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U.S. Householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact
Abstract
Our objective was to obtain national data of the estimated prevalence, sociodemographic relationships, and health impact of persons with functional gastrointestinal disorders. We surveyed a stratified probability random sample of U.S. householders selected from a data base of a national market firm (National Family Opinion, Inc.). Questions were asked about bowel symptoms, sociodemographic associations, work absenteeism, and physician visits. The sampling frame was constructed to be demographically similar to the U.S. householder population based on geographic region, age of householder, population density, household income, and household size. Of 8250 mailings, 5430 were returned suitable for analysis (66% response). The survey assessed the prevalence of 20 functional gastrointestinal syndromes based on fulfillment of multinational diagnostic (Rome) criteria. Additional variables studied included: demographic status, work absenteeism, health care use, employment status, family income, geographic area of residence, population density, and number of persons in household. For this sample, 69% reported having at least one of 20 functional gastrointestinal syndromes in the previous three months. The symptoms were attributed to four major anatomic regions: esophageal (42%), gastroduodenal (26%), bowel (44%), and anorectal (26%), with considerable overlap. Females reported greater frequencies of globus, functional dysphagia, irritable bowel syndrome, functional constipation, functional abdominal pain, functional biliary pain and dyschezia; males reported greater frequencies of aerophagia and functional bloating. Symptom reporting, except for incontinence, declines with age, and low income is associated with greater symptom reporting. The rate of work/school absenteeism and physician visits is increased for those having a functional gastrointestinal disorder. Furthermore, the greatest rates are associated with those having gross fecal incontinence and certain more painful functional gastrointestinal disorders such as chronic abdominal pain, biliary pain, functional dyspepsia and IBS. Preliminary information on the prevalence, socio-demographic features and health impact is provided for persons who fulfill diagnostic criteria for functional gastrointestinal disorders.
... Chronic anorectal pain is estimated to be a common symptom in 11% of the population. However, despite its prevalence and its impact on quality of life, few works have been published in the literature addressing the epidemiology and pathophysiology, making anorectal pain difficult to diagnose and treat [5][6][7][8]. ...
... When considering functional anorectal pain, the prevalence of levator ani syndrome symptoms in the overall population is 6.6%. More than 50% of those affected are between the ages of 30 and 60 years, and this percentage includes more women than men [5,7,12]. ...
... For proctalgia fugax the prevalence is difficult to estimate because of the episodic and self-limiting nature of the problem. It ranges from 6% to 18% and is comparable in both men and women [5,12]. High levels of anxiety disorders, depression, and stress are present in patients suffering from proctalgia fugax and undefined anorectal pain and may act as triggers [12][13][14]. ...
Chronic pelvic pain is a hidden issue which needs to involve many different usually uncoordinated specialists. For this reason there is a risk that treatments, in the absence of well-defined pathways, common goals, and terminology, may be poorly effective. The aim of the present paper is to summarize the evidence on anorectal pelvic pain, offering useful evidence-based practice parameters for colorectal surgeons’ daily activity. Analysis of chronic anorectal and pelvic pain syndromes, the diagnostic and clinical optimal needs for evaluation, and the innumerable low evidence treatments and therapeutic options currently available suggests that a multimodal individualized management of pain may be the most promising approach. The limited availability of dedicated centers still negatively affects the applicability of these principles.
... It has become increasingly evident that previously published epidemiological data [1,2] for disorders of gutbrain interaction (DGBI) [and predominantly irritable bowel syndrome (IBS)] were outdated [3] partially because of the change of the diagnostic criteria in the most recent version of the ROME IV diagnostic tool from 2016 [4]. The difference in the prevalence of IBS using the ROME III and ROME IV criteria is especially significant [1], as the ROME IV criteria are more symptom-specific [5]. ...
... It has become increasingly evident that previously published epidemiological data [1,2] for disorders of gutbrain interaction (DGBI) [and predominantly irritable bowel syndrome (IBS)] were outdated [3] partially because of the change of the diagnostic criteria in the most recent version of the ROME IV diagnostic tool from 2016 [4]. The difference in the prevalence of IBS using the ROME III and ROME IV criteria is especially significant [1], as the ROME IV criteria are more symptom-specific [5]. Therefore, the Rome Foundation Global Epidemiological Study (RFGES) was performed with recently published data [6]. ...
Introduction
There is a substantial lack of data regarding the prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) in the region of Central/Eastern Europe. It is a well-described and known fact that environmental, ethnic, dietary, and cultural factors can influence the reporting of symptoms. Therefore, we aim to provide the first data documenting the prevalence of specific disorders of gut-brain interaction in Slovakia.
Methods
This is a multicenter-based study. The study population consists of medical students from three medical faculties in Slovakia, mainly with Slovakian and Scandinavian permanent residency. Data collection was performed by means of anonymous questionnaires consisting of several demographic questions. Two forms of questionnaires were used. One was in paper form, and the second was distributed via email.
Results
Altogether, 1061 students participated in this study. Symptoms of IBS were presented in 7.3% of students, and FD in 13%. In the Slovakian group, these were FD 12%, and IBS 7%. The subgroup from Scandinavia shows a prevalence of IBS of 11.7% and FD of 14.0%. A lack of exercise and a vegan diet are related to a higher presence of FD.
Conclusion
The results of this multicentre study represent the first published data for the presence of symptoms of IBS and FD in Slovakia. Our data also show a significantly higher prevalence of IBS in students from Scandinavia compared with those from Central/Eastern Europe. A higher frequency of physical exercise is associated with a lower presence of symptoms of FD. On the other hand, the symptoms of FD were mostly prevalent in the group adhering to a vegan and vegetarian type diet.
... Patients with IBS often visit medical facilities even for minor ailments. [26][27][28] The high frequency of visits to medical facilities may have increased exposure to many kinds of drugs, resulting in a higher frequency of drug allergy. Female sex was a risk factor for FGIDs. ...
Background/Aims
Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS. The aim of this study is to determine this issue in young people.
Methods
A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria. Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire.
Results
The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15-1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018).
Conclusion
Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population.
Background
Functional dyspepsia is a highly prevalent digestive disorder. The limited effectiveness of current pharmaceutical interventions necessitates the exploration of alternative therapeutic options for functional dyspepsia. Xiangsha liujunzi decoction, a well-known traditional Chinese medicine formulation, has been widely employed in the treatment of functional dyspepsia in China. Nevertheless, the effectiveness of Xiangsha liujunzi decoction in the treatment of functional dyspepsia remains uncertain.
Objective
To examine the effectiveness and safety of Xiangsha liujunzi decoction for treating functional dyspepsia.
Methods
We retrieved seven databases containing randomized controlled trials on functional dyspepsia published up until 31 July 2023. The quality of these studies was evaluated using the Cochrane Risk of Bias assessment tool. The analysis of data was performed using the software RevMan 5.4. The total clinical effectiveness rate was evaluated as the primary outcome. In addition, gastric emptying rate, symptom score and safety evaluation were evaluated as the secondary outcomes.
Results
The meta-analysis included 23 studies, involving 2,101 individuals. Xiangsha liujunzi decoction demonstrated a significantly higher clinical effectiveness rate compared to the control group (RR 1.27; 95% CI 1.21, 1.33; p < 0.00001). Moreover, it exhibited superior gastric emptying rate and symptom score improvement compared to the control group. Nevertheless, no remarkable differences were detected in safety between Xiangsha liujunzi decoction and the control group (RR 0.67; 95% CI 0.16, 2.76; p = 0.58).
Conclusion
The findings of this study suggest that Xiangsha liujunzi decoction exhibits effectiveness and no significant adverse events observed. However, because of the low quality of the enrolled studies, more high-quality and strict design randomized controlled trials are required in the future.
Functional dyspepsia (FD) is categorized into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). FD is 1.36–2.71 times more common in women than in men in the studies of outpatient clinic, and women demonstrated a higher prevalence in large-scale studies of health checkup participants. Usually, the rate of Helicobacter pylori (H. pylori) infection is significantly higher among males than females after the age of 16. The prevalence of atrophic gastritis and intestinal metaplasia is also higher in males than in females. Furthermore, duodenal and gastric ulcers were twice as common among males as females. However, the incidence of nonsteroidal anti-inflammatory drug (NSAID)-induced gastric ulcers has recently increased among females who take NSAIDs more than males, resulting in gastric ulcers becoming relatively more prevalent and attenuating sex/gender differences. The Lauren classification categorizes gastric cancer (GC) into two types: the intestinal-type and the diffuse-type. A higher prevalence of GC in males than in females can be observed throughout the world, but younger patients with GC are more likely to be female, have the diffuse and undifferentiated types, and present with advanced GC (AGC). Older patients with GC are more likely to be male, have the intestinal-type, and present with simultaneous tumors. A multivariate analysis of the risk factors of diffuse-type GC found that female sex, age under 50, family history of GC, and smoking were independent risk factors. In females, the diffuse-type accounts for most cases before menopause, but the proportion of the intestinal-type becomes similar to that in males 20 years after menopause, indicating that female sex hormones suppress the incidence of intestinal-type GC. Interestingly, the risk of cardiac GC is associated with obesity. This elevated cardiac GC risk related to obesity being greater in males than in females with the following reasons: First, increased concentrations of female hormones in obese females might have a protective effect against GC. Second, different prevalence of cardiac GC precursors such as Barrett’s esophagus is higher in males than in females. Meanwhile, being underweight increases the risk of noncardiac GC, especially in females mainly in Asian countries.
Background
Observational studies have suggested associations between functional gastrointestinal disorders (FGIDs) and variations in the cerebral cortex. However, the causality of these relationships remains unclear, confounded by anxiety and depression. To clarify these causal relationships and explore the mediating roles of anxiety and depression, we applied univariate, multivariable, and mediation Mendelian randomization (MR) analyses.
Method
We utilized genome-wide association study (GWAS) summary data from the FinnGen database and the ENIGMA consortium, identifying genetic variants associated with irritable bowel syndrome (IBS), functional dyspepsia (FD), and cerebral cortex structures. Data on anxiety and depression came from FinnGen and a large meta-analysis. Utilizing a bidirectional univariate MR approach, we explored correlations between FD, IBS, and cortex variations. Then, independent effects were assessed through multivariable MR. A meta-analysis of these results, incorporating data from two cohorts, aimed to increase precision. We also explored the potential mediating roles of anxiety and depression.
Results
Our findings indicate a negative causal correlation between FD and the thickness of the rostral anterior cingulate cortex (rACC) across both global and regional adjustments (β = −0.142, 95% confidence interval (CI): −0.209 to-0.074, P.FDR = 0.004; β = −0.112, 95%CI: −0.163 to-0.006, P.FDR = 0.003) and a positive causal correlation with the globally adjusted thickness of the superior frontal gyrus (SFG) (β = 0.107, 95%CI: 0.062 to 0.153, P.FDR = 0.001). The causal correlation with the rACC persisted after multiple variable adjustments (β = −0.137, 95% CI: −0.187 to-0.087, P.FDR = 1.81 × 10⁻⁵; β = −0.109, 95%CI: −0.158 to-0.06, P.FDR = 0.002). A significant causal association was found between globally adjusted surface area of the caudal anterior cingulate cortex (cACC) and IBS (odds ratio = 1.267, 95%CI: 1.128 to 1.424, P.FDR = 0.02). The analysis showed that neither anxiety nor depression mediated the relationship between FGIDs and cerebral cortex structures.
Conclusion
Our research provides significant MR evidence of a bidirectional causal relationship between FGIDs and the cerebral cortex structures. This evidence not only confirms the two-way communication along the brain-gut axis but also illuminates the underlying pathophysiology, paving the way for identifying potential therapeutic approaches.
Background
Globus pharyngeus is a clinical condition, wherein, a patient senses a lump or a foreign body in the throat with a tightening or choking feeling. A strong association between globus pharyngeus and gastroesophageal reflux disease (GERD) was reported. Therefore, we sought to investigate the predictive factors of globus pharyngeus in patients with established GERD and fit a predictive scoring model for globus pharyngeus.
Methods
In this case-control study, 143 patients having globus pharyngeus along with GERD ( case ) and 109 patients having globus pharyngeus without GERD ( control ) were enrolled. Data comprising demographics, comorbidities, and psychosocial stress levels were recorded. The predictive factors of globus pharyngeus in patients with GERD were unraveled, and a predictive scoring model was fit for globus pharyngeus.
Results
Proton pump inhibitor usage in the case group was significantly higher compared to controls (63.63% vs 24.78%, P < 0.001), and differences in Hiatus Hernia and Stress levels were highly significant between the two groups ( P < 0.001). Multivariate logistic regression revealed that variates, Hiatus Hernia, psychosocial stress, and age were highly significant ( P < 0.001) independent predictors of globus pharyngeus. Using the regression coefficients of all the independent predictor variables, a predictive scoring model was fitted, which yielded an area under receiver operating characteristic (AUROC) curve of 78.9.
Conclusion
Hiatus hernia, psychosocial stress, and age are significant independent predictors of globus pharyngeus in GERD, and our predictive scoring model may help in identifying patients at higher odds of experiencing globus pharyngeus and modulate treatment accordingly.
Globus pharyngeus is a common symptom with considerable suffering. Globus sensation can be caused by reflux. In many places, endoscopy of the esophagus is recommended for clarification, especially when there is a question about the presence of a hiatal hernia as the cause of reflux. Transnasal esophagogastroscopy (TNE) represents an alternative to conventional gastroesophagoscopy. It enables a quick low-complication examination of the upper aerodigestive tract in the sitting, non-sedated patient.
The aim of this work was to assess the feasibility of outpatient TNE in patients with globus sensation. Furthermore, the results of dual-probe pH monitoring were compared with the results of TNE in order to assess the value of TNE in the clarification of globus sensation and reflux.
In 30 patients with globus symptoms, 24-hour dual-probe pH monitoring and TNE were performed. In pH monitoring, reflux number, fraction time, reflux surface area index, and DeMeester score were evaluated as indicators of laryngopharyngeal reflux (LPR) and gastroesophageal reflux (GERD). Abnormalities of the esophageal mucosa and the gastroesophageal junction were recorded in TNE. The results were compared.
The TNE could be performed without any complications. Mean examination time was 5.34 ± 0.12 min. Reflux was measured in 80% of the patients (24/30) with pH monitoring. In almost half of these patients (46%), abnormalities were detected in TNE as indirect evidence of reflux. In addition to an axial hiatal hernia, these included mucosal changes such as erosive esophagitis and Barrett’s metaplasia. Patients with a hiatal hernia also suffered significantly more often from LPR than patients without a hernia (9:1).
TNE is a quick and safe examination method for diagnosing patients with an unclear globus sensation. Detection of a hiatal hernia can be seen as an indication of reflux disease. Lack of evidence of a hernia does not rule out reflux. Thus, TNE is a useful addition to pH monitoring in patients with globus sensation, because reflux-related changes in the mucosa can be recognized early and adequately treated.
Background
Aerophagia (ingestion of air), is a functional aerodigestive disorder in people. Criteria for diagnosis of aerophagia in dogs are >1/3 of bolus volume containing air or ingested air resulting in gastric distention (>1/3 of end gastric volume). Aerophagia is highlighted during eating and drinking. Videofluoroscopic swallow studies (VFSS) document aerophagia in dogs, but the incidence, clinical signs (CS), and associated disorders are unknown.
Objectives
Identify the incidence of aerophagia, compare CS between dogs with and without aerophagia, and identify associated and predisposing disorders using VFSS.
Animals
A total of 120 client‐owned dogs.
Methods
Sequential VFSS and associated medical records from dogs presenting to veterinary teaching hospitals at Auburn University and the University of Missouri were retrospectively reviewed. Statistical comparisons were made using Mann‐Whitney and chi‐squared tests, odds ratios (OR), and multiple logistic regression (P < .05).
Results
The incidence (95% confidence interval [CI]) of aerophagia was 40% (31.7‐48.9). Dogs with mixed CS (gastrointestinal [GI] and respiratory; P < .001, 58.3%) were more likely to have aerophagia than dogs with exclusively respiratory CS (25%). Aerophagia was significantly more common in brachycephalic dogs (P = .01; 45.8% vs 13.8%), dogs with nonbrachycephalic upper airway obstruction (P < .001; 33.3% vs 4.1%), pathologic penetration and aspiration (P‐A) scores (P = .04; 41.6% vs 23.6%), and gagging (P < .001; 25% vs 11.7%). Mixed CS (P = .01), brachycephaly (P < .001), and upper airway obstruction (P < .001) were independent predictors of aerophagia.
Conclusions and Clinical Importance
Aerophagia was common, particularly in dogs with mixed CS. Brachycephalic dogs and dogs with upper airway obstruction are predisposed. Aspiration risk was high, emphasizing overlapping upper aerodigestive pathways.
Since it is not known whether the symptoms and bowel function of patients with the irritable bowel syndrome are truly abnormal we used diaries and frequent telephone interviews over a 31 day period to assess symptoms, defecation, and stool types in 26 unselected female hospital patients with the irritable bowel syndrome, 27 women who admitted to recurrent colonic pain but had not consulted a doctor (non-complainers), and 27 healthy control subjects. Unexpectedly, abdominal pain and bloating occurred in most of the control subjects. Pain, however, was six times more frequent in the patients and was more often considered severe. Bloating occurred three times more often. Defecation was more frequent, more erratic in timing and stool form, and more likely to produce stools of extreme forms, indicating rapid fluctuations in intestinal transit time. Urgency was four times more prevalent in patients than control subjects. Straining to finish defecating was nine times more prevalent and was often accompanied by feelings of incomplete evacuation--a combination which could lead to the misdiagnosis of constipation. The normal relation between stool form and the above symptoms was distorted, possibly due to rectal irritability. Non-complainers were intermediate between patients and control subjects in almost every parameter but were closer to control subjects than to patients. Patients with the irritable bowel syndrome have real cause for complaint and their bowel function is truly abnormal.
One hundred and fifty hospital outpatients were questioned about their bowel habits and then asked to record these in diary booklets for two weeks. Overall, recalled and recorded figures for frequency of defecation agreed fairly closely, but in 16% of patients there was a discrepancy of three or more bowel actions per week. This was usually an exaggeration of the difference from the norm of one a day. Patients were bad at predicting episodes of changed bowel frequency. These findings cast doubt on the value of population surveys of bowel habit based solely on questionnaires. They also suggest that the irritable bowel syndrome might be correctly diagnosed more often if patients were routinely asked to record their bowel actions.
In dentistry, the vast majority of studies attempting to predict who is at high risk for getting a disease or condition, or attempting to identify risk factors for a specific disease or condition, have focused either on only one risk factor at a time, or have measured multiple potential risk factors, but analyzed their effects in isolation. Since researchers tend to agree that most dental conditions have a multiple etiology, it is necessary to develop models that consider simultaneously the effect of a number of potential risk factors on the disease or condition of interest if we are to have any understanding of the relative impact of potential risk factors. Many existing statistical techniques will aid dental researchers in identifying risk factors. However, the selection of an appropriate analytic technique depends on a number of conditions. The strategy for this paper is to discuss a wide range of possible statistical techniques that may be applied to the problem of deriving a model for identification of multiple risk factors for dental diseases and conditions. We have approached this task by presenting a number of dental research problems needing an appropriate analytic technique. Next, basic issues that must be considered in choosing an appropriate analytic strategy are discussed. These issues include features of the study design, the data structure of the variables being measured, and the types of assumptions that are applicable to provide valid inferences about the target population of interest. A matrix of possible analytic techniques is presented for various combinations of study-design and data-structure features. After a discussion of each of the techniques, the appropriate statistical techniques for each of the dental examples are described. The issues and examples presented in this paper should be of use to dental researchers who wish to investigate multiple risk factors for a disease or condition of interest.
Functional gastrointestinal disease is believed to be very common, but reports of its prevalence have not usually evaluated random community samples, and validated questionnaires have not been used to elicit symptoms. The prevalence of specific colonic symptoms and the irritable bowel syndrome among representative middle-aged whites was determined from a defined population, and the impact of these symptoms on presentation for medical care was measured. An age- and sex-stratified random sample of 1021 residents of Olmsted County, Minnesota, aged 30-64 years, was obtained. All subjects were mailed a valid self-report questionnaire that identified gastrointestinal symptoms and functional gastrointestinal disorders. The response rate was 82% (n = 835). The age- and sex-adjusted prevalence of abdominal pain (more than six times in the prior year) was 26.2 per 100 (95% confidence interval, 23.1-29.2). The prevalence of chronic constipation (hard stools and straining and/or less than 3 stools per week greater than 25% of the time) was 17.4 (95% confidence interval, 14.8-20.0), whereas the prevalence of chronic diarrhea (loose watery stools, and/or greater than 3 stools per day greater than 25% of the time) was 17.9 (95% confidence interval, 15.3-20.5). The prevalence of abdominal pain and disturbed defecation was similar in women and men, except that infrequent defecation and straining at stool were more common in women. Using the Manning symptom criteria to identify irritable bowel syndrome (greater than or equal to 2 of 6 symptoms in those with abdominal pain more than six times in the prior year), the prevalence of irritable bowel syndrome was 17.0 per 100 (95% confidence interval, 14.4-19.6). Overall, 71 persons (9%) reported visiting a physician for abdominal pain or disturbed defecation in the prior year; a subset of variables related to pain severity were the best predictors of health care seeking after adjustment for age and gender. However, these accounted for only 22% of the log likelihood. In conclusion, more than one third of an unselected middle-aged population reported chronic abdominal pain or disturbed defecation, and more than one in six had symptoms compatible with the irritable bowel syndrome. Only a minority had presented for medical evaluation; moreover, the characteristics of the abdominal complaints did not explain the seeking of health care in most cases.
Health planning efforts for the population age 65 and over have been hampered continually by the lack of reliable estimates of the noninstitutionalized long-term care population. Until recently national estimates were virtually nonexistent, and reliable small area estimates remain unavailable. However, with the recent publication of several national surveys and the 1990 Census, synthetic estimates can be made for states and counties by using multivariate methods to model functional dependency at the national level, and then applying the predicted probabilities to corresponding state and county data. Using the 1984 National Health Interview Survey's Supplement on Aging and the 1986 Area Health Resources File System, we have produced log-linear regression models that include demographic and contextual variables as predictors of functional dependency among the noninstitutionalized population age 65 and over. Age, sex, race, and the percent of the 65 and over population who reside in poverty were found to be significant predictors of functional dependency. Applying these models to 1986 Medicare Enrollment Statistics, regression-adjusted synthetic estimates of two levels of functional dependency were produced for all states and--as examples of how the rates can be used to produce additional synthetic estimates--the largest county in each state. We also produced point estimates and standard errors for the national prevalence of functional dependency among the noninstitutionalized population age 65 and over.
Data from six large, systematic national health surveys were examined to provide a more complete description of the epidemiology of irritable bowel syndrome in the United States. Data from the Second National Health and Nutrition Examination Survey, 1976-1980, indicated 4.7 million people (2.9% of the population) with self-reported diagnoses of irritable bowel syndrome. Rates for women were 3.2 times those for men, and rates for whites were 5.3 times those for blacks. Rates were highest among those aged 45-64 years. More than 2.6 million (1.6% of the population) were symptomatic at the time of the survey. Data from the National Ambulatory Medical Care Survey, 1985, and the National Disease and Therapeutic Index, 1987, documented between 2.4 and 3.5 million yearly visits to physicians by patients with irritable bowel syndrome and more than 2.2 million medications prescribed. Rates of hospitalization for women have fallen from 71.9 (per 100,000 population) in 1982 to 21.1 in 1987 based on data from the National Hospital Discharge Survey. A similar pattern was observed in data from the Commission on Professional and Hospital Activities. The data support the impression that irritable bowel syndrome is a prevalent condition in the United States with significant impact on health care. Large-scale, population-based surveys using standard criteria are needed to estimate the true extent of irritable bowel syndrome.
Although the collective health of the nation has improved dramatically in the past 30 years, surveys reveal declining satisfaction with personal health during the same period. Increasingly, respondents report greater numbers of disturbing somatic symptoms, more disability, and more feelings of general illness. Four factors contribute to the discrepancy between the objective and subjective states of health. First, advances in medical care have lowered the mortality rate of acute infectious diseases, resulting in a comparatively increased prevalence of chronic and degenerative disorders. Second, society's heightened consciousness of health has led to greater self-scrutiny and an amplified awareness of bodily symptoms and feelings of illness. Third, the widespread commercialization of health and the increasing focus on health issues in the media have created a climate of apprehension, insecurity, and alarm about disease. Finally, the progressive medicalization of daily life has brought unrealistic expectations of cure that make untreatable infirmities and unavoidable ailments seem even worse. Physicians should become more aware of these paradoxical consequences of medical progress so that they do not inadvertently contribute to a rising public dissatisfaction with medicine and medical care.
The frequency of urgency and fecal soiling in the population and among people with irritable bowel syndrome (IBS), and the association of these symptoms with health care seeking is unknown. Among 1128 students and hospital employees that we surveyed, urgency was reported in 14.4%, fecal soiling in 5.3%, and diarrhea in 9.0%. Most persons with fecal soiling did not report urgency or diarrhea. Although bowel dysfunction compatible with IBS was present in 20% (227), only 29% of this group (65) had seen a physician for bowel complaints. People with bowel dysfunction were more likely to be women, to take laxatives, and to have rectal urgency. Fecal soiling was more likely among those with bowel dysfunction who had been to the doctor, and included almost half of the men in this group. There was no difference in the frequency of diarrhea reported among those with bowel dysfunction regardless of whether they had been to the doctor. These data suggest fecal soiling may influence people with bowel dysfunction to go to the doctor. Physiological studies are needed to determine if anal sphincter dysfunction is a component of IBS.
The Delphi technic is a method for obtaining answers to questions that are issues of uncertainty even to experts. Its use for finding a group consensus is illustrated here by its application to a problem of predicting human mortality from an experiment in which trauma to the liver was produced in animals by a riotcontrol device. Expert surgeons were asked to fill in a questionnaire in which they estimated human mortality as a function of the severity of the injury. These initial estimates were then modified by application of a second round of the Delphi technic. Although inherent uncertainties remained, there was a marked increase in the consistency of the answers from the first to the second round. Evidence suggests an increase in reliability as well. (N Engl J Med 288:1272–1275, 1973)