Onset and Disappearance of Gastrointestinal Symptoms and Functional Gastrointestinal Disorders

Abstract

Functional gastrointestinal disorders, including the irritable bowel syndrome, account for up to 40% of referrals to gastroenterologists, but accurate data on the natural history of these disorders in the general population are lacking. Using a reliable and valid questionnaire, the authors estimated the onset and disappearance of symptoms consistent with functional gastrointestinal disorders. An age- and sex-stratified random sample of 1,021 eligible residents of Olmsted County, Minnesota, aged 30-64 years were initially mailed the questionnaire; 82% responded (n = 835). In a remailing to responders 12-20 months later, 83% responded again (n = 690). The age- and sex-adjusted prevalence rates per 100 for irritable bowel syndrome, chronic constipation, chronic diarrhea, and frequent dyspepsia were 18.1 (95% confidence interval (CI) 15.1-21.1), 14.7 (95% CI 11.9-17.4), 7.3 (95% CI 5.3-9.3), and 14.1 (95% CI 11.5-16.8), respectively, on the second mailing. Symptoms were not significantly associated with nonresponse to the second mailing; moreover, the estimated prevalence rates were not significantly different from the first mailing. Among the 582 subjects free of the irritable bowel syndrome on the first survey, 9% developed symptoms during 795 person-years of follow-up, while 38% of the 108 who initially had the irritable bowel syndrome did not meet the criteria after 146 person-years of follow-up. Similar onset and disappearance rates were observed for the other main symptom categories. While functional gastrointestinal symptoms are common in middle-aged persons and overall prevalence appears relatively stable over 12-20 months, substantial turnover is implied by the observed onset and disappearance rates; several potential sources of bias do not seem to account for this variation.

Functional dyspepsia

“…13), which calls into question the sensitivity and specificity of the Rome criteria, at least for IBS and functional dyspepsia. This argument is also supported by the observation that patients with functional dyspepsia might eventually present with IBS symptoms at follow-up, whereas others with IBS might switch to functional dyspepsia after 2-10 years 16,17 . Functional dyspepsia overlaps not only with IBS and other functional gastrointestinal disorders but also with some somatic diseases and functional non-intestinal diseases, such as fibromyalgia, overactive bladder and chronic pelvic pain [18][19][20][21] .…”

Significant psychological morbidity occurs in irritable bowel syndrome: a case‐control study using a pharmacy reimbursement database

“…A stable 18.1% prevalence and 9% incidence of IBS at 1 year follow-up was found, suggesting both a significant resolution and emergence of IBS symptoms over time. 59 The difficulty in assessing IBS incidence is illustrated by the following two studies that give a two-fold difference in estimates of incidence, despite using the same diagnosis-linked United Kingdom General Practice Research Database (UKGPRD). Ruigomez and colleagues estimated an IBS incidence of 3 ⁄ 1000 person-years, whereas Jones and colleagues estimated the incidence of IBS to be 1.9 ⁄ 1,000 for men and 5.8 ⁄ 1000 for women.…”

The epidemiology of irritable bowel syndrome in North America: a systematic review

“…Thus, in this trial in the United Kingdom, patients alternate between several days with symptoms and several days without symptoms. The results from the single IBS natural history trial (including those in this systematic review) demonstrated that up to 38% of IBS patients did not meet diagnostic criteria for IBS, and reported prolonged symptom-free periods after 1 yr of follow-up, suggesting that IBS patients may develop a "remission" after a series of symptomatic episodes (19). Longitudinal studies have also been done outside the US, and one study in particular bears reporting (24).…”

“…Epidemiology of Irritable Bowel Syndrome and abstracts, followed by review of the full manuscripts of potentially relevant articles, identified eight articles that met inclusion criteria (12)(13)(14)(15)(16)(17)(18)(19). Only studies from the United States were found, as there were no published populationbased studies from Mexico or Canada.…”

“…A single study used repeated surveys over time to estimate incidence (19). In Olmsted County, a cohort was surveyed on two occasions 1 yr apart, using the Manning criteria, and 9% of subjects free of IBS at baseline reported IBS in follow-up.…”