Epidemiology of irritable bowel syndrome in Asia: Something old, something new, something borrowed

Abstract

In this review we have unearthed epidemiological data that; support the 'old' concept of irritable bowel syndrome (IBS) as a disorder of civilization, build a 'new' symptom profile of IBS for Asia, and persuade us against the use of 'borrowed' Western diagnostic criteria and illness models by Asian societies. In the 1960s, IBS was described as a disorder of civilization. Early studies from Asia suggested a prevalence of IBS below 5%. Recent studies from Asia suggest a trend for the more affluent city states like Singapore and Tokyo, to have higher prevalence of 8.6% and 9.8%, respectively, while India had the lowest prevalence of 4.2%. Furthermore, there was a trend among the better educated and more affluent strata of society in several urban Chinese populations for a higher prevalence of IBS, as well as a trend for a higher consultation rate. Across Chinese and Indian predominant populations, a majority of patients with IBS criteria report upper abdominal symptoms such as epigastric pain relieved by defecation, bloating and dyspepsia. Bloating and incomplete evacuation appear to be more important determinants of consultation behavior, than psychological factors. The failure of the Rome criteria to recognize the relationship to meals, may have led to a substantial misclassification of IBS as dyspepsia. The relevance of the Western model of psychological disturbance as a determinant of consultation behavior is questionable because of the accessibility and acceptability of medical consultation for gastrointestinal complaints in many Asian communities.

Pros and Cons While Looking Through an Asian Window on the Rome IV Criteria for Irritable Bowel Syndrome: Pros

“…12 However, epigastric localization of pain in Asia in general and India in particular is well-known. 13 The threshold for symptoms as per Rome III was 3 days a month as compared to 1 day per week in the Rome IV criteria. 11,12 This cut-off value is based on evidence, 14 and hence, Rome IV has been claimed to be scientifically more valid.…”

Mapping of Brain Activations to Rectal Balloon Distension Stimuli in Male Patients with Irritable Bowel Syndrome Using Functional Magnetic Resonance Imaging

“…However, in some Asian countries including India, a large proportion of patients with IBS are males. 30,31 This provided us an unique opportunity to study brain response in relation to visceral stimulation among male IBS patients. Phenotype of IBS and brain response are known to differ with respect to gender [32][33][34] and a few authors suggested that sex hormones might explain these differences.…”

Assessment of the Asian Neurogastroenterology and Motility Association Chronic Constipation Criteria: An Asian Multicenter Cross-sectional Study

“…For instance, patients from Asia have a shorter colonic transit time than Western patients, and in South Korea most patients who experience hard stools do not meet Rome criteria for hard stools. 5,9 There are also differences within Asia; in India, patients with self-perceived constipation report a median of 2 bowel movements per day 10 and in China, where there are marked regional differences in the prevalence of constipation. 11 Similarly, and as observed in our results, there are slight differences in the prevalence of CC among Malays, Indians, and Chinese in Singapore.…”