Symptom patterns and relative distribution of functional bowel disorders in 1,023 gastroenterology patients in Iran

Abstract

Background and aims

There are scanty data on functional bowel disorder (FBD) patterns in Iran. This first-time study tried to provide preliminary data on relative distribution of different types of FBD and their symptom patterns in Iranian patients.

Methods

A consecutive sample of 1,023 patients in an outpatient gastroenterology clinic in central Tehran was interviewed using two questionnaires based on Rome II criteria from December 2004 to May 2005 to detect FBD patients.

Results

Of 1,023 gastroenterology patients, 410 met Rome II criteria for FBD; functional constipation, 115 (28%); irritable bowel syndrome (IBS), 110 (27%) [IBS-C, 29%; IBS-D, 11%; IBS-A, 60%]; functional bloating, 102 (25%); unspecified FBD, 76 (18%); and functional diarrhea, 7 (2%). FBD had no association with age or level of education, while it was more frequent in women (P=0.001). FBD was also more frequent among those with a history of abdominal/pelvic surgery (P=0.021). IBS patients had a lower mean of age compared with non-FBD group, while patients with constipation were older (Mann–Whitney U test, P=0.006). Constipation-related symptoms were the most frequent symptoms among IBS patients. Constipation (<3 defecations/week) was also the most frequent change in bowel habit in bloating and unspecified FBD patients. Fourteen percent of IBS consulters and 8.7% of functional constipation consulters met Rome II criteria for dyspepsia (disregarding the ruling out of upper gastrointestinal organic disease). Only 20% of patients with functional constipation were consulters.

Conclusions

Population-based studies at provincial levels are essential to clarify FBD patterns in each provincial district in the country.

Appendix : Questionnaires

Questionnaire I

Year of birth: ……

Sex: □ Male □ Female

Education: □ MS or more

□ MA

□ 2-year university education

□ High school diploma

□ Below high school diploma

□ Illiterate

• 1. How often do you usually have defecation (during the past year)?

  …times in □ Day □ Week □Month

• 2. Have you had each of the following symptoms frequently (at least 4 days per month) during the past year?

  □ Abdominal pain or discomfort which relieves with defecation

  □ Constipation

  □ Diarrhea

  □ Abdominal fullness or bloating

• 3. If your response to the previous question is positive, have you referred to this clinic for the same symptoms?

  □ Yes □ No

• 4. Have you ever undergone any abdominal or pelvic surgical operations? □ Yes □ No

• 5. If your response to the previous question is yes, please indicate the type and date of surgery?

  Surgery:Date:

DX: (This box should be completed by the gastroenterologist)

Questionnaire II

Have you had abdominal pain or discomfort for the past year accompanied by one of the following symptoms?

	>12 week	<12 week
Relieved with defecation	□	□
Onset associated with change in frequency of stool	□	□
Onset associated with change in form of stool	□	□

Have you had any of the following symptoms during the past year?

	>12 week	<12 week
<3 defecations/week	□	□
>3 defecations/day	□	□
Lumpy or hard stools	□	□
Loose or watery stools	□	□
Straining during a bowel movement	□	□
Urgency	□	□
Sensation of incomplete evacuation	□	□
Passage of mucus	□	□
Fullness, bloating or visible distention	□	□
Sensation of anorectal obstruction	□	□
Manual maneuvers to facilitate	□	□
Upper abdominal pain or discomfort having no relationship with defecation	□	□

How long have you had the above mentioned symptoms? … Years