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Cited by 129Gastrointestinal motility and disordersPsychosomatic Disorders and Their TreatmentsFibromyalgia and Chronic Fatigue Syndrome Research

Psychosocial Distress and Somatic Symptoms in Community Subjects With Irritable Bowel Syndrome: A Psychological Component Is the Rule

Open access
Choung, Rok Seon, Locke, G Richard, Zinsmeister, Alan R, Schleck, Cathy D, Talley, Nicholas J·2009·The American Journal of Gastroenterology
DOI 10.1038/ajg.2009.239PMC PMC3772628
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Abstract

OBJECTIVES: Psychosocial factors may drive people with irritable bowel syndrome (IBS) to seek health care, but whether psychological factors are causally linked to IBS is controversial. One hypothesis is that IBS is a heterogeneous syndrome comprising two distinct conditions, one psychological and the other biological. However, it is unclear how many people with IBS in the community have little somatization and minimal psychosocial distress. The aim of our study was to estimate the proportion of people with IBS in a representative US community, who have low levels of somatic and psychological symptoms. METHODS: The cohort comprised subjects from three randomly selected population studies from Olmsted County, Minnesota. All of them filled out a validated gastrointestinal (GI) symptom questionnaire, the Symptom Checklist-90-R (SCL-90-R), and the Somatic Symptom Checklist (SSC) comprising 11 somatic complaint items. Logistic regression models were used to evaluate the associations between somatic symptoms/psychosocial factors and IBS, adjusting for age and gender. RESULTS: Of the 501 eligible subjects, 461 (92%) provided complete data (mean age=56 years, 49% female). IBS (Rome II criteria) was associated with both higher SSC and Global Severity Index (GSI of SCL-90-R) scores. Among subjects with high (75th percentile) SSC scores, 43% reported IBS vs. 10% of those with low (<25th percentile) SSC scores. Among those with high (60) GSI scores, 23% reported IBS vs. 6% with low (<40) GSI scores. Specifically, none of the IBS subjects had both low SSC and low GSI scores. CONCLUSIONS: Psychological factors and somatization are strongly associated with IBS in the community. However, IBS may not be related to low psychological distress and/or somatization.

Integrity signals

Registry

Crossref · 10.1038/ajg.2009.239

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 47 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the results, among subjects with high SSC scores above the 75th percentile, 40% reported IBS, compared with 11% of those with low SSC scores below the 25th percentile.

    “Among subjects with high (>75th percentile) SSC scores, 40% reported IBS vs. 11% of those with low (<25th percentile) SSC scores.”
    Quote in the paperSubstantial claim
  • Findingown data

    Overall SCL-90-R phobic anxiety scores were identical in IBS and non-IBS subjects.

    “Although the overall SCL-90-R phobic anxiety scores for IBS and non-IBS subjects were identical (Table 2), there were modest associations between IBS status and phobic anxiety scores within age and gender subgroups (data not shown).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Within age and gender subgroups, there were modest associations between IBS status and phobic anxiety scores.

    “Although the overall SCL-90-R phobic anxiety scores for IBS and non-IBS subjects were identical (Table 2), there were modest associations between IBS status and phobic anxiety scores within age and gender subgroups (data not shown).”
    Quote in the paperNot a substantial claim
  • Findingown data

    After adjustment for age and gender, IBS status was significantly associated with each somatic item except asthma, heart palpitations, high blood pressure, and weakness.

    “In addition, IBS status was significantly associated with each of the somatic items (except asthma, heart palpitations, high blood pressure, and weakness) adjusting for age and gender.”
    Quote in the paperSubstantial claim
  • Findingown data

    Community subjects with higher somatization scores had greater odds of IBS, with an odds ratio of 2.2 per unit (95% CI 1.2-3.8).

    “The community subjects with greater somatization scores had greater odds for IBS (OR (odds ratio) 2.2 per unit, 95% CI: 1.2–3.8).”
    Quote in the paperSubstantial claim
  • May combine two claims. 25
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Findingown data

    Both the frequency and severity components of the overall mean SSC scores were greater in IBS subjects than in non-IBS subjects.

    “In particular, the separate frequency and severity of the overall mean scores were greater in subjects with IBS than in those without IBS (data not shown).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After adjustment for age and gender, IBS status was significantly associated with physician visits for bowel problems in the past year, and such visits were more common in IBS subjects.

    “However, a significant association between IBS status and physician visits for bowel problems in the last year was detected (adjusted for age and gender), with visits more common in subjects with IBS compared with those without IBS.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In multiple linear regression adjusted for age, gender, and IBS status, the overall SSC score was most strongly correlated with the somatization subscale, with a partial r2 of 31%, and its partial r2 for the GSI score was 17%.

    “Furthermore, in multiple linear regression models, adjusting for age, gender, and IBS status, the overall SSC score was most strongly correlated with the somatization subscale, with a partial r2 value of 31%, whereas, e.g., for the GSI score, the partial r2 of the SSC score was 17%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the total sample, SSC scores were positively correlated with the SCL-90-R somatization, depression, anxiety, and GSI subscales, all with P < 0.05.

    “In the total study sample, a univariate analysis revealed that the SSC scores were positively correlated with somatization, depression, anxiety, and the GSI subscale of the SCL-90-R (all P < 0.05) (Table 6).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    IBS status was not significantly associated with age, marital status, smoking, alcohol use, educational level, or BMI.

    “No statistically significant associations between IBS status and age, marital status, smoking, alcohol, educational level, or BMI (body mass index) (Table 1) were detected.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Headaches, backaches, insomnia, fatigue, general stiffness, heart palpitations, and eye pain were each individually associated with IBS status in the general population defined by Rome criteria.

    “It is noted that, headaches, backaches, insomnia, fatigue, general stiffness, heart palpitations, and eye pain were all individually associated with IBS status in the general population on the basis of the Rome criteria.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After adjustment for age and gender, IBS status was significantly associated with all SCL-90-R subscale scores, with higher mean scores in IBS subjects except for phobic anxiety.

    “A significant association of IBS status with all subscale scores of the SCL-90-R was detected (adjusted for age and gender), with numerically greater mean scores observed in subjects with IBS (except for phobic anxiety, Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After adjustment for age and gender, IBS status was significantly associated with overall SSC scores, with higher scores in IBS subjects.

    “Similarly, a significant association of IBS status with the overall SSC scores was detected (adjusted for age and gender) with greater scores observed in IBS subjects (Table 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    IBS meeting Rome II criteria was associated with higher scores on both the Somatic Symptom Checklist and the SCL-90-R Global Severity Index.

    “IBS (Rome II criteria) was associated with both higher SSC and Global Severity Index (GSI of SCL-90-R) scores.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the results, among subjects with high GSI scores above 60, 33% reported IBS, compared with 8% of those with low GSI scores below 40.

    “Among those with high (>60) GSI scores, 33% reported IBS vs. 8% with low (<40) GSI scores.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The Talley Bowel Disease Questionnaire is a reliable and valid measure of GI symptoms.

    “The Talley BDQ has been shown to be a reliable and valid measure of GI symptoms (31).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Talley NJ, 1990, Mayo Clin Proc source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Eight somatic complaint items were associated with IBS, raising the possibility that a subset of community IBS subjects may not have a specific entity but are part of a general syndrome of bodily distress.

    “Our study also showed that the eight somatic complaint items were associated with IBS, raising the possibility that a subset with IBS in the community may not have a specific entity but are a part of a general syndrome of bodily distress.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Multiple linear regression models assessed the association of SSC score with SCL-90-R scores while adjusting for age, gender, and IBS status.

    “Multiple linear regression models were used to assess the association of the SSC score with SCL-90-R scores adjusting for age, gender, and IBS status.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The 25th and 75th percentile cutoffs for the somatization score were somewhat arbitrary but intuitively reasonable and were chosen to provide sufficient subjects in each cell.

    “For the somatization score, the choice of the 25th and 75th percentile cutoffs was somewhat arbitrary but intuitively reasonable, and was intended to give a sufficient number of subjects in each of the “cells”.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Logistic regression models predicting IBS were used to evaluate associations between somatization or psychosocial factors and IBS symptoms, with adjustment for age and gender.

    “To address the overall aim of this study, logistic regression models (to predict IBS, yes vs. no) were used to evaluate the associations between somatization/psychosocial factors and reporting symptoms consistent with IBS, adjusting for age and gender.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    No adjustment for multiple testing was made because the analyses focused on different hypotheses.

    “The different analyses each focused on different hypotheses and thus, no adjustment for multiple tests was made.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Fink et al. grouped functional somatic symptoms into GI, cardio-pulmonary, and musculoskeletal clusters, found inter-correlations of 0.40-0.45 between symptoms from these groups, and suggested the three functional somatic syndromes represent a common latent phenomenon.

    “Fink et al. (49) showed that functional somatic symptoms could be grouped into three main symptom clusters, namely GI, CP (cardio-pulmonary), and MS (musculoskeletal). In addition, they found significantly inter-correlated correlation coefficients of 0.40–0.45 (Spearman’s rho) between a number of the symptoms from CP, GI, and MS symptom groups, and suggested that the three functional somatic synd”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Whitehead et al. reported in a systematic review that between one quarter and one third of IBS patients meet criteria for somatization disorder, much higher than in the normal population.

    “Furthermore, in the systemic review, Whitehead et al. (20) reported that between a quarter and a third of patients with IBS meet the criteria for somatization disorder, which is much higher than in the normal population.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent population-based nested case-control study found that psychosocial distress measured by SCL-90-R was significantly associated with functional GI disorder and was not explained by health-care utilization.

    “In a recent population-based nested case–control study (17), psychosocial distress as measured by the Symptom Checklist-90-R (SCL-90-R) was significantly associated with the presence of a functional GI disorder and was not explained by health-care utilization.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Psychological factors and somatization are strongly associated with IBS in the community.

    “Psychological factors and somatization are strongly associated with IBS in the community.”
    • Also stated in: § DISCUSSION · boosted
      “We conclude from this population-based study that psychological factors are strongly associated with IBS in the community; notably, somatization is significantly associated with IBS independent of age, gender, education level, marital status, smoking, alcohol use, and BMI.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The normal range for SCL-90-R scores was defined using commercially used and widely accepted cutoffs.

    “The definition of the normal range of SCL-90-R scores was based on commercially used cutoff definitions that are widely accepted (34,47).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] source

      Not checked in the free run.

    • cites [47] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Whitehead et al. reported that 48 of 51 symptom-based diagnoses were significantly more common in IBS patients than controls, including headache, back pain, sleep disorder, muscle weakness, pelvic pain, and blurred vision.

    “Whitehead et al. (40) reported that 48 of 51 symptom-based diagnoses were significantly more common in patients with IBS vs. that in controls, including headache, back pain, sleep disorder, muscle weakness, pelvic pain, and blurred vision.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    More recent population studies have suggested that earlier volunteer non-population-based studies may have been biased, but this view remains controversial.

    “In contrast, more recent population studies (42–45) have suggested that the earlier volunteer non-population-based studies may have been biased, but this view is still controversial (16).”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [42] source

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    • cites [43] source

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    • cites [44] Talley NJ, 1998, Gut source

      Not checked in the free run.

    • cites [45] Herschbach P, 1999, Psychosom Med source

      Not checked in the free run.

    • cites [16] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Koloski et al. reported that psychiatric diagnoses, neuroticism, threatening life event stress, external locus of control, and ineffectual coping styles were significantly associated with IBS and/or dyspepsia, and that somatization was independently associated with IBS in a random population sample from Sydney, Australia.

    “Koloski et al. (19) reported that psychiatric diagnoses, neuroticism, more highly threatening life event stress, an external locus of control, and ineffectual coping styles were significantly associated with having a diagnosis of IBS and/or dyspepsia, and somatization was independently associated with IBS in a random population sample from Sydney, Australia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Sewitch et al. found that patients with IBD had higher psychological distress than controls, with a mean GSI score of 57.1 (s.d. 9.4).

    “Sewitch et al. (47) studied the psychosocial distress in 200 patients with IBD from tertiary care settings. They showed that patients with IBD had higher levels of psychological distress than controls; the mean GSI score of patients with IBD was 57.1 (s.d. = 9.4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other studies have observed an excess somatization tendency in outpatients with IBS.

    “Other studies (21–23) have also observed an excess somatization tendency in outpatients with IBS.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [21] source

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    • cites [22] source

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    • cites [23] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sayuk et al. reported that a higher burden of current somatic symptoms was a strong predictor of functional bowel disease in outpatients presenting with GI complaints.

    “Sayuk et al. (46) reported that a higher burden of the current somatic symptoms was a strong predictor of a functional bowel disease in outpatients presenting with GI complaints.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    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).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [27] Talley NJ, 1991, Gastroenterology source

      Not checked in the free run.

    • cites [39] Talley NJ, 1995, Am J Epidemiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Olmsted County, Minnesota population comprises about 120,000 individuals, 89% of whom are white, and sociodemographically resembles the US white population.

    “The Olmsted County, Minnesota, population comprises ~120,000 individuals, of which 89% are white; sociodemographically, this community resembles the US white population.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The SCL-90-R is a measure of psychological state.

    “The SCL-90-R is a measure of psychological state (34).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The American Gastroenterological Association technical review reported that psychiatric disorder prevalence ranges from 40% to more than 90% among IBS patients referred to tertiary care, but argued these studies overestimated true psychosocial disturbance prevalence because psychological factors influence consultation.

    “The American Gastroenterological Association technical review on IBS (16) reported that the prevalence of a psychiatric disorder ranges from 40 to more than 90% among patients with IBS referred to tertiary care centers, but argued that these studies overestimated the true prevalence of psychosocial disturbance in patients with IBS because psychological factors influence whether patients consult ph”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    IBS is currently conceptualized as a bio-psychosocial disorder involving motor function disturbances, heightened visceral sensitivity, and possibly central nervous system disturbances.

    “Although the cause of the disorder remains essentially unknown, IBS is currently conceptualized as a bio-psychosocial disorder with disturbances of motor function, heightened visceral sensitivity, and possibly central nervous system disturbances (4–6).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [4] source

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    • cites [5] Mayer EA, 2001, Am J Physiol Gastrointest Liver Physiol source

      Not checked in the free run.

    • cites [6] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Early life experiences, adult stressors, lack of social support, and other social learning experiences can affect physiological and psychological responses and may precipitate abdominal distress and psychiatric disorders.

    “Early life experiences (e.g., abuse), adult stressors (e.g., divorce or bereavement), lack of social support, and other social learning experiences can affect both an individual’s physiological and psychological responses, and may precipitate abdominal distress, as well as psychiatric disorders (4,7–11).”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [4] source

      Not checked in the free run.

    • cites [7] Talley NJ, 1995, Am J Gastroenterol

      Not checked in the free run.

    • cites [8] Delvaux M, 1997, Eur J Gastroenterol Hepatol source

      Not checked in the free run.

    • cites [9] Ali A, 2000, Psychosom Med source

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    • cites [10] source

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    • cites [11] Bennett EJ, 1998, Gut source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several volunteer studies reported that persons with IBS who do not see physicians are psychologically similar to those without bowel complaints.

    “Several studies carried out in volunteers (12,13,41) reported that persons with IBS, who do not see physicians, are psychologically similar to those without bowel complaints.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [12] Drossman DA, 1988, Gastroenterology source

      Not checked in the free run.

    • cites [13] Whitehead WE, 1988, Gastroenterology source

      Not checked in the free run.

    • cites [41] Sandler RS, 1984, Gastroenterology source

      Not checked in the free run.

34 of 34

  • The paper relies on this without support.

    There is little community data on the relationship between IBS and somatization or psychosocial distress.

    “In addition, few data regarding the association between IBS and somatization and/or psychosocial distress exist in the community.”

  • The paper relies on this without support.

    The extent of psychological distress among community IBS sufferers is unclear because prior studies have not documented how many are entirely free of psychological comorbidity.

    “However, the burden of psychological distress in IBS remains unclear in the community, as studies have failed to document how many IBS sufferers are totally free of psychological comorbidity.”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • IBS proportion in high SSC group differs across sections

    Major

    The abstract reports 43% IBS prevalence among subjects with high SSC scores, while the Results section later reports 40% for the same high SSC comparison. These are different values for the same subgroup comparison and are not explained as due to a different denominator or rounding.

  • IBS proportion in high GSI group differs across sections

    Major

    The abstract reports 23% IBS among subjects with high GSI scores, while the later Results section reports 33% for the same high-GSI comparison. These values conflict and cannot both describe the same subgroup result.

  • Female proportion differs between abstract and results

    Minor

    For the same 461 subjects, the abstract reports 49% female and the Results section reports 48%.

  • Number of associated somatic complaints changes from seven to eight

    Minor

    The Predictors of IBS section says seven complaints were associated with IBS, while the Discussion says eight were. The predictors statement also names only three exceptions among 11 complaints, leaving eight rather than seven.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Talley NJ, 1995, Am J Gastroenterol, 90, 366
  2. Talley NJ, 1996, Am J Gastroenterol, 91, 19

Cited by

Sorted by citations

Related

Authors
Choung, R. S., Locke, G. R., Zinsmeister, A. R., Schleck, C. D., & Talley, N. J.
Affiliations
Mayo Clinic (US)
Corresponding author
Talley, Nicholas J
ORCID
Venue
The American Journal of Gastroenterology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2009-06-02
Volume
104
Issue
7
Pages
1772-1779
ISSN
  • 0002-9270 (ISSN-L)
  • 1572-0241
DOI
10.1038/ajg.2009.239
PMC
PMC3772628
OpenAlex
W2084613607
Semantic Scholar
6d7a40f1028191d0e3d61e87054f6ff37ff6baaa
Cited by
129
References
55
Citations by year
2026: 1 · 2025: 2 · 2024: 4 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 8 · 2018: 3 · 2017: 8 · 2016: 12 · 2015: 12 · 2014: 12 · 2013: 14 · 2012: 10
FWCI
13.45
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (unspecified)
Locations
  • The American Journal of Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR030582, R01AR30582)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords
irritable bowel syndrome, psychosocial distress, somatic symptoms, somatization, psychological factors, community population, SCL-90-R, Rome II criteria, gastrointestinal symptoms
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Life Change Events, Male, Middle Aged, Probability, Psychiatric Status Rating Scales, Psychology, Surveys and Questionnaires, Reference Values, Severity of Illness Index, Somatoform Disorders, Stress, Psychological, Incidence, Case-Control Studies, Age Distribution, Sex Distribution, Sickness Impact Profile, Risk Assessment, Irritable Bowel Syndrome

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