Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh and Malaysia: A review

Abstract

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder, common in clinic and in the community. It has a significant impact on both society and patients’ quality of life. The epidemiology, clinical presentation, and management of IBS may vary in different geographical regions due to differences in diet, gastrointestinal infection, socio-cultural and psycho-social factors, religious and illness beliefs, symptom perception and reporting. Although previous reviews and consensus reports on IBS in Asia have been published, Asia is quite diverse socio-demographically. In this context, India, Bangladesh and Malaysia share some similarities, including: (1) large proportion of the population living in rural areas; (2) rapid development and associated lifestyle changes in urban areas; and (3) dietary, cultural and religious practices. The present review explores the clinical and epidemiological data on IBS from these three major nations in South and South-East Asia. In-depth review of the literature revealed important differences between IBS in the East, as revealed by studies from these three countries, and the West; these include a predominantly rural profile, differences in bowel habit and symptom profile, raising concern with regards to diagnostic criteria and subtyping of IBS, higher dietary fiber consumption, frequent lactose malabsorption, parasitosis, and possible overlap between post-infectious IBS and tropical sprue. Moreover, the current perception on difference in prevalence of the disorder in these countries, as compared to the West, might be related to variation in survey methods.

Cultural Factors Influencing Functional Gastrointestinal Disorders in the East

“…In both the Manning and Asian criteria, "abdominal pain or discomfort" were not included as an absolute requirement for the diagnosis of IBS, which resulted in their greater frequency for diagnosing IBS in the Indian population. 8 Similar findings have been reported in other Asian populations. In a Hong Kong study, 68.0% of patients with IBS reported bloating, compared to only 32.0% who complained of abdominal pain.…”

“…33 Furthermore, more fiber results in a greater stool weight, which additionally reduces colonic transit time. In the light of the differences in dietary fiber intake, Rahman et al 8 additionally showed that the mean intestinal transit time among Northern Indian adults was 39.9 hours compared to 83.4 hours in Caucasian adults (Fig. 1).…”

“…Similarly, two separate studies from India reported that healthcare consultation was greater in urban compared to rural IBS adults (28.9% urban vs 17.2% rural). 8 In the Indian studies, most IBS subjects sought treatment for their symptoms from either Indian traditional practitioners (Ayurveda) or from homeopathy experts, with only 18.0% seeking attention from modern medical practitioners. 8 These observations suggest a cultural bias towards traditional practitioners rather than modern, Western-trained healthcare practices, in many parts of the Indian sub-continent ( Table 5).…”

“…6 Culture is defined as the values, beliefs, norms, and practices of a group of people which guide thinking, decisions, and actions in a patterned way. 7 In 2 recent review articles on FD 4 and IBS, 8 various differences in clinical presentation and impact of these conditions were observed between the East and the West. In these reviews, "East" included countries from Asia, while Western countries included countries from Europe, North America, and Australia, mainly due to similarities in culture and diet.…”

Post-infection irritable bowel syndrome in the tropical and subtropical regions: Vibrio cholerae is a new cause of this well-known condition

“…The frequency of acute gastroenteritis in the tropics including India and Bangladesh is high [66]. On the other hand, in most of the studies, the prevalence of IBS among the general adult population in India and Bangladesh has been found to be between 4% and 8% [67], which is lower compared with the global prevalence of 11.2% [68]. The reason for the low prevalence of IBS in spite of the high prevalence of acute gastroenteritis in these countries remains enigmatic.…”