A prospective comparison of UK and Malaysian patients with irritable bowel syndrome in secondary care

Abstract

Summary Background The prevalence of irritable bowel syndrome (IBS) is now known to be similar in various geographical regions, but there has been no study directly comparing characteristics of patients with IBS between populations. Aims To evaluate clinical and psychological differences between adults with IBS seen in secondary care in the United Kingdom (UK) and Malaysia. Methods Age‐ and sex‐matched patients with IBS from a single centre in the UK (Leeds) and two centres in Malaysia (Kuala Lumpur and Kota Bharu), who fulfilled Rome III criteria, were recruited prospectively. Demographic characteristics and gastrointestinal and psychological symptoms were compared between both groups. Results A total of 266 (133 UK and 133 Malaysian) age‐ and sex‐matched patients with Rome III IBS were recruited (mean age: 45.1 years Malaysia, vs. 46.5 years UK; 57.9% female). UK patients were more likely to consume alcohol than Malaysian patients (54.1% vs. 10.5%, p < 0.001). Compared with Malaysian patients, UK patients had more frequent abdominal pain, abdominal bloating, meal‐related symptoms (p < 0.001 for all), higher symptom scores (mean 268.0 vs 166.0; p < 0.001), greater limitation of activities due to IBS (p = 0.007) and were more likely to report abnormal anxiety scores (p < 0.001). Higher perceived stress (mean 21.3 vs. 19.1, p = 0.014) and gastrointestinal symptom‐specific anxiety scores (mean 50.8 vs. 43.0, p < 0.001) were also observed in UK patients. Finally, UK patients had higher somatoform symptom‐reporting scores (mean 8.9 vs. 6.9, p < 0.001). Conclusions IBS is more severe and is associated with a higher level of psychological symptoms in the UK compared with Malaysian patients in secondary care.

Editorial: Recognising the regional variations in profile of irritable bowel syndrome—better late than never! Authors' reply

“…We thank Dr Ghoshal for his interest in our study, examining differences in IBS between patients in the UK and Malaysia in secondary care, 1 and his acknowledgement of the regional variations in the profile of IBS. 2 IBS does not contribute to mortality, but it has a substantial impact on quality of life, which has been reported to be worse than some severe chronic organic diseases.…”

“…It revealed more severe gastrointestinal and psychological symptoms, and a greater limitation of activities among patients in the UK compared with Malaysia. 1 Although there was a slight difference in the survey method (paper vs. web-based), potential bias was reduced by participants from both countries completing self-administered questionnaires. In contrast, the prevalence of IBS differed significantly between household in-person interview methods and internet surveys in the Rome Foundation Global Epidemiology study.…”

Editorial: Recognising the regional variations in profile of irritable bowel syndrome—better late than never!

“…A prospective comparison of patients in secondary care meeting Rome III criteria for IBS in the United Kingdom (UK; n = 133) and Malaysia (n = 133) reported that patients from UK had more frequent abdominal pain, bloating, meal-related symptoms, and higher symptom score, greater activity impairment and mental health abnormalities than those from Malaysia. 3 More patients in the UK had diarrhoea-predominant IBS than in Malaysia, where constipationpredominant IBS was commoner. In some Asian countries, stool frequency is higher, and stool form is looser among healthy people.…”