A 10-Yr Natural History of Symptoms and Factors That Influence Consultation
A 10-Yr Natural History of Symptoms and Factors That Influence Consultation
Objective: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. The natural history of the condition has been studied extensively, but few studies have examined factors that predict its new onset or health care-seeking behavior.
Methods: Individuals, now aged 50-59 yr, originally enrolled in a population-screening program for Helicobacter pylori (H. pylori) were contacted via postal questionnaire, utilizing the Manning criteria for IBS diagnosis. Baseline demographic data, quality of life, and IBS and dyspepsia symptom data were already on file. Consent to examine primary care records was sought, and data regarding IBS- and dyspepsia-related consultations were extracted.
Results: Of 8,407 individuals originally involved, 3,873 (46%) provided symptom data at baseline and 10-yr follow-up. Of 3,659 individuals without IBS at baseline, 542 (15%) developed new-onset IBS at 10-yr follow-up. After multivariate logistic regression, lower quality of life at baseline (odds ratio [OR] 4.41, 99% confidence interval [CI] 2.92-6.65), dyspepsia at baseline (OR 1.77, 99% CI 1.28-2.46), and female gender (OR 2.14, 99% CI 1.56-2.94) were significant risk factors for new-onset IBS. Of 651 individuals with IBS at either baseline or 10-yr follow-up, 113 (17%) consulted a primary care physician with symptoms. H. pylori infection (OR 1.93, 99% CI 1.03-3.62) and any dyspepsia-related consultation (OR 2.14, 99% CI 1.15-4.00) significantly increased the likelihood of consultation.
Conclusions: Poor quality of life at baseline was a strong predictor of new-onset IBS, but not of IBS-related consultation behavior, which was associated with consultation for dyspepsia during the study period.
Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal (GI) tract characterized by abdominal pain or discomfort with an associated disturbance in bowel habit. The condition is common, and has been estimated to account for at least 25% of a gastroenterologist's workload in the outpatient department. In population-based surveys, the prevalence of IBS has been estimated at between 3 and 22%, depending on the diagnostic criteria used to define its presence.
The natural history of the condition has been studied previously, and its prevalence is reported to remain relatively stable over short periods of time, with the resolution of symptoms in some individuals matched by the onset of new symptoms in others. However, as only small numbers of participants developed new-onset IBS in such studies, few meaningful conclusions can be drawn with respect to identifying factors that may influence this phenomenon. In addition, follow-up in these longitudinal studies has been limited to 1 or 2 yr. One study has examined the natural history of the condition over a longer time frame, and reported an increase in prevalence of IBS in the population studied after 7 yr of follow-up, but there are few other published data available to support this observation. A recent systematic review of the natural history of IBS recommended that long-term follow-up studies of individuals based in primary care would be beneficial to our understanding of the condition.
Individuals with IBS are more likely to consume health-care resources than those without GI symptoms. This is probably due, in part, to the fact that between 20 and 80% of those with IBS will consult a primary care physician as a result of their symptoms, and of these, a significant minority may be referred for a specialist opinion in secondary care. Number, frequency, and severity of symptoms experienced, fear of serious underlying illness, lower quality of life, and other coexisting functional GI diseases have been shown to predict consultation behavior. These studies have some limitations because most involve a relatively small number of individuals, and they rely on self-reporting of IBS-related consultations by subjects that is prone to recall bias rather than accurate data collection from primary care records. In addition, none have investigated the effect of numerous sociodemographic variables, other GI disorders, and the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) on consultation behavior in individuals with IBS simultaneously.
It has been suggested that quality of life is significantly impaired in those with IBS compared with that in asymptomatic controls, particularly in those with higher symptom intensity, but as most of these reports are cross-sectional surveys, which can measure associations only at one point in time, it is unclear as to whether IBS causes a reduction in quality of life, or whether individuals with a poor quality of life are more likely to complain of symptoms compatible with IBS.
We have attempted to resolve deficits in the knowledge of the long-term natural history of IBS by conducting a 10-yr longitudinal follow-up study of a large number of individuals, who were originally randomly selected from the general population, to identify factors that may influence both the new onset of symptoms in those previously asymptomatic or not meeting the diagnostic criteria for IBS as well as the decision to consult a physician in primary care as a result of symptoms. We specifically examined the effect of poor quality of life at baseline on both these aspects of the condition, and obtained data concerning IBS-related consultations with a physician directly from the participants' primary care records.
Objective: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. The natural history of the condition has been studied extensively, but few studies have examined factors that predict its new onset or health care-seeking behavior.
Methods: Individuals, now aged 50-59 yr, originally enrolled in a population-screening program for Helicobacter pylori (H. pylori) were contacted via postal questionnaire, utilizing the Manning criteria for IBS diagnosis. Baseline demographic data, quality of life, and IBS and dyspepsia symptom data were already on file. Consent to examine primary care records was sought, and data regarding IBS- and dyspepsia-related consultations were extracted.
Results: Of 8,407 individuals originally involved, 3,873 (46%) provided symptom data at baseline and 10-yr follow-up. Of 3,659 individuals without IBS at baseline, 542 (15%) developed new-onset IBS at 10-yr follow-up. After multivariate logistic regression, lower quality of life at baseline (odds ratio [OR] 4.41, 99% confidence interval [CI] 2.92-6.65), dyspepsia at baseline (OR 1.77, 99% CI 1.28-2.46), and female gender (OR 2.14, 99% CI 1.56-2.94) were significant risk factors for new-onset IBS. Of 651 individuals with IBS at either baseline or 10-yr follow-up, 113 (17%) consulted a primary care physician with symptoms. H. pylori infection (OR 1.93, 99% CI 1.03-3.62) and any dyspepsia-related consultation (OR 2.14, 99% CI 1.15-4.00) significantly increased the likelihood of consultation.
Conclusions: Poor quality of life at baseline was a strong predictor of new-onset IBS, but not of IBS-related consultation behavior, which was associated with consultation for dyspepsia during the study period.
Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal (GI) tract characterized by abdominal pain or discomfort with an associated disturbance in bowel habit. The condition is common, and has been estimated to account for at least 25% of a gastroenterologist's workload in the outpatient department. In population-based surveys, the prevalence of IBS has been estimated at between 3 and 22%, depending on the diagnostic criteria used to define its presence.
The natural history of the condition has been studied previously, and its prevalence is reported to remain relatively stable over short periods of time, with the resolution of symptoms in some individuals matched by the onset of new symptoms in others. However, as only small numbers of participants developed new-onset IBS in such studies, few meaningful conclusions can be drawn with respect to identifying factors that may influence this phenomenon. In addition, follow-up in these longitudinal studies has been limited to 1 or 2 yr. One study has examined the natural history of the condition over a longer time frame, and reported an increase in prevalence of IBS in the population studied after 7 yr of follow-up, but there are few other published data available to support this observation. A recent systematic review of the natural history of IBS recommended that long-term follow-up studies of individuals based in primary care would be beneficial to our understanding of the condition.
Individuals with IBS are more likely to consume health-care resources than those without GI symptoms. This is probably due, in part, to the fact that between 20 and 80% of those with IBS will consult a primary care physician as a result of their symptoms, and of these, a significant minority may be referred for a specialist opinion in secondary care. Number, frequency, and severity of symptoms experienced, fear of serious underlying illness, lower quality of life, and other coexisting functional GI diseases have been shown to predict consultation behavior. These studies have some limitations because most involve a relatively small number of individuals, and they rely on self-reporting of IBS-related consultations by subjects that is prone to recall bias rather than accurate data collection from primary care records. In addition, none have investigated the effect of numerous sociodemographic variables, other GI disorders, and the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) on consultation behavior in individuals with IBS simultaneously.
It has been suggested that quality of life is significantly impaired in those with IBS compared with that in asymptomatic controls, particularly in those with higher symptom intensity, but as most of these reports are cross-sectional surveys, which can measure associations only at one point in time, it is unclear as to whether IBS causes a reduction in quality of life, or whether individuals with a poor quality of life are more likely to complain of symptoms compatible with IBS.
We have attempted to resolve deficits in the knowledge of the long-term natural history of IBS by conducting a 10-yr longitudinal follow-up study of a large number of individuals, who were originally randomly selected from the general population, to identify factors that may influence both the new onset of symptoms in those previously asymptomatic or not meeting the diagnostic criteria for IBS as well as the decision to consult a physician in primary care as a result of symptoms. We specifically examined the effect of poor quality of life at baseline on both these aspects of the condition, and obtained data concerning IBS-related consultations with a physician directly from the participants' primary care records.
