Abstract
Objectives
Irritable bowel syndrome (IBS) is a chronic, debilitating, functional gastrointestinal disorder with symptoms of abdominal pain, bloating, and altered bowel behaviours of constipation (IBS-C), diarrhea (IBS-D), or a mixture of both (IBS-M). There is limited information published on the impact of symptoms on everyday life in the Canadian population.
Methods
An online survey was conducted with individuals diagnosed with IBS to capture the severity and frequency of patient-reported symptoms, including impact on productivity, quality of life, healthcare utilization, treatment access, and corresponding symptom relief. Responses from the three subtypes of IBS were categorized to illustrate differences among these.
Results
There were 2,470 qualified respondents (filtered from 2,981, which included nonspecific IBS). IBS-M was the most common subtype, at 44 percent. Most individuals from all three IBS subtypes reported experiencing moderate to severe abdominal pain (63–70 percent) and bloating (59–75 percent) over the previous 3 months. Persons living with IBS-C reported severe bloating (32 percent), straining (72 percent), and tenesmus (78 percent) whereas those with IBS-D experienced severe urgency (63 percent) and incontinence (29 percent). Symptoms interfered in daily life, sometimes in 46 percent and often in 23 percent of respondents. Patients reported mood and anxiety disorders as common comorbidities with IBS (mood disorders: 30–34 percent; anxiety disorders: 25–30 percent).
Conclusions
This study focuses on the differences among the IBS subtypes. IBS impacts productivity and healthcare utilization, which requires further investigation on approaches to improve treatment. The frequency and severity of symptoms in IBS are high and only a few respondents reported that their symptoms are under control.
Keywords: irritable bowel syndrome, patient experience, diarrhea, constipation, quality of life, pain, patient-reported outcomes
INTRODUCTION
Irritable bowel syndrome (IBS) is a common, chronic, often debilitating, functional gastrointestinal disorder characterized by abdominal pain, bloating, constipation, and/or diarrhea. IBS has a significant global burden, with approximately 11 percent of the world’s population living with the disorder, using Rome III criteria.1–3 The Rome III diagnostic criteria were in place at the time the survey was active. The most common subtype reported is IBS with predominant diarrhea (IBS-D), affecting 40 percent of patients.4
Rome IV, established in 2016, is the latest diagnostic criteria for IBS. For diagnosis, a person must have recurrent abdominal pain (≥1 day/week for ≥3 months) associated with a change in defecation and a change in stool frequency or appearance. The criteria must be fulfilled for the last 3 months, with symptom onset at least 6 months before diagnosis.5 IBS subtype is determined accordingly with predominant symptoms into IBS with predominant diarrhea (IBS-D), IBS with predominant constipation (IBS-C), IBS with mixed bowel habits (IBS-M), and IBS unclassified.6 Rome IV is trying to get a new insight into IBS’s pathophysiology, giving more importance to the newly found roles of the gut-brain interaction and inflammation in IBS.6,7
Studies report that IBS lowers a person’s quality of life more than that of the general population, and they have greater healthcare utilization.8–12 However, most of these studies or questionnaires assessing the quality of life and patient-reported symptoms have focused on these factors as a whole or focused on a single IBS subtype and they have a limited number of study participants. Although IBS diagnosis and management guidelines exist,13–15 there can be significant delays in diagnosis for many individuals, with more than 40 percent of patients waiting up to 5 years.16 These data suggest that the IBS patient experience remains poorly understood.
Our objective was to improve our understanding of the Canadian IBS patient experience and compare the three IBS subtypes for symptom severity and frequency, quality of life-related outcomes, healthcare utilization, treatments, and overall symptom control.
METHODS
Recruitment
The Gastrointestinal Society and the Canadian Society of Intestinal Research, both registered Canadian charities, hosted a survey on their combined English (www.badgut.org) and French (www.mauxdeventre.org) websites from January 15, 2016, to August 4, 2016. These websites are accessed by individuals with gastrointestinal disorders. Participants self-identified as having IBS based on symptoms and diagnoses made by their healthcare providers. The survey was web-based. Healthcare and medication use was by patient recall. Links were shared on social media, by posters in physicians’ offices, and with the help of an email to individuals identified as diagnosed with IBS via a Canadian market research company. The inclusion criteria were persons living with IBS, residents of Canada, and 18 years of age or older (or a parent/caregiver of a child with IBS). All responses that did not meet the inclusion criteria, were not completed, or had answers that disqualified them (not IBS, not residing in Canada) were excluded from the analysis. The software, SurveyMonkey, prevented duplicates and unauthorized use.
Survey content
The first section collected demographic data, including age, sex, province/territory of residence, and diagnosis duration. It continued with a series of questions on symptoms, medication use, experience with the healthcare system, comorbidities, and quality of life. The authors developed the questionnaire to collect information about symptoms, quality of life-related factors, and healthcare utilization. Questions were designed to identify the frequency of quality of life-related outcome experiences over the previous month, including days of absence from work or school, related to IBS symptoms.
Statistical analysis
Statistical analysis was performed using the XL STAT add-on for Excel. Statistically significant differences between responses of the three IBS subtypes were calculated using k-proportions tests. A P-value of <0.05 was considered statistically significant. The Monte Carlo and the Marascuilo methods were used to compare the proportions if the null hypothesis was rejected.
Survey respondents selected one of the three IBS subtypes that they had been diagnosed with and were included in the analysis as either IBS-C, IBS-D, or IBS-M. Respondents who failed to select a subtype were not included in further analysis (511 of 2,981 respondents were excluded). Symptom severity was scored on a four-point scale (never, mild, moderate, and severe), and each parameter is displayed as a proportion of the total IBS subtype population. Symptom frequency and quality of life-related outcomes were scored on a five-point scale (never, rarely, sometimes, often, and always).
RESULTS
Demographics and symptom duration
Two thousand four hundred seventy qualified respondents were included in this analysis, 2,108 in English and 362 in French, from all ten Canadian provinces, and two territories. There were no responses from Nunavut. Representative of the population, the majority were from Ontario (39 percent), Quebec (17.5 percent), and BC (13.4 percent). The most common IBS subtype was IBS-M (44 percent), followed by IBS-D (37 percent) and IBS-C (19 percent), (Table 1). Most respondents were female (88 percent). The most common age ranges were 50–59 years (28.5 percent), 60–69 years (21.9 percent), and 40–49 years (19.6 percent). Symptom duration was similar between IBS subtypes, with 51–56 percent of individuals reporting living with IBS for more than 10 years (Table 1).
Table 1.
Population demographics and symptom duration.
| Parameter | IBS-M | IBS-D | IBS-C |
|---|---|---|---|
| Individuals, N (%) | 1,086 (44.0) | 917 (37.1) | 467 (18.9) |
| Male/Female (%) | 120/956 (11/88) | 128/789 (14/86) |
33*/430 (7/92) *P < 0.05 vs. IBS-M & -D |
| Age range (n, %) | |||
| <19 | 9 (0.8) | 5 (0.5) | 3 (0.6) |
| 19–29 | 69 (6.4) | 46 (5.0) | 36 (7.7) |
| 30–39 | 139 (12.8), *P < 0.05 vs. IBS-D | 163 (17.8) | 69 (14.8) |
| 40–49 | 216 (19.9) | 190 (20.7) | 90 (19.3) |
| 50–59 | 336 (30.9), *P < 0.05 vs. IBS-D | 238 (26.0) | 133 (28.5) |
| 60–69 | 222 (20.4) | 210 (22.9) | 94 (20.1) |
| ≥70 | 89 (8.2) | 63 (6.9) | 38 (8.1) |
| Prefer not to say | 6 (0.6) | 1 (0.1) | 4 (0.9) |
| Province of residence (n, %) | |||
| Alberta | 113 (10.4) | 75 (8.2) | 55 (11.8) |
| British Columbia | 150 (13.9) | 118 (12.9) | 52 (11.1) |
| Manitoba | 47 (4.3) | 52 (5.7) | 19 (4.1) |
| New Brunswick | 38 (3.5) | 33 (3.6) | 19 (4.1) |
| Newfoundland | 30 (2.8) | 22 (2.4) | 11 (2.4) |
| Northwest Territories | 0 (0.0) | 1 (0.1) | 0 (0.0) |
| Nova Scotia | 59 (5.5) | 60 (6.5) | 27 (5.8) |
| Ontario | 416 (38.4) | 346 (37.7) | 188 (40.3) |
| Prince Edward Island | 13 (1.2) | 5 (0.5) | 4 (0.9) |
| Quebec | 174 (16.1) | 168 (18.3) | 73 (15.6) |
| Saskatchewan | 42 (3.9) | 36 (3.9) | 19 (4.1) |
| Yukon | 0 (0.0) | 1 (0.1) | 0 (0.0) |
| Symptom duration (n, %) | |||
| <1 year | 23 (2.1) | 21 (2.3) | 9 (1.9) |
| 1–3 years | 108 (9.9) | 98 (10.7) | 41 (8.8) |
| 3–5 years | 129 (11.9) | 113 (12.3) | 58 (12.4) |
| 5–10 years | 235 (21.6) | 219 (23.9) | 97 (20.8) |
| >10 years | 591 (54.4) | 466 (50.8) | 262 (56.1) |
Patient-reported symptoms
Severity
The most common self-reported symptom among all subtypes was abdominal pain, followed by bloating and diarrhea. The majority of all three IBS subtypes reported experiencing moderate to severe abdominal pain and bloating over the previous 3 months (fig. 1). Individuals with IBS-D experienced significantly less severe bloating (16 percent) than those with IBS-C (32 percent) or IBS-M (25 percent) (P < 0.0001) (fig. 1b). As expected, those with IBS-M and IBS-C experienced significantly greater moderate to severe constipation (moderate: IBS-M [44 percent], IBS-C [43 percent] vs. IBS-D [9 percent]; P < 0.0001, severe: IBS-M [22 percent] vs. IBS-C [42 percent] vs. IBS-D [2 percent]; P < 0.0001) (fig. 1c). Again, as expected, a significant proportion of those living with IBS-M and IBS-D reported moderate to severe diarrhea (moderate: IBS-M [44 percent], IBS-D [40 percent] vs. IBS-C [8 percent]; P < 0.0001, severe: IBS-M [26 percent] vs. IBS-D [41 percent] vs. IBS-C [2 percent]; P < 0.0001) (fig. 1d). Additional symptoms, including severe urgency and incontinence were most frequently reported by individuals with IBS-D (27 percent and 12 percent, respectively), compared to those with IBS-M (16 percent and 7 percent) or IBS-C (4 percent and 3 percent) (fig. 1e, f). Straining and tenesmus were greatest in those with IBS-C with 39 percent and 31 percent reporting severe respectively, compared to those with IBS-M (24 percent and 21 percent), or IBS-D (6 percent and 11 percent) (P > 0.0001) (fig. 1g, h).
Figure 1.
Patient reported symptoms experienced during the last 3 months: degree of severity.
Frequency
The symptoms reported with the most frequency (often or always) over the last 3 months among all subtypes were abdominal pain and bloating with 45–53 percent and 42–66 percent, respectively (fig. 2a, b). Bloating was most often experienced by those living with IBS-C over the previous 3 months with 28 percent reporting always, compared to 16 percent with IBS-M, or 10 percent IBS-D (P < 0.0001) (fig. 2b). As expected, participants living with IBS-C experienced the most constipation with 33 percent reporting always, compared to 7 percent with IBS-M, or 0 percent with IBS-D (P < 0.0001) (fig. 2c). Of those living with IBS-D, 28 percent reported always experiencing diarrhea over the prior 3 months compared to 8 percent with IBS-M or 0 percent with IBS-C (P < 0.0001) (fig. 2d). The greatest proportion of individuals with IBS-D (11 percent and 4 percent) reported always experiencing urgency and incontinence, respectively, over the previous 3 months compared to those with IBS-M (5 percent and 2 percent), or IBS-C (1 percent and 1 percent) (P < 0.0001 and P ≤ 0.003, respectively) (fig. 2e, f). In contrast, straining and tenesmus were most frequently experienced by those with IBS-C (27 percent and 22 percent, respectively), compared to IBS-M (11 percent and 13 percent), or IBS-D (2 percent and 7 percent) (P < 0.0001) (fig. 2g, h).
Figure 2.
Patient reported symptoms experienced during the last 3 months: frequency.
Impacts on quality of life
The most common limitation reported related to quality of life in all three IBS subtypes was dietary limitations, impacting 47–54 percent of individuals often or always over the past month, with no significant differences between subtypes (fig. 3c). Limitations to home activities (17–22 percent) and social activities (23–40 percent) also occurred often or always amongst all subtypes. However, individuals with IBS-C were significantly less limited in-home activity (15 percent reporting never over prior month) compared to IBS-M (10 percent never, P ≤ 0.02) and in social activity (32 percent reporting rarely over prior month) compared to both IBS-M (21 percent) and IBS-D (19 percent) (P < 0.0001) (fig. 3d–e). Individuals living with IBS-C were also less limited in their ability to leave home with 42 percent reporting their ability to leave home was never impacted over the prior month compared to 26 percent with IBS-M and 27 percent with IBS-D (P < 0.0001) (fig. 3b). Anxiety was more often experienced by those living with IBS-D than IBS-C (16 percent vs. 10 percent, respectively reporting always, P < 0.008), while nausea was more often experienced by those living with IBS-C than IBS-D (5 percent vs. 2 percent respectively reporting always, P = 0.017) (fig. 3a, f). Poor quality of life (15–19 percent) and trouble sleeping (25–29 percent) were often or always experienced by a large proportion of respondents with all three IBS subtypes over the previous month, with no significant differences between the groups (fig. 3h, i). When asked how many days of work or school were missed over the previous 3 months due to IBS, 22–28 percent reported missing 1 to 5 days, with 3 percent missing 6 days or more (no significant differences between groups) (fig. 3j).
Figure 3.
Patient reported quality of life-related outcomes and days of work or school missed.
Healthcare utilization
The most common reason driving individuals to the doctor for IBS-C and IBS-M was pain or discomfort (27 percent and 25 percent, respectively vs. 12 percent IBS-D, P < 0.0001) (fig. 4a). However, those with IBS-D were most likely to go to the doctor because they did not feel well, and either their daily, personal, or professional life was affected by their symptoms (29 percent vs. 13 percent IBS-C vs. 19 percent IBS-M, P < 0.0001) (fig. 4a). Family doctors were the most commonly consulted healthcare providers for all IBS subtypes (92–95 percent), followed by gastroenterologists (48–50 percent) (fig. 4b). Significantly more individuals with IBS-C consulted a naturopath (20 percent) than those with IBS-M (12 percent) and IBS-D (12 percent) (P < 0.0001) (fig. 4b). Individuals living with IBS-D were less likely to visit their healthcare provider during the year prior to the survey, with 29 percent visiting 0 times compared to those with IBS-M (24 percent) and IBS-C (22 percent) (P = 0.006). Also, 11–15 percent of individuals reported hospitalization relating to IBS, with no statistical difference between IBS subtypes (fig. 4e).
Figure 4.
Healthcare utilization: healthcare professionals visited, diagnostic tests performed, hospitalizations, and comorbidities.
The most frequently recommended diagnostic tests by healthcare providers were colonoscopies (60 percent IBS-C, 61 percent IBS-D, and 63 percent IBS-M), followed by laboratory tests (33 percent IBS-C, 36 percent IBS-D, and 37 percent IBS-M), both of which did not vary by IBS subtype (fig. 4d). Gastroscopies were more frequently recommended for those with IBS-M (34 percent) compared to IBS-D (28 percent) (P = 0.019) (fig. 4d).
Comorbidities
Together, mood disorders including depression (30–34 percent), and anxiety disorders such as post-traumatic stress disorder (25–30 percent) were among the top comorbidities reported with no significant differences between IBS subtypes (fig. 4f). The second most common comorbidity reported was gastroesophageal reflux disease (GERD) with significantly fewer individuals living with IBS-D impacted by GERD (23 percent) compared to IBS-M (31 percent) (P < 0.0001) (fig. 4f). As well, significantly fewer individuals living with IBS-D reported sleep disorders (20 percent) compared to IBS-M (28 percent) and IBS-C (27 percent) (P < 0.0001) (fig. 4f).
Individuals living with IBS-D were less likely to visit their healthcare provider during the year prior to the survey, with 29 percent visiting 0 times compared to those with IBS-M (24 percent) and IBS-D (22 percent) (P = 0.011).
Treatments and symptom relief
The proportion of respondents using one treatment on a regular basis varied significantly by IBS subtype (32 percent IBS-M, 44 percent IBS-D, 28 percent IBS-C) (P < 0.0001) (fig. 5a). Significantly fewer individuals living with IBS-D used three or four treatments regularly (12 percent and 3 percent, respectively), as compared to IBS-M (17 percent and 14 percent, respectively) and IBS-C (20 percent and 7 percent, respectively) (P = 0.001 and P < 0.0001, respectively) (fig. 5a). The most common treatment that had been, or was currently being, used by all three groups was dietary changes (71 percent IBS-M, 72 percent IBS-D, 72 percent IBS-C) with no statistical differences between the subtypes (fig. 5b, c). Individuals living with IBS-C were more likely to currently be using a low-fermentable oligosaccharide, disaccharides, monosaccharides, polyols (low-FODMAP) diet (11 percent) compared to IBS-D (7 percent) (P = 0.022), as well as probiotics (34 percent) compared to IBS-D (26 percent) (P = 0.017) (fig. 5b). Additionally, individuals living with IBS-C were more likely to have previously used or currently be using herbal/natural therapies (previously: 34 percent IBS-C vs. 27 percent IBS-M and 22 percent IBS-D; P < 0.0001, and currently: 16 percent IBS-C vs. 10 percent IBS-M and 10 percent IBS-D; P < 0.0001), enemas (previously: 24 percent IBS-C vs. 15 percent IBS-M vs. 6 percent IBS-D; P < 0.0001, and currently: 3 percent IBS-C vs. 1 percent IBS-M and 0 percent IBS-D; P < 0.0001), and laxatives (previously: 43 percent IBS-C vs. 35 percent IBS-M vs. 13 percent IBS-D; P < 0.0001, and currently: 18 percent IBS-C vs. 9 percent IBS-M vs. 2 percent IBS-D; P < 0.0001) (fig. 5b, c). Not surprisingly, individuals living with IBS-C were least likely to previously or currently be using anti-diarrheals (18 percent IBS-C vs. 36 percent IBS-M and 33 percent IBS-D; P < 0.0001, and 1 percent IBS-C vs. 11 percent IBS-M vs. 19 percent IBS-D; P < 0.0001, respectively). Symptom control was inadequate for 30 percent of individuals with IBS-M, compared to 35 percent with IBS-D and 39 percent with IBS-C (P = 0.0001) (fig. 5d–f).
Figure 5.
Treatments used and symptom relief.
DISCUSSION
We found that the most common subtype of IBS in Canada is IBS-M with 44 percent. We had a high number of female participants (86–92 percent, depending on subtype), which is historically typical for our surveys to have more women than men responding. As expected, constipation was usually or always experienced by those living with IBS-C (78 percent), followed by IBS-M (42 percent), and only a small number of individuals with IBS-D (3 percent) (fig. 2c). Respondents with IBS-D (74 percent) reported often or always having diarrhea, followed by IBS-M (47 percent) and IBS-C (3 percent). These show that while many individuals fit neatly into their categorized subtypes, there are still those who do not.
The most common symptom among every subtype of IBS was bloating, followed by abdominal pain. This supports the idea that clinicians should prioritize these symptoms in treatment for all IBS subtypes. Not surprisingly, diarrhea was more common in IBS-D, as constipation was in IBS-C. Every subtype of IBS must be treated accordingly, with IBS-D likely having the most problems with severe urgency and incontinence.5 Guidance toward precautions should be provided early to avoid potential anxiety, embarrassment, or stigma related to these symptoms. In the same way, individuals with IBS-C should receive education and guidance on how best to manage bloating, straining, and tenesmus. These symptoms can be exceptionally bothersome and, recognizing that these are common in the IBS-C group, clinicians should select preventative approaches targeted to these symptoms.
Several studies have reported how IBS affects quality of life, daily performance in working life (presenteeism), and work absence.17–19 We found that school or work absence occurs more frequently than previously thought; 22–28 percent of respondents reported missing 1–5 days over 3 months, with IBS-D being the most common subtype affected. The primary concern about living with IBS identified through our self-reported survey was a lack of quick access to a public toilet and the potential of experiencing an accident or incontinence. IBS symptoms may lead to embarrassment associated with using public bathrooms, urgency to reach a toilet, fecal incontinence, or severe abdominal pain during work or school time. It can significantly affect the everyday life of each individual. These responses highlight the need to better understand the disorder and improve treatment options.
Mood disorders, including depression, have also previously been associated with IBS, with the co-occurrence of depression estimated at 30 percent.20 We report comparable results from survey respondents self-reported comorbidities, the most common being mood and anxiety disorders, although significant differences between IBS subtype were identified. Recognizing the importance of mood and anxiety disorders in IBS may help in better symptom management. The use of antidepressants in the treatment of IBS, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants may be beneficial for managing the syndrome. SSRIs have also been found to have anti-inflammatory properties and to modulate intestinal motility.21
Those living with IBS often use multiple treatment modalities. Treatment recommendations should be based on IBS severity and predominant symptoms. Education about living with IBS, including lifestyle and dietary changes, are the preferred initial treatments. We found that most individuals living with IBS use one to two treatments regularly (66–83 percent, depending on subtype), with fewer respondents using three or more treatments (17–33 percent). Those with IBS-D were more likely to use one treatment on a regular basis (32 percent IBS-M vs. 44 percent IBS-D vs. 28 percent IBS-C) (P < 0.0001), and significantly less likely to use three or four treatments (12 percent and 3 percent, respectively) compared to IBS-M (17 percent and 14 percent, respectively) and IBS-C (20 percent and 7 percent, respectively) (P = 0.001 and P < 0.0001, respectively).
The most commonly used treatments include a change in diet (71–72 percent) and the addition of probiotics (60–68 percent, significantly higher amongst IBS-C than IBS-D respondents). Even though a low-FODMAP diet has been shown to reduce IBS-related symptoms,21,22 only 7–11 percent of respondents reported that they were currently using it, with individuals living with IBS-C significantly more likely to use it than those with IBS-D. This highlights a need for targeted development of low-FODMAP education resources and protocols for both healthcare providers and patients to facilitate its use.
The use of pain relievers is widespread among individuals living with IBS, although no significant difference was demonstrated between IBS subtypes. Regardless of the subtype, the use of antispasmodics like dicyclomine to control abdominal pain can be dosed on an as-needed basis and be beneficial for short-term relief.23 More than half of our respondents were taking pain relievers. We did not capture data on the specific type of pain relievers used in this survey. As expected, the use of fibre supplements was less common in persons who live with IBS-D than those living with IBS-M and IBS-C (P < 0.0001), while the use of laxatives was most common among individuals with IBS-C (P < 0.0001). As previous studies have reported benefits of treating constipation in IBS-C using laxatives like polyethylene glycol,24 we expected the high prevalence of laxative use in this population.
Even with the use of several treatment modalities by each subtype, symptom control was poorly acquired in 18 percent of individuals with IBS-C, followed by IBS-D (21 percent) and IBS-M (22 percent).
Among the three subtypes of IBS, the most frequent diagnostic tests recommended by healthcare providers were colonoscopies (60–63 percent), followed by laboratory tests (33–37 percent), and upper endoscopies/gastroscopies (28–34 percent). For a few, celiac disease testing and allergy testing were recommended. The use of the tests mentioned above seems to follow the tendency reported previously in diagnosing IBS. However, IBS can be diagnosed without the need for extensive diagnostic testing based on discarding other differential diagnoses.14,21 A full assessment must be made to distinguish IBS from other diagnoses. It is reasonable to question the patients about red flags, such as rectal bleeding, unintentional weight loss, and family history of colon cancer, so that the use of additional workup is well established.21
With 2,981 survey responses filtered down to 2,470 qualified respondents, this survey had a good response rate. We do acknowledge that the information collected, including IBS diagnosis and comorbidities, is self-reported and therefore may be subject to interpretation and recall. However, we developed the survey questions carefully, to be clear and unambiguous. Since the survey was hosted and promoted on a patient advocacy website, respondents may have self-selected to respond to the survey and there may be a selection bias but is reflective of the individuals who have IBS concerns and symptoms. The strength of this approach is that the results are reflective of the patients’ experiences and perceptions as they face the impacts of IBS on their daily lives.
CONCLUSIONS
In a large Canadian population, this study characterizes the main symptoms, impacts on quality of life, and healthcare use associated with IBS, focusing on differences between its subtypes. All forms of IBS manifest pain as a symptom interfering with everyday life. IBS impacts productivity and healthcare utilization in many of those surveyed, which requires further investigation on approaches to improving treatment. The frequency and severity of symptoms in IBS are high, and with few respondents reporting that their symptoms are under control, we suggest that targeted research using this information characterizing IBS patients and the impact of the disease should be conducted to improve symptoms, quality of life, and productivity.
Supplementary Material
Contributor Information
Ganive Bhinder, Canadian Society of Intestinal Research, Vancouver, BC, Canada.
Javier M Meza-Cardona, Gastroenterology Department, Hospital Español de Mexico, Mexico City, Mexico.
Alan Low, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Gastrointestinal Society, Vancouver, BC, Canada.
Guy Aumais, Départmente de médicine, Université de Montréal, Montréal, QC, Canada.
Gail P Attara, Canadian Society of Intestinal Research, Vancouver, BC, Canada; Gastrointestinal Society, Vancouver, BC, Canada.
James R Gray, Canadian Society of Intestinal Research, Vancouver, BC, Canada; Gastrointestinal Society, Vancouver, BC, Canada; Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
Author contributions
GB, JMMC, and AL: interpreting data, preparing manuscript and figures. GA: planning and conducting the study, interpreting data. GPA: conceiving, planning, and conducting the study, collecting and interpreting data, preparing manuscript. JRG: planning and conducting the study and interpreting data, project oversight.
Funding
The Gastrointestinal Society requested and received an unrestricted educational grant from Actavis Specialty Pharmaceuticals Co., an affiliate of Allergan PLC, to conduct this independent survey in 2016. The funders were not involved in study design, collection, analysis, interpretation of the data, or writing of the manuscript. No funding was received to write this manuscript. GPA is an employee of the Gastrointestinal Society and initiated this project as part of her employment, in collaboration with the Canadian Society of Intestinal Research. GB, AL, GA, and JRG did not receive any compensation for their contributions. JMMC received compensation from the charities to review and validate data and contribute to drafting the manuscript. No others contributed.
Conflict of interest
There are no conflicts to declare.
Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
References
- 1. Lovell, Rebecca M., and Ford Alexander C.. “Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-Analysis.” Clinical Gastroenterology and Hepatology 10, no. 7 (2012): 712–721.e4. 10.1016/j.cgh.2012.02.029. [DOI] [PubMed] [Google Scholar]
- 2. Endo, Yuka, Shoji Tomotaka, and Fukudo Shin. “Epidemiology of Irritable Bowel Syndrome.” Annals of Gastroenterology 28, no. 2 (2015): 158–9. [PMC free article] [PubMed] [Google Scholar]
- 3. Canavan, Caroline, West Joe, and Card Timothy. “The Epidemiology of Irritable Bowel Syndrome.” Clinical Epidemiology 6 (2014): 71–80. 10.2147/CLEP.S40245. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Olafur, S. Palsson, William Whitehead, Hans Törnblom, Sperber Ami D., Simren Magnus. “Prevalence of Rome IV Functional Bowel Disorders Among Adults in the United States, Canada, and the United Kingdom.” Gastroenterology 158, no. 5 (2020): 1262–1273.e3. [DOI] [PubMed] [Google Scholar]
- 5. Grad, Simona, and Dumitrascu Dan L.. “Irritable Bowel Syndrome Subtypes: New Names for Old Medical Conditions.” Digestive Diseases 38, no. 2 (2020): 122–7. [DOI] [PubMed] [Google Scholar]
- 6. Schmulson, Max J., and Drossman Douglas A.. “What is New in Rome IV.” Journal of Neurogastroenterology and Motility 23, no. 2 (2017): 151–63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Ng, Qin Xiang, Soh Alex Yu Sen, Loke Wayren, Lim Donovan Yutong, and Yeo Wee-Song. “The Role of Inflammation in Irritable Bowel Syndrome (IBS).” Journal of Inflammation Research 11 (2018): 345–9. 10.2147/JIR.S174982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Canavan, Caroline, West Joe, and Card Timothy. “Change in Quality of Life for Patients with Irritable Bowel Syndrome following Referral to a Gastroenterologist: A Cohort Study.” PLoS One 10, no. 10 (2015): e0139389. 10.1371/journal.pone.0139389. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Jamali, Raika, Jamali Arsia, Poorrahnama Maryam, Omidi Abdollah, Jamali Bardia, Moslemi Neda, Ansari Reza, Dolatshahi Shahab, and Ebrahimi Daryani Naser. “Evaluation of Health Related Quality of Life in Irritable Bowel Syndrome Patients.” Health and Quality of Life Outcomes 10 (2012): 12. 10.1186/1477-7525-10-12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Andrae, David A., Patrick Donald L., Drossman Douglas A., and Covington Paul S.. “Evaluation of the Irritable Bowel Syndrome Quality of Life (IBS-QOL) Questionnaire in Diarrheal-Predominant Irritable Bowel Syndrome Patients.” Health and Quality of Life Outcomes 11 (2013): 208. 10.1186/1477-7525-11-208. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Sayuk, Gregory S., Wolf Ray, and Chang Lin. “Comparison of Symptoms, Healthcare Utilization, and Treatment in Diagnosed and Undiagnosed Individuals With Diarrhea-Predominant Irritable Bowel Syndrome.” American Journal of Gastroenterology 112, no. 6 (2017): 892–9. 10.1038/ajg.2016.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Ladabaum, Uri, Boyd Erin, Zhao Wei K., Mannalithara Ajitha, Sharabidze Annie, Singh Gurkirpal, Chung Elaine, and Levin Theodore R.. “Diagnosis, Comorbidities, and Management of Irritable Bowel Syndrome in Patients in a Large Health Maintenance Organization.” Clinical Gastroenterology and Hepatology 10, no. 1 (2012): 37–45. 10.1016/j.cgh.2011.08.015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Lacy, Brian E., Mearin Fermín, Chang Lin, Chey William D., Lembo Anthony J., Simren Magnus, and Spiller Robin. “Bowel Disorders.” Gastroenterology 150 (2016): 1393–1407.e5. [DOI] [PubMed] [Google Scholar]
- 14. Moayyedi, Paul, Andrews Christopher N., MacQueen Glenda, Korownyk Christina, Marsiglio Megan, Graff Lesley, Kvern Brent,. et al. “Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS).” Journal of the Canadian Association of Gastroenterology 2, no. 1 (2019): 6–29. 10.1093/jcag/gwy071. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Ford, Alexander C., Lacy Brian E., and Talley Nicholas J.. “Irritable Bowel Syndrome.” New England Journal of Medicine 376, no. 26 (2017): 2566–78. 10.1056/NEJMra1607547. [DOI] [PubMed] [Google Scholar]
- 16. Burbige, Eugene J. “Irritable Bowel Syndrome: Diagnostic Approaches in Clinical Practice.” Clinical and Experimental Gastroenterology 3 (2010): 127–37. 10.2147/CEG.S12596. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Silk, David B. “Impact of Irritable Bowel Syndrome on Personal Relationships and Working Practice.” European Journal of Gastroenterology and Hepatology 13, no. 11 (2001): 1327–32. 10.1097/00042737-200111000-00011. [DOI] [PubMed] [Google Scholar]
- 18. Dean, Bonnie B., Aguilar Daniel, Barghout V, Kahler Kristijan H., Frech Feride, Groves David, and Ofman Joshua J. “Impairment in Work Productivity and Health-Related Quality of Life in Patients with IBS.” The American Journal of Managed Care 11, no. 1 Suppl (2005): S17–26. [PubMed] [Google Scholar]
- 19. Faresjö, Åshild, Walter Susanna, Norlin Anna-Karin, Faresjö Tomas, and Jones Michael P.. “Gastrointestinal Symptoms—An Illness Burden That Affects Daily Work in Patients with IBS.” Health and Quality of Life Outcomes 17, no. 1 (2019): 113. 10.1186/s12955-019-1174-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Lee, Changhyun, Doo Eunyoung, Choi Ji Min, Jang Seung-Ho, Ryu Han-Seung, Lee Ju Yup, Oh Jung Hwan, Park Jung Ho, and Kim Yong Sung; Brain-Gut Axis Research Group of Korean Society of Neurogastroenterology and Motility. “The Increased Level of Depression and Anxiety in Irritable Bowel Syndrome Patients Compared with Healthy Controls: Systematic Review and Meta-analysis.” Journal of Neurogastroenterology and Motility 23, no. 3 (2017): 349–62. 10.5056/jnm16220. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. Defrees, Dean Nathanial, and Bailey Justin. “Irritable Bowel Syndrome Epidemiology, Pathophysiology, Diagnosis, and Treatment.” Primary Care 44, no. 4 (2017): 655–71. 10.1016/j.pop.2017.07.009. [DOI] [PubMed] [Google Scholar]
- 22. Halmos, Emma P., Power Victoria A., Shepherd Susan J., Gibson Peter R., and Muir Jane G.. “A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome.” Gastroenterology 146, no. 1 (2014): 67–75.e5. 10.1053/j.gastro.2013.09.046. [DOI] [PubMed] [Google Scholar]
- 23. Ruepert, Lisa, Quartero A. Otto, de Wit Niek J., van der Heijden Geert J., Rubin Gregory, and Muris Jean WM. “Bulking Agents, Antispasmodics and Antidepressants for the Treatment of Irritable Bowel Syndrome.” Cochrane Database of Systematic Reviews (Online) 2013, no. 3 (2011): CD003460. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Lesbros-Pantoflickova, Draha, Pierre Michetti, M.Fried, Christoph Beglinger, and Blum. André L.. “Meta-Analysis: The Treatment of Irritable Bowel Syndrome.” Alimentary Pharmacology and Therapeutics 20, no. 11-12 (2004): 1253–69. 10.1111/j.1365-2036.2004.02267.x. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data underlying this article will be shared on reasonable request to the corresponding author.