Pictograms are more effective than verbal descriptors in Spanish for bloating and distension

Abstract

Bloating in English is defined as the subjective sensation of an increase in abdominal girth, while abdominal distension is the visible or true increase in abdominal girth. 1 The first one is a symptom, while the second one is both a symptom and a clinical sign. In addition, bloating and distension can coexist and they are very commonly reported by patients and subjects in the general population. 2 Their underlying mechanism is not completely elucidated; however, bloating may be related to gut hypersensitivity, while abdominal distension can be related to an increment in intraluminal gas, as well as a behavioral response, featuring a diaphragmatic contraction and descent with anterior wall protrusion known as abdomino-phrenic dyssynergia. 2 Earlier epidemiological studies in North America

Pictograms to assess bloating and distension symptoms in the general population in Mexico: Results of The Rome Foundation Global Epidemiology Study

“…In addition, the pictograms showed a positive agreement with the physician's diagnosis and a negative agreement with VDs, in both groups of patients. Finally, these pictograms were more sensitive and specific than the VDs 3 . The above findings suggested that the bloating/distension pictograms could be used in the clinic, in clinical trials as well as in epidemiological studies in Spanish‐speaking countries.…”

“…There is no term for bloating in Spanish and abdominal distension is a very technical expression for people to understand, making it very difficult to investigate these symptoms in Spanish‐speaking populations like in Mexico 1 . Therefore, we previously validated the use of pictograms to assess the presence of bloating and/or distension in patients from a general gastroenterology clinic and with IBS by Rome III criteria in this country 3 . In these studies, we found that “inflammation” was the most frequent VD used by the patients and distension was commonly interpreted as a sensation (“inflammation”) and/or an increase in abdominal girth 3 .…”

“…Therefore, we previously validated the use of pictograms to assess the presence of bloating and/or distension in patients from a general gastroenterology clinic and with IBS by Rome III criteria in this country 3 . In these studies, we found that “inflammation” was the most frequent VD used by the patients and distension was commonly interpreted as a sensation (“inflammation”) and/or an increase in abdominal girth 3 . In addition, 82.2% of the general GI patients and 89.6% with IBS‐Rome III without bloating/distension by VDs, reported the presence of these symptoms by the Pictograms.…”

“…The bloating/distension pictograms (Figure 1) were preceded by the following instruction: “Please mark if you have any of the following manifestations.” They are also intended to investigate about the presence of bloating and distension at that specific moment. The pictograms are generic in nature, that is, they do not depict any body parts, and include a normal abdomen, one representing bloating depicting a red balloon inside the tummy, one representing distension which shows an increment in the abdominal girth with arrows detailing that increment, and one with both bloating and distension 3 . The two VD questions for abdominal bloating and distension in Spanish, were: “Do you have abdominal inflammation or does your abdomen swell?” And: “Do you have abdominal distension?”.…”

“…We recently evaluated the use of pictograms for assessing bloating and/or distension in patients with general gastrointestinal symptoms and those with irritable bowel syndrome (IBS) and correlated them with verbal descriptors (VDs: i.e. abdominal “inflammation”/“swelling” and distension) and the physician's diagnosis 3 . We also confirmed that “inflammation” was the most frequently used VD, while distension was commonly interpreted as a sensation (“inflammation”) and/or increased abdominal girth.…”