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Notes: Background: We tested the hypothesis that subjects with relatives who suffered from abdominal pain or bowel dysfunction would be at an increased risk of more persistent irritable bowel syndrome.Methods: A valid, self-report questionnaire was mailed to an age- and gender-stratified random sample of residents, aged 30–64 years, in Olmsted County, MN, USA, on three occasions over a 4-year period. Persistent irritable bowel syndrome was defined as the presence of irritable bowel syndrome on at least two of the three surveys, and fluctuating irritable bowel syndrome was defined as the presence of irritable bowel syndrome on only one of the surveys.Results: Subjects were less likely to have persistent irritable bowel syndrome over the age of 50 years [odds ratio (OR), 0.20; 95% confidence interval (CI), 0.09, 0.47]. A positive family history was reported by 23%. A family history of gastrointestinal symptoms was independently associated with persistent irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.5; 95% CI, 1.3, 4.9) and fluctuating irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.4; 95% CI, 1.3, 4.4). However, subjects reporting a positive family history were not more likely to report persistent vs. fluctuating irritable bowel syndrome (OR, 1.2; 95% CI, 0.5, 2.9). The use of non-steroidal anti-inflammatory drugs (OR, 2.3; 95% CI, 1.2, 4.3) and a history of food sensitivity (OR, 3.6; 95% CI, 1.9, 6.9) were the only other predictors of persistent irritable bowel syndrome.Conclusions: A history of abdominal pain or bowel troubles in first-degree relatives appears to be independently associated with both persistent and fluctuating irritable bowel syndrome.

Notes: Background:  Non-cardiac chest pain is a common and expensive condition. Risk factors for non-cardiac chest pain are poorly understood and lack description in the USA community.Aim:  To explore risk factors and health-seeking behaviour in non-cardiac chest pain in a USA community.Methods:  Olmsted County, MN subjects who reported at least monthly or severe chest pain in response to a validated questionnaire were compared with controls. All the Mayo Clinic medical records were reviewed; those with cardiac disease or relevant organic conditions were excluded.Results:  Of 2118 eligible subjects, 1524 (72%) returned a questionnaire, 389 subjects (26%) reported any chest pain and 186 (12.2%) at least monthly or severe chest pain. Of these, 62 were excluded for a cardiac diagnosis or another organic cause. Thus, 124 subjects (9.1%, 95% CI: 7.6–10.8%) reported at least monthly or severe non-cardiac chest pain, of which 65 (52.4%) had frequent reflux symptoms. Independent risk factors for non-cardiac chest pain were obesity (OR 3.0, 95% CI: 1.64–5.50), family history of reflux (OR 2.8, 95% CI: 1.73–4.32), previous cigarette use (OR 2.0, 95% CI: 1.27–3.18), aspirin use (OR 1.5, 95% CI: 1.00–2.31) and use of antiarthritis medicines (OR 2.0, 95% CI: 1.27–3.16). Compared with subjects with non-cardiac chest pain and associated gastro-oesophageal reflux symptoms, subjects with non-cardiac chest pain without associated gastro-oesophageal reflux symptoms were less likely to have a family history of reflux, more likely to be younger, and less likely to be obese. Compared with controls, subjects with non-cardiac chest pain without gastro-oesophageal reflux symptoms were younger (OR 0.97, 95% CI: 0.95–0.99), reported higher somatic symptom scores (OR 1.1, 95% CI: 1.08–1.73) and were more likely to be obese (OR 2.6, 95% CI: 1.15–5.93).Conclusions:  Recurrent or severe non-cardiac chest pain is common in the community. Half of the people with significant non-cardiac chest pain have frequent reflux symptoms, thus, risk factors for non-cardiac chest pain are similar to risk factors for gastro-oesophageal reflux disease. People with non-cardiac chest pain without reflux symptoms have a slightly different risk factor profile.

Notes: Background : Body mass index (BMI) is a risk factor for gastro-oesophageal reflux but may simply be explained by diet and lifestyle.Aim : We aimed to determine the contribution of BMI, diet and exercise to GER.Methods : Community subjects (n = 211, mean age =36 years, 43% males) completed validated questionnaires on gastro-oesophageal reflux, energy expenditure (Harvard Alumni Activity Survey), dietary intake (Harvard Food Frequency Questionnaire) and measures of personality and life event stress. Diet, exercise, BMI and other potential risk factors for reflux were analysed using logistic regression analyses.Results : The overall mean (±s.d.) BMI was 26.6 (±5.7); 79 (37%) reported infrequent (〈weekly) reflux and 16 (8%) reported frequent (≥weekly) reflux. The median caloric intake was 2097 cal/day and the median daily energy expenditure was 1753 cal/day. Among those with BMI 〉 25, 10% reported frequent reflux compared to 4% of those with BMI ≤ 25. In a model which included age, sex and Symptom Checklist-90 somatisation T-score, BMI was associated with reflux (OR per 5 units = 1.9, 95% CI: 1.2, 3.0). In models which included diet and exercise variables, BMI but not diet or exercise was associated with reflux.Conclusion : BMI may be associated with symptomatic gastro-oesophageal reflux independent of diet and exercise.

Notes: Aim : To measure the prevalence of gastro-oesophageal reflux symptoms and to identify associated factors in a representative sample of the Spanish population.Methods : A telephone survey of 2500 subjects was performed using a validated questionnaire. The association of gastro-oesophageal reflux symptoms (defined as the presence of heartburn or acid regurgitation) and their clinical characteristics with potential risk factors was summarized using the odds ratios (OR) obtained by multiple logistic regression.Results : The response rate was 71.2%. The annual prevalence of gastro-oesophageal reflux symptoms was 31.6%[95% confidence interval (CI), 29.8–33.4] and the weekly prevalence was 9.8% (95% CI, 8.6–10.9). Gastro-oesophageal reflux symptoms were associated with excess weight (OR, 1.53; 95% CI, 1.23–1.92), obesity (OR, 1.74; 95% CI, 1.30–2.32), the psychosomatic symptom score (OR, 2.98; 95% CI, 2.41–3.67) and the presence of gastro-oesophageal reflux symptoms in a direct family member (OR, 1.61; 95% CI, 1.17–2.23). Gastro-oesophageal reflux symptoms of ≥ 10 years' duration were more frequent in obese subjects (OR, 1.92; 95% CI, 1.14–3.22) and those with a direct family member with gastro-oesophageal reflux symptoms (OR, 2.42; 95% CI, 1.44–4.06). Factors associated with gastro-oesophageal reflux symptoms of ≤ 1 year duration were a spouse with gastro-oesophageal reflux symptoms (OR, 2.33; 95% CI, 1.39–3.9) and the consumption of 1–5 aspirins/week (OR, 1.70; 95% CI, 1.01–2.86).Conclusions : The prevalence of frequent gastro-oesophageal reflux symptoms in Spain is lower than that observed in other Western populations. The psychosomatic symptom score is the factor most strongly associated with gastro-oesophageal reflux symptoms. Long-term gastro-oesophageal reflux symptoms are associated with certain genetic factors (obesity, family history of gastro-oesophageal reflux symptoms), whereas short-term gastro-oesophageal reflux symptoms are associated with factors of probable environmental nature.

Notes: Background : The prevalence, severity and risk factors of faecal incontinence in women in the community are incompletely characterized.Aim : To develop and validate a self-report questionnaire (faecal incontinence and constipation assessment) to address these issues.Method : Eighty-three women completed the instrument; 20 randomly selected patients answered the faecal incontinence and constipation assessment again 6 weeks later. A gastroenterologist also completed the faecal incontinence and constipation assessment in all 83 subjects after a detailed clinical assessment. Concurrent validity was evaluated by comparing the patient's self-report to a doctor interview for every question. Reproducibility was evaluated by a test–retest approach for every question. The severity of faecal incontinence was rated by incorporating the frequency and type of faecal incontinence, rectal urgency and use of sanitary devices.Results : The questionnaire was well-understood. Reproducibility [median κ statistic, 0.80 (interquartile range: 0.66–0.90)]; and concurrent validity [0.59 (0.47–0.67)] were acceptable. For the index question on faecal incontinence, the κ for reproducibility and concurrent validity was 0.90 and 0.95, respectively. The faecal incontinence severity score was also valid (κ = 0.5).Conclusion : The faecal incontinence and constipation assessment has excellent reproducibility and reasonable validity for assessing the presence, risk factors and severity of faecal incontinence and associated bowel disorders in women when compared against clinical assessment.

Notes: Background : The incidence of irritable bowel syndrome is uncertain. We aimed to determine the incidence of clinically diagnosed irritable bowel syndrome in the community.Methods : Using the Rochester Epidemiology Project, all diagnoses of irritable bowel syndrome made among adult residents of Olmsted County, Minnesota, over a 3-year period were identified. The complete medical records of a random sample of the potential subjects were reviewed for the 10 years prior to the irritable bowel syndrome diagnosis and any patient who had received a previous diagnosis of irritable bowel syndrome was excluded (prevalent cases).Results : The diagnostic index listed 1245 possible irritable bowel syndrome patients; 416 patient charts were reviewed and, of these, 149 were physician diagnosed incident cases of irritable bowel syndrome. The age- and sex-adjusted incidence rate was 196 per 100 000 person-years and increased with age (P = 0.006). The age-adjusted annual incidence per 100 000 in women was higher than in men: 238 vs. 141 (ratio 3:2; P = 0.005). The overall symptom frequency at the time of diagnosis was abdominal pain (73%), diarrhoea (41%) and constipation (16%).Conclusions : The incidence of a clinical diagnosis of irritable bowel syndrome in adults was estimated to be two per 1000 per year, increased with age and was higher in women than men. As many people with irritable bowel syndrome do not seek care, the true incidence of irritable bowel syndrome is likely to be higher.

Notes: Background : The health-related quality of life is impaired in patients with functional gastrointestinal disorders seen in referral centres.Aim : To determine whether the health-related quality of life is impaired in subjects with functional disorders in the community and whether any differences can be explained by psychological co-morbidity.Methods : In a population-based, nested, case–control study, subjects reporting symptoms of either dyspepsia or irritable bowel syndrome and healthy controls were interviewed and completed a battery of psychological measures plus a validated, generic, health-related quality of life measure (Medical Outcomes Study 36-item short form health survey, SF-36). The association between irritable bowel syndrome and dyspepsia and the physical and mental composite scores of SF-36 were assessed with and without adjustment for psychological state.Results : One hundred and twelve cases (30 dyspepsia, 39 irritable bowel syndrome, 32 dyspepsia and irritable bowel syndrome and 11 gastrointestinal symptoms but not dyspepsia or irritable bowel syndrome) and 110 controls were enrolled. In the unadjusted linear regression models, irritable bowel syndrome (but not dyspepsia) was negatively associated with the physical composite score (P 〈 0.05); in an adjusted model, the association between the physical health-related quality of life and irritable bowel syndrome was explained by the Symptom Checklist-90 somatization score alone. In unadjusted models, irritable bowel syndrome and dyspepsia were each negatively associated with the mental composite score (P 〈 0.05). The association between the mental health-related quality of life and dyspepsia remained after adjusting for psychological covariates, but the association between this and irritable bowel syndrome was not significant after adjustment.Conclusions : In the community, health-related quality of life is impaired in subjects with irritable bowel syndrome and dyspepsia; however, much of this association can be explained by psychological factors.

Notes: Background : The impact of irritable bowel syndrome, a gastrointestinal motility disorder, is underestimated and poorly quantified, as clinicians may see only a minority of sufferers.Aim : To determine the prevalence, symptom patterns and impact of irritable bowel syndrome in the US.Methods : This two-phase community survey used quota sampling and random-digit telephone dialling (screening interview) to identify individuals with medically diagnosed irritable bowel syndrome or individuals not formally diagnosed, but fulfilling irritable bowel syndrome diagnostic criteria (Manning, Rome I or II). Information on irritable bowel syndrome symptoms, general health status, lifestyle and impact of symptoms on individuals’ lives was collected using in-depth follow-up interviews. Data were also collected for healthy controls identified in the screening interviews.Results : The total prevalence of irritable bowel syndrome in 5009 screening interviews was 14.1% (medically diagnosed: 3.3%; undiagnosed, but meeting irritable bowel syndrome criteria: 10.8%). Abdominal pain/discomfort was the most common symptom prompting consultation. Most sufferers (74% medically diagnosed; 63% undiagnosed) reported alternating constipation and diarrhoea. Previously diagnosed gastrointestinal disorders occurred more often in sufferers than non-sufferers. Irritable bowel syndrome sufferers had more days off work (6.4 vs. 3.0) and days in bed, and reduced activities to a greater extent than non-sufferers.Conclusions : Most (76.6%) irritable bowel syndrome sufferers in the US are undiagnosed. Irritable bowel syndrome has a substantial impact on sufferers’ well-being and health, with considerable socioeconomic consequences.