Irritable bowel syndrome (IBS) is a common functional gastrointestinal disease worldwide. Current guidelines of IBS are mostly based on the western populations and expected to vary in different communities. China has a large population and a vast literature is available on IBS. Due to linguistic variations in the literature, the studies are not widely known and their conclusions thus remain largely obscured to the western medical literature. In this article, we reviewed the published literatures on the investigations of IBS epidemiology, diagnosis, and management in the Chinese population and emphasized the different findings gleaned from the western publications. The detailed literature review will benefit understanding of and promote future study on IBS.
China/epidemiology* ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome/therapy*

BACKGROUND/AIMS: There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. METHODS: Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. RESULTS: Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. CONCLUSIONS: Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.
Anti-Bacterial Agents ; Asia ; Asian Continental Ancestry Group ; Consensus ; Constipation ; Diagnosis ; Diarrhea ; Diet ; Epidemiology ; Gastrointestinal Diseases ; Humans ; Intestines ; Irritable Bowel Syndrome ; Life Style ; Methods ; Probiotics

BACKGROUND/AIMS: The epidemiology of functional gastrointestinal disorders (FGIDs) in developed and developing countries involves a high prevalence of constipation and irritable bowel syndrome. This study examined the prevalence of functional gastrointestinal disorders in schoolchildren and adolescents in Colombia using the Rome III criteria. METHODS: A cross-sectional study was performed on Colombian children between 8 and 17 years old. The Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version self-report form was answered by students from two schools. The prevalence of FGID was calculated and correlation tests were conducted among the variables analyzed. RESULTS: A total of 864 children with a mean age of 12.5±2.5 years were analyzed; 50.7% were female. Two hundred and fifty-nine children (30%) had at least one FGID, and of these, 163 were female (62.9%). Sixty-nine children had two or more FGIDs (8%). Functional constipation was the most prevalent disorder (13.2%), followed in order by abdominal migraine (8.3%), irritable bowel syndrome (6.9%), and aerophagia (3.1%). A significantly higher prevalence of FGID was observed in females (p=0.000). No significant difference was observed between the age groups or type of school they attended. CONCLUSIONS: The overall prevalence of FGID in the sample was 30%, with functional constipation being the most common. These results are similar to those of other prevalence studies reported elsewhere.
Adolescent ; Child ; Colombia ; Constipation ; Cross-Sectional Studies ; Developing Countries ; Epidemiology ; Female ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome ; Migraine Disorders ; Prevalence

BACKGROUND/AIMS: Several studies have demonstrated that sleep problems are associated with functional gastrointestinal disorders (FGIDs): irritable bowel syndrome (IBS), functional dyspepsia, etc, but the relationship between excessive daytime sleepiness (EDS) and FGIDs has not been systematically studied in the general population. This study aims to explore the relationship between EDS and specific types of FGIDs and the effect of the number of FGIDs on EDS. METHODS: A sample of 3600 individuals (aged 18–80 years) was selected from 5 regions in China using a randomized, stratified, multi-stage sampling method. EDS was measured by the Epworth Sleepiness Scale, while gastroesophageal reflux disease (GERD) and other FGIDs were assessed by Reflux Disease Questionnaire and the Rome II diagnostic criteria, respectively. RESULTS: The survey was completed by 2906 individuals (response rate: 80.72%), and 644 individuals (22.16%) had EDS. EDS was significantly associated with ulcer-like dyspepsia (OR, 2.50; 95% CI, 1.08–5.79), diarrhea-predominant IBS (OR, 2.00; 95% CI, 1.09–3.66), alternating IBS (OR, 2.32; 95% CI, 1.30–4.13), functional constipation (OR, 1.68; 95% CI, 1.20–2.35), and GERD (OR, 1.72; 95% CI, 1.08–2.72). Risk of EDS increased along with the increasing numbers of FGIDs: with 1 FGID (OR, 1.72; 95% CI, 1.37–2.15); with 2 FGIDs (OR, 2.43; 95% CI, 1.63–3.62); and with 3 or more FGIDs (OR, 3.26; 95% CI, 1.37–7.78). CONCLUSIONS: FGIDs, such as ulcer-like dyspepsia, diarrhea-predominant IBS, alternating IBS, functional constipation, and GERD, were significantly associated with EDS. Those who suffered from more kinds of FGIDs were more susceptible to EDS.
China* ; Constipation ; Disorders of Excessive Somnolence ; Dyspepsia ; Epidemiology ; Gastroesophageal Reflux ; Gastrointestinal Diseases* ; Irritable Bowel Syndrome ; Methods

BACKGROUND/AIMS: Bloating is common bothersome symptoms and most studies conducted in the Western countries found that bloating was frequently associated with lower gastrointestinal (GI) symptoms but many patients complaint bloating as upper GI symptoms in the clinical setting. This study was conducted to assess the prevalence of bloating, and to identify symptom grouping and finally document the impact of bloating in the diagnosis of functional GI disorders. METHODS: Participants in a comprehensive health-screening cohort were enrolled. They were asked about demographic, medical, and social history and upper and lower GI symptoms by using a validated questionnaire. Factor analysis with principal component analysis method with varimax rotation was used. RESULTS: Among the total of 1050 subjects (mean age, 44.6 ± 10.2 years; females, 46.4%), significant bloating symptoms were found in 282 (26.9%); the prevalence of functional bloating was 6.9%. Factor analysis revealed a 5-component structure with upper GI symptoms, constipation, diarrhea-predominant irritable bowel syndrome (IBS), constipation-predominant IBS, and fecal incontinence. Abdominal bloating loaded on both the upper GI symptoms (0.51 of loadings) and constipation (0.40). On logistic regression analysis, bloating was more predictable for IBS (OR, 7.5; P < 0.001) than functional dyspepsia (FD; OR, 3.7; P = 0.002). Bloating was more frequently combined with IBS according to their severity, but this association was not detected in patients with FD. CONCLUSIONS: Abdominal bloating is common symptom in about a quarter of patients and appears as upper as well as lower GI symptoms. However, abdominal bloating is more predictable for IBS, especially constipation-predominant IBS, than FD.
Cohort Studies ; Constipation ; Diagnosis ; Dyspepsia ; Epidemiology ; Fecal Incontinence ; Female ; Gastrointestinal Diseases* ; Humans ; Irritable Bowel Syndrome ; Logistic Models ; Methods ; Prevalence ; Principal Component Analysis

BACKGROUND/AIMS: The prevalence of irritable bowel syndrome (IBS) has risen considerably over the past decade in Singapore. We aim to explore the contribution of changes in diet, lifestyle and habits that may contribute to the increased prevalence and development of IBS. METHODS: This is a survey-based cross-sectional population study aimed to gather demographic, socio-economical, lifestyle, dietary, antibiotic usage and other related information. Subjects were adult male or female Singaporeans aged 21 years or above. Association of the factors gathered with the presence or absence of IBS (by Rome III criteria) was assessed using chi-square or Fisher’s exact test. Variables with a level of statistical significance of 0.1 or less in the univariate analysis were entered into a stepwise logistic regression model. RESULTS: A total of 297 subjects participated in the study (female 60.3%). Overall, 20.9% subjects fulfilled the Rome III IBS criteria. Univariate analysis showed that IBS was associated with pet ownership, antibiotic usage, late dinner, (> 9 PM) and consumption of Western meals, coffee, and bread. The multivariate logistic regression analyses showed that IBS was independently associated with being a pet owner (P = 0.008; OR, 2.5; 95% CI, 1.278–5.037). CONCLUSIONS: The prevalence of IBS was 20.9% using the Rome III criteria in our study. The association between IBS and pet ownership will need further investigation.
Adult ; Bread ; Coffee ; Diet ; Epidemiology ; Female ; Humans ; Irritable Bowel Syndrome* ; Life Style* ; Logistic Models ; Male ; Meals ; Ownership ; Pets ; Prevalence* ; Singapore*

PURPOSE: Recent studies have revealed close relationships between hepatic injury, metabolic pathways, and gut microbiota. The microorganisms in the intestine also cause irritable bowel syndrome (IBS). The aim of this study was to examine whether IBS was associated with elevated hepatic enzyme [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)], gamma-glutamyl transferase (gamma-GT) levels, and metabolic syndrome (MS). MATERIALS AND METHODS: This was a retrospective, cross-sectional, case-control study. The case and control groups comprised subjects who visited our health promotion center for general check-ups from June 2010 to December 2010. Of the 1127 initially screened subjects, 83 had IBS according to the Rome III criteria. The control group consisted of 260 age- and sex-matched subjects without IBS who visited our health promotion center during the same period. RESULTS: Compared to control subjects, patients with IBS showed significantly higher values of anthropometric parameters (body mass index, waist circumference), liver enzymes, gamma-GT, and lipid levels. The prevalences of elevated ALT (16.9% vs. 7.7%; p=0.015) and gamma-GT (24.1% vs. 11.5%; p=0.037) levels were significantly higher in patients with IBS than in control subjects. A statistically significant difference was observed in the prevalence of MS between controls and IBS patients (12.7% vs. 32.5%; p<0.001). The relationships between elevated ALT levels, MS, and IBS remained statistically significant after controlling for potential confounding factors. CONCLUSION: On the basis of our study results, IBS may be an important condition in certain patients with elevated ALT levels and MS.
Adult ; Alanine Transaminase/analysis/*metabolism ; Aspartate Aminotransferases/analysis/*metabolism ; Body Mass Index ; Case-Control Studies ; Cross-Sectional Studies ; Female ; Humans ; Irritable Bowel Syndrome/diagnosis/*enzymology/epidemiology ; Liver/metabolism ; Male ; Metabolic Syndrome X/complications/diagnosis/*enzymology/epidemiology ; Middle Aged ; Obesity/epidemiology ; Prevalence ; Retrospective Studies ; Waist Circumference ; gamma-Glutamyltransferase/analysis/*metabolism

Functional gastrointestinal disorders (FGIDs), represented by functional dyspepsia (FD) and irritable bowel syndrome (IBS), are a group of disorders that include variable combinations of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. FGIDs account for a significant percentage of patients seen in primary care settings with abdominal symptoms. Although the definition of FGIDs can easily affect the prevalence, the prevalences of dyspepsia/FD and IBS diagnosed by the Rome III criteria in the general population are 5.3-20.4% and 1.1-29.2%, respectively. Recent reports of FD and IBS defined by the Rome III criteria indicated a female predominance. Regarding the subtype prevalence of FD, postprandial distress syndrome was more prevalent than epigastric pain syndrome (5.6-13.9% vs 0.9-9.5%). The subtype prevalence of IBS is characterized by male predominance for IBS with diarrhea and female predominance for IBS with constipation. Factors affecting the development of FGIDs such as epidemiological factors including genetic and environmental factors, are important. Gene polymorphisms are involved in the development of FGIDs. The prevalence differs among races and geographic areas. Foods may affect the development of FGIDs, but the causal relationships between food and FGIDs are not conclusive. The symptoms often regress and appear in the course of these entities. Building a favorable patient-doctor relationship is effective for controlling symptoms of FGIDs. Physicians should explain that FGIDs are highly prevalent conditions, impair the patients' quality of life even without evident underlying organic causes and are not life-threatening conditions to ensure patients' understanding.
Constipation ; Continental Population Groups ; Diarrhea ; Dyspepsia ; Epidemiology* ; Female ; Gastrointestinal Diseases* ; Humans ; Irritable Bowel Syndrome ; Japan* ; Male ; Prevalence ; Primary Health Care ; Quality of Life

PURPOSE: This study investigated evidence for the use of relaxation therapies as interventions to decrease irritable bowel syndrome (IBS) symptoms and severity as well as reduce anxiety and improve quality of life in IBS patients. METHODS: A search of electronic bibliographic databases (e.g., Medline Ovid, Embase, KoreaMed, and National Discovery for Science Leaders) was conducted to identify randomized controlled trials that included relaxation exercise programs for adults (>18 years old) with IBS. Of the 486 publications identified, 8 studies met inclusion and exclusion criteria, and all studies were used in the meta-analysis. We used Cochrane's risk of bias to assess study quality. RESULTS: The results showed that IBS symptoms decreased significantly, 6.19 (95% confidence interval [2.74, 14.02]) and there was no heterogeneity. Symptom severity and anxiety decreased by 0.38 (95% confidence interval [-1.41, 0.65]) and -0.08 (95% confidence interval [-0.38, 0.23]) due to relaxation therapies, but theses scores were not statistically significant. CONCLUSION: This review revealed positive effects of relaxation therapy on IBS symptoms in adult patients with IBS. However, these results should be interpreted with caution due to the small number of studies examined and the associated methodological problems. Further studies are needed to ascertain the longterm effects of relaxation therapy and the underlying psychosocial mechanisms leading to anxiety reduction and improved quality of life.
Adult ; Anxiety ; Bias (Epidemiology) ; Databases, Bibliographic ; Humans ; Irritable Bowel Syndrome* ; Population Characteristics ; Quality of Life ; Relaxation ; Relaxation Therapy*

Patients with dyspepsia/functional dyspepsia (FD) show frequent overlapping of other gastrointestinal (GI) diseases, such as irritable bowel syndrome, and non-GI diseases, in addition to internal subgroup overlapping. These overlap patients have more frequent or more severe symptoms, poorer health-related quality of life and higher somatization scores, and they are more likely to experience anxiety, depression or insomnia compared to non-overlap patients. The higher prevalence of overlap in patients with dyspepsia/FD is not by chance, indicating common pathogeneses, including visceral hypersensitivity, altered GI motility, infection, and stressful early life events. There are few clinical trials targeting overlap in patients with dyspepsia/FD, and no therapeutic strategy has been established. Further studies in this research area are needed. In this review, we describe the epidemiology, pathogenesis and treatment of overlap in patients with dyspepsia/FD.
Anxiety ; Depression ; Dyspepsia* ; Epidemiology ; Gastroesophageal Reflux ; Humans ; Hypersensitivity ; Irritable Bowel Syndrome ; Prevalence ; Quality of Life ; Sleep Initiation and Maintenance Disorders