 2019: A paradigm shift in pathophysiological basis of irritable bowel syndrome and its implication on treatment

“…Irritable bowel syndrome (IBS), a common enigmatic functional gastrointestinal disorder (FGID), is characterized by abdominal pain, discomfort, bloating, altered stool forms, and frequency 1 . IBS is diagnosed by symptom‐based criteria such as Manning's criteria and different iteration of the Rome criteria 2, 3 . The current iteration of Rome criteria (version IV) released in 2016 underscored the abdominal discomfort and bloating over pain, making the symptom‐based diagnostic criteria for this condition somewhat insensitive 3, 4 .…”

“…The current iteration of Rome criteria (version IV) released in 2016 underscored the abdominal discomfort and bloating over pain, making the symptom‐based diagnostic criteria for this condition somewhat insensitive 3, 4 . However, the treatment of the condition largely depends on the subtyping of the condition such as constipation–or diarrhea–predominant syndrome and the underlying pathophysiology that has undergone substantial paradigm shift during the recent years 2, 3, 5, 6 . In fact, earlier, it was thought that IBS is largely a functional condition.…”

Data Mining Approach for the Characterization of Functional Bowel Disorders According to Symptom Intensity Provides a Small Number of Homogenous Groups

“…The severity of patients could vary from one center to another. It is thus possible that the diagnosis algorithm used here, will have to be adapted from one country to another [32,33]. Another limit of this CDBP symptom classification scheme is the noninclusion of the fluctuation of the nonorganic bowel symptoms [34].…”