Article Report

The Prevalence and Impact of Overlapping Rome IV-Diagnosed Functional Gastrointestinal Disorders on Somatization, Quality of Life, and Healthcare Utilization: A Cross-Sectional General Population Study in Three Countries

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Abstract

Objectives:

The population prevalence of Rome IV-diagnosed functional gastrointestinal disorders (FGIDs) and their cumulative effect on health impairment is unknown.

Methods:

An internet-based cross-sectional health survey was completed by 5,931 of 6,300 general population adults from three English-speaking countries (2100 each from USA, Canada, and UK). Quota-based sampling was used to generate demographically balanced and population representative samples with regards to age, sex, and education level. The survey enquired for demographics, medication, surgical history, somatization, quality of life (QOL), doctor-diagnosed organic GI disease, and criteria for the Rome IV FGIDs. Comparisons were made between those with Rome IV-diagnosed FGIDs against non-GI (healthy) and organic GI disease controls.

Results:

The number of subjects having symptoms compatible with a FGID was 2,083 (35%) compared with 3,421 (57.7%) non-GI and 427 (7.2%) organic GI disease controls. The most frequently met diagnostic criteria for FGIDs was bowel disorders (n=1,665, 28.1%), followed by gastroduodenal (n=627, 10.6%), anorectal (n=440, 7.4%), esophageal (n=414, 7%), and gallbladder disorders (n=10, 0.2%). On average, the 2,083 individuals who met FGID criteria qualified for 1.5 FGID diagnoses, and 742 of them (36%) qualified for FGID diagnoses in more than one anatomic region. The presence of FGIDs in multiple regions was associated with increasing somatization, worse mental/physical QOL, more medical therapies, and a higher prevalence of abdominal surgeries; all P<0.001. Notably, individuals with FGIDs in multiple regions had greater somatization and worse QOL than organic GI disease controls.

Conclusions:

Roughly a third of the general adult population fulfils diagnostic criteria for a Rome IV FGID. In a third of this subset multiple GI regions are involved and this overlap is associated with increased health impairment.

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Acknowledgements

The study was performed in accordance with the STROBE statement. The study was approved by the Institutional Review Board of the University of North Carolina, United States.

Author information

Affiliations

  1. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    • Imran Aziz
    • , Hans Törnblom
    •  & Magnus Simrén
  2. Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina, USA

    • Olafur S Palsson
    • , William E Whitehead
    •  & Magnus Simrén
  3. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    • Ami D Sperber

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Competing interests

Guarantor of the article: Imran Aziz, MBChB, MD.

Specific author contributions: OSP and WEW contributed to the study design, questionnaire development, execution of survey, data processing, and manuscript editing. ADS contributed to the study design, questionnaire development, and manuscript editing. HT contributed to interpretation of data and manuscript editing. MS contributed to study design, interpretation of data and manuscript editing. IA analyzed the data and drafted the manuscript. All authors reviewed and approved the final version of the manuscript.

Financial Support: This study was supported by the Rome Foundation, NIDDK (grant RO1 DK31369), the Swedish Medical Research Council (grants 13409, 21691 and 21692), AFA Insurance, an unrestricted grant from Ferring Pharmaceuticals, and by the Faculty of Medicine, University of Gothenburg.

Potential competing interests: MS has received unrestricted research grants from Danone, and Ferring Pharmaceuticals, and served as a Consultant/Advisory Board member for AstraZeneca, Danone, Nestlé, Almirall, Allergan, Albireo, Glycom, and Shire, and as a speaker for Tillotts, Menarini, Takeda, Shire, Allergan, and Almirall. HT has served as Consultant/Advisory Board member for Almirall, Danone, and Shire. OSP has received salary support from a research grants from Takeda Pharmaceuticals and Salix Pharmaceuticals and from a consulting agreement with Ironwood Pharmaceuticals and an educational grant provided by Takeda Pharmaceuticals, and received a speaker honorarium in an educational programe supported by Ironwood Pharmaceuticals and Takeda Pharmaceuticals. WEW received research grants from Takeda, Ironwood, Salix, and the Rome Foundation; served as a consultant to Biomerica USA, Ono Pharmaceuticals and Ferring; and received unrestricted educational grants from Takeda and Ferring.

Corresponding author

Correspondence to Imran Aziz.

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