Epidemiology of colonic symptoms and the irritable bowel syndrome
Abstract
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.
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The modified Rome II definition used here has been applied in earlier studies and provides data similar to a physician interview.
“We have applied this definition in earlier studies and shown that it provides data similar to that of a physician interview (27,39).”
From Psychosocial Distress and Somatic Symptoms in Community Subjects With Irritable Bowel Syndrome: A Psychological Component Is the Rule (2009) · cites this paper as [27]
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MethodHeightened visceral sensation in functional gastrointestinal disease is not site-specific
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“Despite the high prevalence of so-called functional gastrointestinal disease (1, 2) and its extensive investigation, the underlying alterations of function remain for from clear.”
BackgroundMearin, X. B. (2001) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520152584770 · Cited by 240 · see citing works
“These criteria have subsequently been modi ed by various investigators (4, 8, 9) and other new criteria (10, 11), including the consensus criteria of Rome I (12) and its recent revision, Rome II (13), have been produced.”
BackgroundFord, A. C., Forman, D., Bailey, A. G., Axon, A. T. R., & Moayyedi, P. (2008) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2007.01740.x · Cited by 233 · see citing works
“Our use of at least three symptoms is in line with other reports in the literature (2, 3, 6, 9, 10, 16), and agreement between these and the Rome criteria to define IBS has been excellent in other communitybased studies (2, 5).”
ResultKoloski, N. A., Talley, N. J., & Boyce, P. M. (2001) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2001.03789.x · Cited by 253 · see citing works
“Despite the evidence that abdominal pain is at least responsible for some of the health care seeking in these disorders, no studies have been able to show that abdominal pain accounts for a significant proportion of the variance in health care seeking (1, 11, 16, 23, 26, 27).”
BackgroundResultSelf-citationIdentification of distinct upper and lower gastrointestinal symptom groupings in an urban population
Talley, N. J., Boyce, P. M., & Jones, M. (1998) · Gut · doi:10.1136/gut.42.5.690 · Cited by 226 · see citing works
Self-citationSaito, Y. A., Locke, R. G., Talley, N. J., Zinsmeister, A. R., Fett, S. L., & Melton, J. L. (2000) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2000.03192.x · Cited by 227 · see citing works
“METHODS: A population-based, cross-sectional survey study was conducted by mailing a valid, reliable questionnaire to an age- and gender-stratified random sample of residents of Olmsted County, MN, aged 30–69 yr.”
BackgroundResultInfluentialSelf-citationEvidence of a Genetic Contribution to Functional Bowel Disorder
Morris‐Yates, A. D., Talley, N. J., Boyce, P. M., Nandurkar, S., & Andrews, G. (1998) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.1998.440_j.x · Cited by 225 · see citing works
“In this sample, the prevalence of functional bowel disorder is lower than in community-based studies of IBS, in which the prevalence has been found to range between 9% and 22% (3, 4).”
BackgroundSelf-citationBritish Society of Gastroenterology guidelines for the management of the irritable bowel syndrome
Jones, J. R. A., Boorman, J., Cann, P., Forbes, A., Gomborone, J., Heaton, K., Hungin, P., Kumar, D., Libby, G., Spiller, R. E., et al. (2000) · Gut · doi:10.1136/gut.47.suppl_2.ii1 · Cited by 225 · see citing works
Efficacy of alosetron in irritable bowel syndrome: a meta‐analysis of randomized controlled trials
Cremonini, F., Delgado‐Aros, S., & Camilleri, M. (2003) · Neurogastroenterology & Motility · doi:10.1046/j.1365-2982.2003.00389.x · Cited by 219 · see citing works
Gender-related differences in IBS symptoms
Lee, O. Y., Mayer, E. A., Schmulson, M., Chang, L., & Naliboff, B. (2001) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2001.03961.x · Cited by 228 · see citing works
Boyce, P. M., Koloski, N. A., & Talley, N. J. (2000) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2000.03197.x · Cited by 225 · see citing works
Self-citationMadisch, A., Holtmann, G., Plein, K., & Hotz, J. (2004) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2004.01859.x · Cited by 216 · see citing works
Cremonini, F., & Talley, N. J. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.02.008 · Cited by 215 · see citing works
Self-citationHalder, S. L. S., Locke, G. R., Talley, N. J., Fett, S. L., Zinsmeister, A. R., & Melton, L. J. (2004) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.0269-2813.2004.01807.x · Cited by 211 · see citing works
Self-citationImpairment in work productivity and health-related quality of life in patients with IBS.
Dean, B. B., Aguilar, D., Barghout, V. E., Kahler, K. H., Frech, F. H., Groves, D., & Ofman, J. J. (2005) · PubMed · Cited by 210 · see citing works
Liu, J.-H., Chen, G., Yeh, H., Huang, C.-K., & Poon, S. (1997) · Journal of Gastroenterology · doi:10.1007/bf02936952 · Cited by 210 · see citing works
Familial Association in Adults With Functional Gastrointestinal Disorders
Locke, G. R., Zinsmeister, A. R., Talley, N. J., Fett, S. L., & Melton, L. J. (2000) · Mayo Clinic Proceedings · doi:10.4065/75.9.907 · Cited by 258 · see citing works
Self-citationAndresen, V., Montori, V. M., Keller, J., West, C. P., Layer, P., & Camilleri, M. (2008) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2007.12.015 · Cited by 207 · see citing works
A Double-Blind Placebo-Controlled Trial with Loperamide in Irritable Bowel Syndrome
Efskind, P., Bernklev, T., & Vatn, M. H. (1996) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365529609006766 · Cited by 206 · see citing works
Symptoms and Visceral Perception in Patients With Pain-Predominant Irritable Bowel Syndrome
Lembo, T., Naliboff, B., Munakata, J., Fullerton, S., Saba, L., Tung, S., Schmulson, M., & Mayer, E. A. (1999) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.1999.01009.x · Cited by 202 · see citing works
“Prevalence of Pain Predominance in Tertiary Referral Population It has previously been demonstrated that the presence and frequency of pain is a predictor of health care use (6, 7, 18).”
BackgroundCamilleri, M., Drossman, D. A., Becker, G., Webster, L. R., Davies, A. N., & Mawe, G. M. (2014) · Neurogastroenterology & Motility · doi:10.1111/nmo.12417 · Cited by 200 · see citing works
Camilleri, M. (2001) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2001.00925.x · Cited by 198 · see citing works
Sensory neuro-immune interactions differ between Irritable Bowel Syndrome subtypes
Hughes, P. A., Harrington, A. M., Castro, J., Liebregts, T., Adam, B., Grasby, D. J., Isaacs, N. J., Maldeniya, L., Martin, C. M., Persson, J., et al. (2012) · Gut · doi:10.1136/gutjnl-2011-301856 · Cited by 195 · see citing works
Irritable bowel syndrome in developing countries – a disorder of civilization or colonization?
Gwee, K. (2005) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2005.00627.x · Cited by 193 · see citing works
Kay, L., Jørgensen, T., & Jensen, K. H. (1994) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.1994.tb01115.x · Cited by 193 · see citing works
Cumulative incidence of chronic constipation: a population‐based study 1988–2003
Choung, R. S., Locke, G. R., Schleck, C. D., Zinsmeister, A. R., & Talley, N. J. (2007) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2007.03540.x · Cited by 194 · see citing works
Self-citationRisk factors for irritable bowel syndrome: role of analgesics and food sensitivities
Locke, G. R., Zinsmeister, A. R., Talley, N. J., Fett, S. L., & Melton, L. J. (2000) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2000.01678.x · Cited by 185 · see citing works
“In this study and in our previous reports (3, 9), IBS was significantly associated with a somatic symptom score, which included headache, backache, general stiffness, joint pains, and eye pains.”
ResultSelf-citationLipid-induced intestinal gas retention in irritable bowel syndrome
Serra, J., Salvioli, B., Azpiroz, F., & Malagelada, J. (2002) · Gastroenterology · doi:10.1053/gast.2002.35394 · Cited by 184 · see citing works
Halpert, A., Dalton, C. B., Palsson, O., Morris, C., Hu, Y., Bangdiwala, S., Hankins, J., Norton, N., & Drossman, D. (2007) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2007.01254.x · Cited by 184 · see citing works
“We present the results organized in four themes reflecting the goals of the study: (1) Current knowledge and misconceptions about IBS, (2) educational needs regarding IBS, (3) subgroup analysis of the educational needs based on subgroups by clinic/Web use status, (4) current knowledge and misconceptions about IBS, and…”
BackgroundMethodMeta‐analysis: do irritable bowel syndrome symptoms vary between men and women?
Adeyemo, M. A., Spiegel, B. M. R., & Chang, L. (2010) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2010.04409.x · Cited by 186 · see citing works
Italian consensus conference for colonic diverticulosis and diverticular disease
Cuomo, R., Barbara, G., Pace, F., Annese, V., Bassotti, G., Binda, G. A., Casetti, T., Colecchia, A., Festi, D., Fiocca, R., et al. (2014) · United European Gastroenterology Journal · doi:10.1177/2050640614547068 · Cited by 183 · see citing works
“First, IBS incidence peaks in the second and third decades of life and declines thereafter, whereas diverticulosis increases with age, particularly after 60 years of age.(74) As a consequence, the overlapping conditions are predominantly present in middle-aged or older patients.”
BackgroundEhlers Danlos syndrome and gastrointestinal manifestations: a 20‐year experience at Mayo Clinic
Nelson, A. D., Mouchli, M. A., Valentin, N., Deyle, D., Pichurin, P., Acosta, A., & Camilleri, M. (2015) · Neurogastroenterology & Motility · doi:10.1111/nmo.12665 · Cited by 182 · see citing works
Nicholl, B. I., Halder, S. L. S., Macfarlane, G. J., Thompson, D. G., O’Brien, S. J., Musleh, M., & McBeth, J. (2007) · Pain · doi:10.1016/j.pain.2007.08.029 · Cited by 182 · see citing works
“One of the common FGID symptoms is pain [11,34].”
Serotoninergic neuroenteric modulators
Talley, N. J. (2001) · The Lancet · doi:10.1016/s0140-6736(01)07103-3 · Cited by 178 · see citing works
Self-citationAsian consensus on irritable bowel syndrome
Gwee, K., Bak, Y., Ghoshal, U. C., Gonlachanvit, S., Lee, O. Y., Fock, K. M., Chua, A. S. B., Lu, C., Goh, K., Kositchaiwat, C., et al. (2010) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2010.06353.x · Cited by 172 · see citing works
Choung, R. S., & Locke, G. R. (2011) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2010.12.006 · Cited by 173 · see citing works
Familial aggregation of irritable bowel syndrome: a prospective study
Kalantar, J. S., Locke, G. R., Zinsmeister, A. R., Beighley, C. M., & Talley, N. J. (2003) · Gut · doi:10.1136/gut.52.12.1703 · Cited by 168 · see citing works
Self-citationEpidemiology of irritable bowel syndrome in Asia: Something old, something new, something borrowed
Gwee, K., Lu, C., & Ghoshal, U. C. (2009) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2009.05984.x · Cited by 171 · see citing works
McCrea, G. L., Miaskowski, C. A., Stotts, N. A., Macera, L., & Varma, M. G. (2008) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2008.04.016 · Cited by 167 · see citing works
Immune dysfunction in patients with functional gastrointestinal disorders
Kindt, S., Van Oudenhove, L., Broekaert, D., Kasran, A., Ceuppens, J. L., Bossuyt, X., Fischler, B., & Tack, J. (2009) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2008.01220.x · Cited by 165 · see citing works
Sleep, immunity and inflammation in gastrointestinal disorders
Ali, T. (2013) · World Journal of Gastroenterology · doi:10.3748/wjg.v19.i48.9231 · Cited by 166 · see citing works
Drossman, D. A., Li, Z., Toner, B. B., Diamant, N. E., Creed, F. H., Thompson, D. G., Read, N. W., Babbs, C., Barreiro, M. A., Bank, L., et al. (1995) · Digestive Diseases and Sciences · doi:10.1007/bf02064187 · Cited by 165 · see citing works
Intestinal gas dynamics and tolerance in humans
Serra, J., Azpiroz, F., & Malagelada, J. (1998) · Gastroenterology · doi:10.1016/s0016-5085(98)70133-7 · Cited by 163 · see citing works
Fibromyalgia in The Irritable Bowel Syndrome: Studies of Prevalence and Clinical Implications
Sperber, A. D., Atzmon, Y., Neumann, L., Weisberg, I., Shalit, Y., Abu-Shakrah, M., Fich, A., & Buskila, D. (1999) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.1999.01643.x · Cited by 220 · see citing works
- Authors
- Talley, N. J., Zinsmeister, A. R., van Dyke, C., & Melton, L. J.
- Affiliations
- Mayo Clinic (US)
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 1991-10
- Volume
- 101
- Issue
- 4
- Pages
- 927-934
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W1606920119
- Cited by
- 648
- References
- 33
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 9 · 2022: 6 · 2021: 10 · 2020: 7 · 2019: 4 · 2018: 9 · 2017: 10 · 2016: 8 · 2015: 19 · 2014: 26 · 2013: 16 · 2012: 25
- FWCI
- 17.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5p30dk034988-05)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK 34988)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR030582, AR30582)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- irritable bowel syndrome, functional gastrointestinal disorders, prevalence, abdominal pain, chronic constipation, chronic diarrhea, health-seeking behavior, middle-aged adults, sex differences, Olmsted County, Minnesota, community survey, unmet care needs
- MeSH terms
- Colonic Diseases, Functional, Constipation, Diarrhea, Female, Humans, Male, Middle Aged, Minnesota, Patient Acceptance of Health Care, Surveys and Questionnaires, Abdominal Pain, Prevalence
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