Despite being a large ethnic group within the South-East Asia, there is a paucity of reported literatures on dyspepsia in the Malay population. Recent population-based studies indicate that uninvestigated dyspepsia, based on the Rome II criteria, is reported in 12.8% and 11.6% of Malays in the urban and rural communities respectively. Organic causes of dyspepsia including upper gastrointestinal tract cancers, its precancerous lesions, and erosive diseases are uncommon which is largely due to an exceptionally low prevalence of Helicobacter pylori infection in this population. On the other hand, functional dyspepsia and irritable bowel syndrome are relatively common in the Malays than expected. Within a primary care setting, functional dyspepsia, based on the Rome III criteria, is reported in 11.9% of Malays, of which epigastric pain syndrome is found to be more common. Married Malay females are more likely to have functional dyspepsia and psychosocial alarm symptoms. Also based on the Rome III criteria, irritable bowel syndrome, commonly overlapped with functional dyspepsia, is reported in 10.9% of Malays within a community-based setting. Rather than psychosocial symptoms, red flags are most likely to be reported among the Malays with irritable bowel syndrome despite having a low yield for organic diseases. Based upon the above observations, "proton pump inhibitor test" is probably preferable than the "test and treat H. pylori" strategy in the initial management of dyspepsia among the Malays.
Asia ; Dyspepsia ; Ethnic Groups ; Female ; Hand ; Helicobacter pylori ; Humans ; Irritable Bowel Syndrome ; Malaysia ; Prevalence ; Primary Health Care ; Rome ; Rural Population ; Upper Gastrointestinal Tract

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders and when compared to the vast knowledge pertaining to adults with IBS, very little is known about IBS in children and adolescents. We aimed to explore the prevalence of IBS, identify symptoms and contributing factors and also to examine the efficacy of trimebutine maleate in children and adolescents. METHODS: The study involved 345 children and adolescents (4-18 years) and parents were requested to fill in a questionnaire, Rome III criteria was used to diagnose IBS. To exclude organic disease, all patients underwent medical investigations. Half of the randomly selected IBS patients were treated with trimebutine maleate while the rest of IBS patients were not. The IBS patients were reevaluated at the end of 3 weeks. RESULTS: The prevalence of IBS according to Rome III criteria in children and adolescents was 22.6% and IBS with constipation was the predominant subtype. Back pain (OR, 6.68), headache (OR, 4.72) and chronic fatigue (OR, 3.74) were significantly higher in IBS group. The prevalence of IBS in both parents and depression in mothers was greater for the patient group than the healthy controls (P < 0.0001). The prevalence of functional dyspepsia in IBS group was 80.8% and was significantly higher than control group. Clinical recovery was seen in 94.9% of the trimebutine maleate group versus spontaneous recovery in 20.5% of the non-medicated group. The difference was significant (P < 0.0001). CONCLUSIONS: IBS is a common disorder in children and adolescents. IBS is closely associated with somatic and familial factors. Trimebutine maleate is effective for pediatric IBS patients.
Adolescent ; Adult ; Back Pain ; Child ; Constipation ; Depression ; Dyspepsia ; Fatigue ; Gastrointestinal Diseases ; Headache ; Humans ; Incidence ; Irritable Bowel Syndrome ; Maleates ; Mothers ; Parents ; Prevalence ; Surveys and Questionnaires ; Rome ; Trimebutine

BACKGROUND/AIMS: This study evaluated the effect of Helicobacter pylori eradication on functional dyspepsia (FD), and the relationship between the changes of histological gastritis and FD symptom responses. METHODS: A total of 213 FD patients diagnosed by Rome III criteria were consecutively enrolled. H. pylori tests and gastritis grade by the Sydney system were performed before and 1 year after the proton pump based-eradication therapy for 7 days. Serum levels of pepsinogen, and genetic polymorphisms IL-6, IL-8 and IL-10 were investigated. RESULTS: Total of 91 patients completed the 1 year follow-up. When the response rate of dyspepsia was compared at 1 year between the non-eradicated group (n = 24) and eradicated group (n = 67), each group showed complete response of 62.5% and 62.7%; satisfactory response (> or = 50%) of 0.0% and 19.4%; partial response (< 50%) of 12.5% and 11.9%; and refractory response of 25.0% and 6.0%, respectively (P = 0.015). In addition, the responder group (complete + satisfactory response) at 1 year showed improvement of activity and chronic inflammation in both the antrum and corpus (all P < 0.001). Multivariate analysis showed that H. pylori eradication (OR, 5.81; 95% CI, 1.07-31.59) and symptom improvement at 3 month (OR, 28.90; 95% CI, 5.29-157.82) were associated with the improvement of dyspepsia at 1 year. Among the successfully eradicated FD patients (n = 67), male (P = 0.013) and higher initial BMI (P = 0.016) were associated with the improvement of dyspepsia at 1 year. CONCLUSIONS: H. pylori eradication improved FD symptoms, as well as gastritis at 1 year, suggesting that inflammation mediates FD.
Dyspepsia ; Follow-Up Studies ; Gastritis ; Helicobacter ; Helicobacter pylori ; Humans ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Interleukin-8 ; Male ; Multivariate Analysis ; Pepsinogen A ; Polymorphism, Genetic ; Proton Pumps ; Rome

BACKGROUND/AIMS: Korean patients with constipation have differences, both among themselves and as compared to other populations, with regard to race, diet, and cultural factors and are expected to have different characteristics to those of western patients, but few studies have been conducted in this regard. We evaluated the epidemiological and physiological characteristics of patients with constipation who visited a tertiary referral center. METHODS: A total of 338 patients with constipation were included. They completed a questionnaire and took physiological tests such as defecography, colon transit time, and anorectal manometry. We classified the types of constipation according to the physiological tests and analyzed the results. RESULTS: The mean age of the study patients was 53.8 +/- 16.3 years and 42.3% of the patients were > or = 60 years old. Patients who had tried folk remedies reached 64.3%. Among the self-reported patients with constipation, 89.1% satisfied the Rome III criteria for constipation. However, 84% of the patients who did not satisfy the criteria showed abnormal results on the physiological tests. Patients with normal transit constipation, slow transit constipation, and dyssynergic defecation were 21%, 27%, and 29% of the all patients, respectively. Rectal hyposensitivity was found in 16.9% of patients and 25% of them revealed anatomic abnormalities on defecography. CONCLUSIONS: Korean patients with constipation have a tendency to delay an accurate diagnosis and treatment and to use folk remedies. As physiological tests for patients with constipation who visited a tertiary hospital showed a relatively high rate of abnormal results, such as dyssynergic defecation and anatomic problems, active physiological evaluations should be considered for such patients.
Colon ; Constipation ; Continental Population Groups ; Defecation ; Defecography ; Diet ; Humans ; Manometry ; Medicine, Traditional ; Surveys and Questionnaires ; Referral and Consultation ; Rome ; Tertiary Care Centers

BACKGROUND/AIMS: Many candidate gene studies have revealed that polymorphisms of the 5'-flanking controlled SERT gene linked polymorphic region (5HTT-LPR) gene and G-protein beta3 C825T gene might be associated with functional dyspepsia (FD) and irritable bowel syndrome (IBS). This study was performed to investigate polymorphisms of the 5HTT-LPR gene and G-protein beta3 C825T gene in FD and IBS in Korean children. METHODS: In total, 102 patients with FD, 72 patients with IBS based on the Rome III criteria and 148 healthy controls without gastrointestinal symptoms were included in the study to analyze 5HTT-LPR and G-protein beta3 C825T polymorphisms. RESULTS: 5HTT-LPR genotype analysis revealed no signifi cant differences in FD and IBS patients compared with controls. The GNbeta3 C825T genotype distribution for CC, CT, and TT was 23.6%, 53.4%, and 23.0% in controls, 36.3%, 38.2%, and 25.5% in FD and 37.5%, 38.9%, and 23.6% in IBS, respectively. The CC genotype was more common in FD and IBS patients than controls (p<0.05). When the IBS patients were grouped according to IBS subtypes, CC genotype GNbeta3 C825T was common in diarrhea-dominant IBS, and the TT genotype was common in constipation-dominant IBS (p<0.05). CONCLUSIONS: The CC genotype of G-protein beta3 C825T may be associated with FD and diarrhea-predominant IBS. The TT genotype may be associated with constipation-predominant IBS.
Child ; Dyspepsia ; Genotype ; GTP-Binding Proteins ; Heterotrimeric GTP-Binding Proteins ; Humans ; Irritable Bowel Syndrome ; Rome ; Serotonin ; Serotonin Plasma Membrane Transport Proteins

OBJECTIVE: To report the defecation patterns of brain-injured patients and evaluate the relationship between functional ability and colon transit time (CTT) in stroke patients. METHOD: A total of 55 brain-injured patients were recruited. Patient interviews and medical records review of pattern of brain injury, anatomical site of lesion, bowel habits, constipation score, and Bristol scale were conducted. We divided the patients into constipation (n=29) and non-constipation (n=26) groups according to Rome II criteria for constipation. The CTTs of total and segmental colon were assessed using radio-opaque markers Kolomark(R) and functional ability was evaluated using the functional independence measure (FIM). RESULTS: Constipation scores in constipation and non-constipation groups were 7.32+/-3.63 and 5.04+/-2.46, respectively, and the difference was statistically significant. The CTTs of the total colon in both groups were 46.6+/-18.7 and 32.3+/-23.5 h, respectively. The CTTs of total, right, and left colon were significantly delayed in the constipation group (p<0.05). No significant correlation was found between anatomical location of brain injury and constipation score or total CTT. Only the CTT of the left colon was delayed in the patient group with pontine lesions (p<0.05). CONCLUSION: The constipation group had significantly elevated constipation scores and lower Bristol stool form scale, with prolonged CTTs of total, right, and left colon. In classification by site of brain injury, we did not find significantly different constipation scores, Bristol stool form scale, or CTTs between the groups with pontine and suprapontine injury.
Brain Injuries ; Colon ; Constipation ; Defecation ; Humans ; Medical Records ; Rome ; Stroke

BACKGROUND/AIMS: To study the prevalence of somatic and psychiatric co-morbidities in the patients of irritable bowel syndrome (IBS) and to assess the quality of life (QOL) of these patients. METHODS: One hundred and eighty-four IBS patients and 198 controls were included. Diagnosis of IBS, its sub-classification and assessment of other functional gastrointestinal disorders (FGIDs) was made on basis of Rome III criteria. Severity of IBS was assessed using IBS severity scoring system. Psychiatric evaluation was done using Patient Heath Questionnaire. QOL was evaluated using WHO QOL-BREF. RESULTS: One hundred and forty-seven (79.9%) and 158 (85.9%) patients with IBS had at least one other FGID or at least one somatic co-morbidity, respectively. Higher number of patients had at least one psychiatric co-morbidity compared to controls (79.9% vs 34.3%; P < 0.001). Major depressive syndrome (47.3% vs 5.1%; P < 0.001), somatoform disorder (50% vs 14.6%; P < 0.001) and panic syndrome (44% vs 11.6%; P < 0.001) were more common in IBS than controls. Only 14 (7.6%) patients were receiving drug treatment for their psychiatric illness. Severe IBS symptoms were present in significantly higher number of patients with constipation predominant IBS than diarrhea predominant IBS. Those with severe disease had higher prevalence of psychiatric (95.1%) and somatic (96.7%) co-morbidities compared with mild disease. QOL of IBS patients was significantly lower in all four domains compared to controls. Presence of at least one other FGID was significantly associated with presence of one or more psychiatric co-morbidity (P < 0.001). CONCLUSIONS: Majority of IBS patients presenting to a tertiary care center had associated psychiatric, somatic co-morbidities and reduced QOL. Very few of them received specific psychiatric treatment.
Anxiety Disorders ; Constipation ; Depression ; Depressive Disorder ; Diarrhea ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome ; Panic ; Prevalence ; Quality of Life ; Surveys and Questionnaires ; Rome ; Somatoform Disorders ; Tertiary Care Centers ; Tertiary Healthcare

BACKGROUND/AIMS: This study was conducted with objectives of assessing subtypes of irritable bowel syndrome (IBS) in children aged 10-16 years, their symptomatology and gender differences. METHODS: For this survey, 107 children who fulfilled Rome III criteria for IBS and 1,610 healthy controls were recruited from 8 randomly selected schools, in 4 provinces in Sri Lanka. Data was collected using a previously validated, self administered questionnaire. RESULTS: Constipation predominant, diarrhea predominant and mixed type IBS were almost equally distributed (27%-28%), while unsubtyped IBS had a lower prevalence (17.8%). IBS was more common in girls (59.8% vs 40.2% in boys, P = 0.001). Bloating, flatulence, burping, headache and limb pain were significantly higher in affected children (P < 0.05). CONCLUSIONS: This study highlights the distribution of IBS subtypes among Sri Lankan children and adolescents and its female preponderance. This study also shows a higher prevalence of other intestinal-related and extraintestinal somatic symptoms among affected children.
Adolescent ; Aged ; Child ; Constipation ; Diarrhea ; Extremities ; Female ; Flatulence ; Headache ; Humans ; Irritable Bowel Syndrome ; Prevalence ; Rome ; Sri Lanka

The diagnosis of functional dyspepsia (FD) is challenging since it depends largely on symptoms which are often heterogeneous and overlapping. This is particularly so in Asia with many different cultures and languages. Symptom-based diagnosis of FD based on Rome III criteria has not been fully validated and it may not be suitable in some Asian populations. Clinicians often assume that investigations in FD are not rewarding and physiological tests are often not available unless in the research setting. Investigation of alarm features and role of Helicobacter pylori in FD remain controversial but experts agreed that both should be tested. Physiological tests including gastric accommodation and chemical hypersensitivity tests are underutilized in Asia and available studies were few. While experts do not recommend routine clinical use of gastric accommodation tests but they agree that these tests can be advocated if clinically indicated. Empiric therapeutic trial is not currently a diagnostic option. The pathogenesis of FD is still poorly understood and there is a substantial placebo response. As a conclusion, a diagnosis of FD is challenging especially so in the context of Asia and despite the limitations of available physiological tests experts agreed that these tests can be advocated if and when clinically indicated.
Asia ; Asian Continental Ancestry Group ; Dyspepsia ; Helicobacter pylori ; Humans ; Hypersensitivity ; Reward ; Rome

As a disease that reduces quality of life, functional dyspepsia (FD) is associated with foods that may worsen its symptoms or cause it. The purpose of this study was to examine the nutritional status and dietary behaviors of FD patients. We investigated food intake, food intake frequency, and dietary habits of 45 FD subjects according to the Rome III Diagnosis Criteria. Average age and body mass index (BMI) were 47.7 years and 22.6 kg/m2 (males: 23.4 kg/m2, females: 22.1 kg/m2), respectively. Average energy intake was 77% of Korean Dietary Reference Intake (KDRI), and it was less than that of the Korea National Health and Nutrition Examination Surveys (KNHANES). Other nutrient intake levels were similar to the KNHANES. Energy intake proportion of carbohydrates:protein:fat was 56:18:26, and the ratio of fat intake was higher than that of the KNHANES. Beans, laver, tomato, and yogurt were consumed very frequently. In the results of meal regularity, dietary behaviors and composition of diet were relatively good. It is likely that the patient controlled their diet by eating cautiously and by reducing alcohol drinking and smoking. Our results indicate that FD patients' nutritional status by consumption of nutrients was at a level of normal healthy people and that dietary habits were better than normal adults. However, their fat intake levels were somewhat higher than normal people. Therefore, further research is required to identify the relationship between dietary intakes and FD.
Adult ; Alcohol Drinking ; Body Mass Index ; Diet ; Dyspepsia ; Eating ; Energy Intake ; Fabaceae ; Food Habits ; Humans ; Korea ; Lycopersicon esculentum ; Meals ; Nutritional Status ; Quality of Life ; Rome ; Smoke ; Smoking ; Yogurt