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Prospective Diary Evaluation of Unexplained Abdominal Pain and Bowel Dysfunction: A Population-Based Colonoscopy Study

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Abstract

Introduction

Diagnostic criteria for irritable bowel syndrome (IBS) have not been validated by prospective symptom diary. We investigated the bowel patterns in community subjects with and without non-organic abdominal pain, and compared the symptoms with subjects fulfilling the Rome II criteria (IBS).

Methods

From the Swedish population register, a random sample completed an abdominal symptom questionnaire. Responders were subsequently invited for a clinical evaluation and offered a colonoscopy regardless of whether they had abdominal symptoms or not. A total of 268 subjects underwent colonoscopy, clinical evaluation by gastroenterologist, laboratory investigations, and completed the Rome questionnaire and prospective gastrointestinal (GI) symptom diaries for 1 week. Twenty-three subjects of 268 were excluded due to organic GI disease.

Results

Subjects recorded 2,194 bowel movements and 370 abdominal pain episodes on 1,504 days. Subjects with pain in the diary (n = 81) had higher stool frequency (P = 0.01), more urgency (P = 0.0002), feelings of incomplete evacuation (P = 0.0002), nausea (P = 0.0009), and abdominal bloating (P = 0.0005) than subjects without pain (n = 151). Twenty-eight subjects (12%) fulfilled the Rome II criteria for IBS. Together, they had 96 pain episodes but only 4% were improved by defecation; 29% of the pain episodes started or worsened after a meal. Subjects with IBS and other subjects with non-organic abdominal pain (n = 64) exhibited no differences in terms of the proportions of pain episodes improved by defecation, bloating, stool frequency, consistency, or defecatory symptoms.

Conclusions

Current criteria for IBS that rely on recall of the relationship between abdominal pain and bowel disturbance may overcall this association when measured prospectively.

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Acknowledgment

We acknowledge the recently deceased Professor Göran Bodemar for his enthusiastic help with the design of this study.

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Authors and Affiliations

  1. Institution of Clinical and Experimental Medicine (IKE), Division of Gastroenterology, Linköping University, Linköping, Sweden

    Susanna A. Walter

  2. Department of Gastroenterology, Sabbatsbergs Hospital, Karolinska Institutet, Stockholm, Sweden

    Lars Kjellström

  3. Faculty of Health, University of Newcastle, Newcastle, NSW, Australia

    Nicholas J. Talley

  4. Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden

    Anna Nixon Andreasson & Lars Agréus

  5. Department of Gastroenterology, Karolinska Institutet, Stockholm, Sweden

    Henry Nyhlin

Authors
  1. Susanna A. Walter
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  2. Lars Kjellström
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  3. Nicholas J. Talley
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  4. Anna Nixon Andreasson
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  5. Henry Nyhlin
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  6. Lars Agréus
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Correspondence to Susanna A. Walter.

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Walter, S.A., Kjellström, L., Talley, N.J. et al. Prospective Diary Evaluation of Unexplained Abdominal Pain and Bowel Dysfunction: A Population-Based Colonoscopy Study. Dig Dis Sci 56, 1444–1451 (2011). https://doi.org/10.1007/s10620-010-1468-y

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  • DOI: https://doi.org/10.1007/s10620-010-1468-y

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