Irritable bowel syndrome epidemiology and demographics: Difference between revisions

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==Overview==
==Overview==
Irritable bowel disease ([[Irritable bowel syndrome|IBS]]) is an extremely common disorder among the general population. The [[incidence]] of [[Irritable bowel syndrome|IBS]] is approximately 200 per 100,000 individuals worldwide. The [[prevalence]] of [[Irritable bowel syndrome|IBS]] is approximately 11,200 per 100,000 individuals worldwide. The [[prevalence]] of [[Irritable bowel syndrome|IBS]] varies with geographical and [[Demographics|demographic]] distribution. [[Females]] are more commonly affected by IBS than [[males]]. The [[female]] to [[male]] ratio is approximately 1:2. The [[prevalence]] of [[Irritable bowel syndrome|IBS]] in USA and Europe is 10,000-20,000 per 100,000 individuals. In USA and Australia, 1 in every 10 people fulfill the Rome IV criteria for [[Irritable bowel syndrome|IBS]]. In Asia, Africa and South America, [[Irritable bowel syndrome|IBS]] is becoming increasingly [[Prevalence|prevalent]] as a disease of urbanization and industrialization. This is due to increased access to health care, higher [[Stress (medicine)|stress]] levels and differing [[Diet (nutrition)|dietary]] choices.
Irritable bowel disease ([[Irritable bowel syndrome|IBS]]) is an extremely common disorder among the general population. The [[incidence]] of [[Irritable bowel syndrome|IBS]] is approximately 200 per 100,000 individuals worldwide. The [[prevalence]] of [[Irritable bowel syndrome|IBS]] is approximately 11,200 per 100,000 individuals worldwide. The [[prevalence]] of [[Irritable bowel syndrome|IBS]] varies with geographical and [[Demographics|demographic]] distribution. [[Females]] are more commonly affected by IBS than [[males]]. The [[female]] to [[male]] ratio is approximately 1:2. The [[prevalence]] of [[Irritable bowel syndrome|IBS]] in USA and Europe is 10,000-20,000 per 100,000 individuals. In USA and Australia, 1 in every 10 people fulfill the Rome IV criteria for [[Irritable bowel syndrome|IBS]]. In Asia, Africa and South America, [[Irritable bowel syndrome|IBS]] is becoming increasingly [[Prevalence|prevalent]] as a disease of urbanization and industrialization. This is due to increased access to health care, higher [[Stress (medicine)|stress]] levels and differing [[Diet (nutrition)|dietary]] choices.


==Epidemiology and Demographics==
==Epidemiology and Demographics==
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*The [[prevalence]] of [[Irritable bowel syndrome|IBS]] is approximately 11,200 per 100,000 individuals worldwide.<ref name="pmid21333897">{{cite journal |vauthors=Choung RS, Locke GR |title=Epidemiology of IBS |journal=Gastroenterol. Clin. North Am. |volume=40 |issue=1 |pages=1–10 |year=2011 |pmid=21333897 |doi=10.1016/j.gtc.2010.12.006 |url=}}</ref><ref name="pmid28901578">{{cite journal |vauthors=Gwee KA, Ghoshal UC, Chen M |title=Irritable bowel syndrome in Asia: pathogenesis, natural history, epidemiology and management |journal=J. Gastroenterol. Hepatol. |volume= |issue= |pages= |year=2017 |pmid=28901578 |doi=10.1111/jgh.13987 |url=}}</ref><ref name="pmid27623513">{{cite journal |vauthors=Quigley EM, Fried M, Gwee KA, Khalif I, Hungin AP, Lindberg G, Abbas Z, Fernandez LB, Bhatia SJ, Schmulson M, Olano C, LeMair A |title=World Gastroenterology Organisation Global Guidelines Irritable Bowel Syndrome: A Global Perspective Update September 2015 |journal=J. Clin. Gastroenterol. |volume=50 |issue=9 |pages=704–13 |year=2016 |pmid=27623513 |doi=10.1097/MCG.0000000000000653 |url=}}</ref><ref name="pmid7657095">{{cite journal |vauthors=Agréus L, Svärdsudd K, Nyrén O, Tibblin G |title=Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time |journal=Gastroenterology |volume=109 |issue=3 |pages=671–80 |year=1995 |pmid=7657095 |doi= |url=}}</ref><ref name="pmid18492027">{{cite journal |vauthors=Husain N, Chaudhry IB, Jafri F, Niaz SK, Tomenson B, Creed F |title=A population-based study of irritable bowel syndrome in a non-Western population |journal=Neurogastroenterol. Motil. |volume=20 |issue=9 |pages=1022–9 |year=2008 |pmid=18492027 |doi=10.1111/j.1365-2982.2008.01143.x |url=}}</ref><ref name="pmid11837727">{{cite journal |vauthors=Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L |title=Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire |journal=Dig. Dis. Sci. |volume=47 |issue=1 |pages=225–35 |year=2002 |pmid=11837727 |doi= |url=}}</ref><ref name="pmid1587415">{{cite journal |vauthors=Heaton KW, O'Donnell LJ, Braddon FE, Mountford RA, Hughes AO, Cripps PJ |title=Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters |journal=Gastroenterology |volume=102 |issue=6 |pages=1962–7 |year=1992 |pmid=1587415 |doi= |url=}}</ref><ref name="pmid1737146">{{cite journal |vauthors=Jones R, Lydeard S |title=Irritable bowel syndrome in the general population |journal=BMJ |volume=304 |issue=6819 |pages=87–90 |year=1992 |pmid=1737146 |pmc=1880997 |doi= |url=}}</ref><ref name="pmid15239910">{{cite journal |vauthors=Wilson S, Roberts L, Roalfe A, Bridge P, Singh S |title=Prevalence of irritable bowel syndrome: a community survey |journal=Br J Gen Pract |volume=54 |issue=504 |pages=495–502 |year=2004 |pmid=15239910 |pmc=1324800 |doi= |url=}}</ref><ref name="pmid22426087">{{cite journal |vauthors=Lovell RM, Ford AC |title=Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=10 |issue=7 |pages=712–721.e4 |year=2012 |pmid=22426087 |doi=10.1016/j.cgh.2012.02.029 |url=}}</ref>
*The [[prevalence]] of [[Irritable bowel syndrome|IBS]] is approximately 11,200 per 100,000 individuals worldwide.<ref name="pmid21333897">{{cite journal |vauthors=Choung RS, Locke GR |title=Epidemiology of IBS |journal=Gastroenterol. Clin. North Am. |volume=40 |issue=1 |pages=1–10 |year=2011 |pmid=21333897 |doi=10.1016/j.gtc.2010.12.006 |url=}}</ref><ref name="pmid28901578">{{cite journal |vauthors=Gwee KA, Ghoshal UC, Chen M |title=Irritable bowel syndrome in Asia: pathogenesis, natural history, epidemiology and management |journal=J. Gastroenterol. Hepatol. |volume= |issue= |pages= |year=2017 |pmid=28901578 |doi=10.1111/jgh.13987 |url=}}</ref><ref name="pmid27623513">{{cite journal |vauthors=Quigley EM, Fried M, Gwee KA, Khalif I, Hungin AP, Lindberg G, Abbas Z, Fernandez LB, Bhatia SJ, Schmulson M, Olano C, LeMair A |title=World Gastroenterology Organisation Global Guidelines Irritable Bowel Syndrome: A Global Perspective Update September 2015 |journal=J. Clin. Gastroenterol. |volume=50 |issue=9 |pages=704–13 |year=2016 |pmid=27623513 |doi=10.1097/MCG.0000000000000653 |url=}}</ref><ref name="pmid7657095">{{cite journal |vauthors=Agréus L, Svärdsudd K, Nyrén O, Tibblin G |title=Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time |journal=Gastroenterology |volume=109 |issue=3 |pages=671–80 |year=1995 |pmid=7657095 |doi= |url=}}</ref><ref name="pmid18492027">{{cite journal |vauthors=Husain N, Chaudhry IB, Jafri F, Niaz SK, Tomenson B, Creed F |title=A population-based study of irritable bowel syndrome in a non-Western population |journal=Neurogastroenterol. Motil. |volume=20 |issue=9 |pages=1022–9 |year=2008 |pmid=18492027 |doi=10.1111/j.1365-2982.2008.01143.x |url=}}</ref><ref name="pmid11837727">{{cite journal |vauthors=Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L |title=Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire |journal=Dig. Dis. Sci. |volume=47 |issue=1 |pages=225–35 |year=2002 |pmid=11837727 |doi= |url=}}</ref><ref name="pmid1587415">{{cite journal |vauthors=Heaton KW, O'Donnell LJ, Braddon FE, Mountford RA, Hughes AO, Cripps PJ |title=Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters |journal=Gastroenterology |volume=102 |issue=6 |pages=1962–7 |year=1992 |pmid=1587415 |doi= |url=}}</ref><ref name="pmid1737146">{{cite journal |vauthors=Jones R, Lydeard S |title=Irritable bowel syndrome in the general population |journal=BMJ |volume=304 |issue=6819 |pages=87–90 |year=1992 |pmid=1737146 |pmc=1880997 |doi= |url=}}</ref><ref name="pmid15239910">{{cite journal |vauthors=Wilson S, Roberts L, Roalfe A, Bridge P, Singh S |title=Prevalence of irritable bowel syndrome: a community survey |journal=Br J Gen Pract |volume=54 |issue=504 |pages=495–502 |year=2004 |pmid=15239910 |pmc=1324800 |doi= |url=}}</ref><ref name="pmid22426087">{{cite journal |vauthors=Lovell RM, Ford AC |title=Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=10 |issue=7 |pages=712–721.e4 |year=2012 |pmid=22426087 |doi=10.1016/j.cgh.2012.02.029 |url=}}</ref>
*The [[prevalence]] of [[Irritable bowel syndrome|IBS]] varies with geographical and [[Demographics|demographic]] distribution.  
*The [[prevalence]] of [[Irritable bowel syndrome|IBS]] varies with geographical and [[Demographics|demographic]] distribution.  
*The [[prevalence]] of [[Irritable bowel syndrome|IBS]] in USA and Europe is 10,000-20,000 per 100,000 individuals.<ref name="pmid8359066">{{cite journal |vauthors=Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E |title=U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact |journal=Dig. Dis. Sci. |volume=38 |issue=9 |pages=1569–80 |year=1993 |pmid=8359066 |doi= |url=}}</ref><ref name="pmid20074154">{{cite journal |vauthors=Grundmann O, Yoon SL |title=Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners |journal=J. Gastroenterol. Hepatol. |volume=25 |issue=4 |pages=691–9 |year=2010 |pmid=20074154 |doi=10.1111/j.1440-1746.2009.06120.x |url=}}</ref>
*The [[prevalence]] of [[Irritable bowel syndrome|IBS]] in USA and Europe is ranges from a low of 10,000 per 100,000 individuals to a high of 20,000 per 100,000 individuals.<ref name="pmid8359066">{{cite journal |vauthors=Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E |title=U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact |journal=Dig. Dis. Sci. |volume=38 |issue=9 |pages=1569–80 |year=1993 |pmid=8359066 |doi= |url=}}</ref><ref name="pmid20074154">{{cite journal |vauthors=Grundmann O, Yoon SL |title=Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners |journal=J. Gastroenterol. Hepatol. |volume=25 |issue=4 |pages=691–9 |year=2010 |pmid=20074154 |doi=10.1111/j.1440-1746.2009.06120.x |url=}}</ref>


===Age===
===Age===
*IBS commonly affects individuals younger than 35 years of age.<ref name="pmid9400529">{{cite journal |vauthors=Maxwell PR, Mendall MA, Kumar D |title=Irritable bowel syndrome |journal=Lancet |volume=350 |issue=9092 |pages=1691–5 |year=1997 |pmid=9400529 |doi= |url=}}</ref>
*IBS commonly affects individuals younger than 35 years of age.<ref name="pmid9400529">{{cite journal |vauthors=Maxwell PR, Mendall MA, Kumar D |title=Irritable bowel syndrome |journal=Lancet |volume=350 |issue=9092 |pages=1691–5 |year=1997 |pmid=9400529 |doi= |url=}}</ref>
*The incidence of [[Irritable bowel syndrome|IBS]] decreases with age.
*The [[incidence]] of [[Irritable bowel syndrome|IBS]] decreases with age.
*The prevalence of [[Irritable bowel syndrome|IBS]] is 25% lower in individuals over 50 years of age.<ref name="pmid22426087">{{cite journal |vauthors=Lovell RM, Ford AC |title=Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=10 |issue=7 |pages=712–721.e4 |year=2012 |pmid=22426087 |doi=10.1016/j.cgh.2012.02.029 |url=}}</ref> <ref name="pmid23326122">{{cite journal |vauthors=Tang YR, Yang WW, Liang ML, Xu XY, Wang MF, Lin L |title=Age-related symptom and life quality changes in women with irritable bowel syndrome |journal=World J. Gastroenterol. |volume=18 |issue=48 |pages=7175–83 |year=2012 |pmid=23326122 |pmc=3544019 |doi=10.3748/wjg.v18.i48.7175 |url=}}</ref>
*The [[prevalence]] of [[Irritable bowel syndrome|IBS]] is 25% lower in individuals over 50 years of age.<ref name="pmid22426087">{{cite journal |vauthors=Lovell RM, Ford AC |title=Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=10 |issue=7 |pages=712–721.e4 |year=2012 |pmid=22426087 |doi=10.1016/j.cgh.2012.02.029 |url=}}</ref> <ref name="pmid23326122">{{cite journal |vauthors=Tang YR, Yang WW, Liang ML, Xu XY, Wang MF, Lin L |title=Age-related symptom and life quality changes in women with irritable bowel syndrome |journal=World J. Gastroenterol. |volume=18 |issue=48 |pages=7175–83 |year=2012 |pmid=23326122 |pmc=3544019 |doi=10.3748/wjg.v18.i48.7175 |url=}}</ref>


===Race===
===Race===
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===Gender ===
===Gender ===
*Females are more commonly affected by [[Irritable bowel syndrome|IBS]] than males. The female to male ratio is approximately 1.5-3. This is due to social and biological factors.<ref name="pmid9096434">{{cite journal |vauthors=Thompson WG |title=Gender differences in irritable bowel symptoms |journal=Eur J Gastroenterol Hepatol |volume=9 |issue=3 |pages=299–302 |year=1997 |pmid=9096434 |doi= |url=}}</ref>
*Females are more commonly affected by [[Irritable bowel syndrome|IBS]] than males. The female to male ratio is approximately 1:2. This is due to social and biological factors.<ref name="pmid9096434">{{cite journal |vauthors=Thompson WG |title=Gender differences in irritable bowel symptoms |journal=Eur J Gastroenterol Hepatol |volume=9 |issue=3 |pages=299–302 |year=1997 |pmid=9096434 |doi= |url=}}</ref>
''Social factors:''
'''''Social factors:'''''
*The ratio is high in females as the ''likelihood of diagnosis of [[Irritable bowel syndrome|IBS]]'' is 2-3 times more in women as compared to men. This is because ''health care seeking behavior'' for symptoms is 4-5 times higher in women as compared to men.<ref name="pmid8359066" /><ref name="pmid16115580">{{cite journal |vauthors=Payne S |title=Sex, gender, and irritable bowel syndrome: making the connections |journal=Gend Med |volume=1 |issue=1 |pages=18–28 |year=2004 |pmid=16115580 |doi= |url=}}</ref><ref name="pmid22613905">{{cite journal |vauthors=Lovell RM, Ford AC |title=Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis |journal=Am. J. Gastroenterol. |volume=107 |issue=7 |pages=991–1000 |year=2012 |pmid=22613905 |doi=10.1038/ajg.2012.131 |url=}}</ref><ref name="pmid9824603">{{cite journal |vauthors=Kennedy TM, Jones RH, Hungin AP, O'flanagan H, Kelly P |title=Irritable bowel syndrome, gastro-oesophageal reflux, and bronchial hyper-responsiveness in the general population |journal=Gut |volume=43 |issue=6 |pages=770–4 |year=1998 |pmid=9824603 |pmc=1727355 |doi= |url=}}</ref> <ref name="pmid19728159">{{cite journal |vauthors=Voci SC, Cramer KM |title=Gender-related traits, quality of life, and psychological adjustment among women with irritable bowel syndrome |journal=Qual Life Res |volume=18 |issue=9 |pages=1169–76 |year=2009 |pmid=19728159 |doi=10.1007/s11136-009-9532-9 |url=}}</ref><ref name="pmid16807154">{{cite journal |vauthors=Quigley EM, Bytzer P, Jones R, Mearin F |title=Irritable bowel syndrome: the burden and unmet needs in Europe |journal=Dig Liver Dis |volume=38 |issue=10 |pages=717–23 |year=2006 |pmid=16807154 |doi=10.1016/j.dld.2006.05.009 |url=}}</ref><ref name="pmid698649">{{cite journal |vauthors=Manning AP, Thompson WG, Heaton KW, Morris AF |title=Towards positive diagnosis of the irritable bowel |journal=Br Med J |volume=2 |issue=6138 |pages=653–4 |year=1978 |pmid=698649 |pmc=1607467 |doi= |url=}}</ref>
*[[Females]] are predominantly affected by IBS as the likelihood of diagnosis of [[Irritable bowel syndrome|IBS]] is 2-3 times more in women as compared to men. This is because health care seeking behavior for [[symptoms]] is 4-5 times higher in women as compared to men.<ref name="pmid8359066" /><ref name="pmid16115580">{{cite journal |vauthors=Payne S |title=Sex, gender, and irritable bowel syndrome: making the connections |journal=Gend Med |volume=1 |issue=1 |pages=18–28 |year=2004 |pmid=16115580 |doi= |url=}}</ref><ref name="pmid22613905">{{cite journal |vauthors=Lovell RM, Ford AC |title=Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis |journal=Am. J. Gastroenterol. |volume=107 |issue=7 |pages=991–1000 |year=2012 |pmid=22613905 |doi=10.1038/ajg.2012.131 |url=}}</ref><ref name="pmid9824603">{{cite journal |vauthors=Kennedy TM, Jones RH, Hungin AP, O'flanagan H, Kelly P |title=Irritable bowel syndrome, gastro-oesophageal reflux, and bronchial hyper-responsiveness in the general population |journal=Gut |volume=43 |issue=6 |pages=770–4 |year=1998 |pmid=9824603 |pmc=1727355 |doi= |url=}}</ref> <ref name="pmid19728159">{{cite journal |vauthors=Voci SC, Cramer KM |title=Gender-related traits, quality of life, and psychological adjustment among women with irritable bowel syndrome |journal=Qual Life Res |volume=18 |issue=9 |pages=1169–76 |year=2009 |pmid=19728159 |doi=10.1007/s11136-009-9532-9 |url=}}</ref><ref name="pmid16807154">{{cite journal |vauthors=Quigley EM, Bytzer P, Jones R, Mearin F |title=Irritable bowel syndrome: the burden and unmet needs in Europe |journal=Dig Liver Dis |volume=38 |issue=10 |pages=717–23 |year=2006 |pmid=16807154 |doi=10.1016/j.dld.2006.05.009 |url=}}</ref><ref name="pmid698649">{{cite journal |vauthors=Manning AP, Thompson WG, Heaton KW, Morris AF |title=Towards positive diagnosis of the irritable bowel |journal=Br Med J |volume=2 |issue=6138 |pages=653–4 |year=1978 |pmid=698649 |pmc=1607467 |doi= |url=}}</ref>
''Biological factors:''
'''''Biological factors:'''''
*The fluctuation of [[Sex steroid|sex hormones]] in women during the [[menstrual cycle]] causes exacerbation of [[Irritable bowel syndrome|IBS]] symptoms. <ref name="pmid7995186">{{cite journal |vauthors=Jackson NA, Houghton LA, Whorwell PJ, Currer B |title=Does the menstrual cycle affect anorectal physiology? |journal=Dig. Dis. Sci. |volume=39 |issue=12 |pages=2607–11 |year=1994 |pmid=7995186 |doi= |url=}}</ref><ref name="pmid8379554">{{cite journal |vauthors=Walker EA, Katon WJ, Roy-Byrne PP, Jemelka RP, Russo J |title=Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease |journal=Am J Psychiatry |volume=150 |issue=10 |pages=1502–6 |year=1993 |pmid=8379554 |doi=10.1176/ajp.150.10.1502 |url=}}</ref><ref name="pmid19406367">{{cite journal |vauthors=Heitkemper MM, Chang L |title=Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? |journal=Gend Med |volume=6 Suppl 2 |issue= |pages=152–67 |year=2009 |pmid=19406367 |pmc=3322543 |doi=10.1016/j.genm.2009.03.004 |url=}}</ref>
*The fluctuation of [[Sex steroid|sex hormones]] in women during the [[menstrual cycle]] causes exacerbation of [[Irritable bowel syndrome|IBS]] symptoms. <ref name="pmid7995186">{{cite journal |vauthors=Jackson NA, Houghton LA, Whorwell PJ, Currer B |title=Does the menstrual cycle affect anorectal physiology? |journal=Dig. Dis. Sci. |volume=39 |issue=12 |pages=2607–11 |year=1994 |pmid=7995186 |doi= |url=}}</ref><ref name="pmid8379554">{{cite journal |vauthors=Walker EA, Katon WJ, Roy-Byrne PP, Jemelka RP, Russo J |title=Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease |journal=Am J Psychiatry |volume=150 |issue=10 |pages=1502–6 |year=1993 |pmid=8379554 |doi=10.1176/ajp.150.10.1502 |url=}}</ref><ref name="pmid19406367">{{cite journal |vauthors=Heitkemper MM, Chang L |title=Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? |journal=Gend Med |volume=6 Suppl 2 |issue= |pages=152–67 |year=2009 |pmid=19406367 |pmc=3322543 |doi=10.1016/j.genm.2009.03.004 |url=}}</ref>
*Women have a lower threshold for pain and are at greater risk for development of [[Somatoform disorder|functional]] and [[chronic pain disorders]] such as [[Irritable bowel syndrome|IBS]] and [[fibromyalgia]].<ref name="pmid21665365">{{cite journal |vauthors=Goffaux P, Michaud K, Gaudreau J, Chalaye P, Rainville P, Marchand S |title=Sex differences in perceived pain are affected by an anxious brain |journal=Pain |volume=152 |issue=9 |pages=2065–73 |year=2011 |pmid=21665365 |doi=10.1016/j.pain.2011.05.002 |url=}}</ref>   
*Women have a lower threshold for pain and are at greater risk for development of [[Somatoform disorder|functional]] and [[chronic pain]] disorders such as [[Irritable bowel syndrome|IBS]] and [[fibromyalgia]].<ref name="pmid21665365">{{cite journal |vauthors=Goffaux P, Michaud K, Gaudreau J, Chalaye P, Rainville P, Marchand S |title=Sex differences in perceived pain are affected by an anxious brain |journal=Pain |volume=152 |issue=9 |pages=2065–73 |year=2011 |pmid=21665365 |doi=10.1016/j.pain.2011.05.002 |url=}}</ref>   
*'''Pediatric population:'''   
*'''Pediatric population:'''   
*The worldwide prevalence of [[Irritable bowel syndrome|IBS]] is higher in girls.   
*Worldwide, the [[prevalence]] of [[Irritable bowel syndrome|IBS]] is higher in girls.   
* The prevalence of [[Irritable bowel syndrome|IBS]] in Asia is higher in girls as compared to boys.<ref name="pmid22837878">{{cite journal |vauthors=Rajindrajith S, Devanarayana NM |title=Subtypes and Symptomatology of Irritable Bowel Syndrome in Children and Adolescents: A School-based Survey Using Rome III Criteria |journal=J Neurogastroenterol Motil |volume=18 |issue=3 |pages=298–304 |year=2012 |pmid=22837878 |pmc=3400818 |doi=10.5056/jnm.2012.18.3.298 |url=}}</ref><ref name="pmid16140684">{{cite journal |vauthors=Dong L, Dingguo L, Xiaoxing X, Hanming L |title=An epidemiologic study of irritable bowel syndrome in adolescents and children in China: a school-based study |journal=Pediatrics |volume=116 |issue=3 |pages=e393–6 |year=2005 |pmid=16140684 |doi=10.1542/peds.2004-2764 |url=}}</ref><ref name="pmid16678566">{{cite journal |vauthors=Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS |title=Childhood functional gastrointestinal disorders: child/adolescent |journal=Gastroenterology |volume=130 |issue=5 |pages=1527–37 |year=2006 |pmid=16678566 |doi=10.1053/j.gastro.2005.08.063 |url=}}</ref>
* The [[prevalence]] of [[Irritable bowel syndrome|IBS]] in Asia is higher in girls as compared to boys.<ref name="pmid22837878">{{cite journal |vauthors=Rajindrajith S, Devanarayana NM |title=Subtypes and Symptomatology of Irritable Bowel Syndrome in Children and Adolescents: A School-based Survey Using Rome III Criteria |journal=J Neurogastroenterol Motil |volume=18 |issue=3 |pages=298–304 |year=2012 |pmid=22837878 |pmc=3400818 |doi=10.5056/jnm.2012.18.3.298 |url=}}</ref><ref name="pmid16140684">{{cite journal |vauthors=Dong L, Dingguo L, Xiaoxing X, Hanming L |title=An epidemiologic study of irritable bowel syndrome in adolescents and children in China: a school-based study |journal=Pediatrics |volume=116 |issue=3 |pages=e393–6 |year=2005 |pmid=16140684 |doi=10.1542/peds.2004-2764 |url=}}</ref><ref name="pmid16678566">{{cite journal |vauthors=Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS |title=Childhood functional gastrointestinal disorders: child/adolescent |journal=Gastroenterology |volume=130 |issue=5 |pages=1527–37 |year=2006 |pmid=16678566 |doi=10.1053/j.gastro.2005.08.063 |url=}}</ref>
'''Children'''
'''Children'''
* In the Western pediatric population, [[Irritable bowel syndrome|IBS]] is the commonest cause of functional Recurrent abdominal pain(RAP) as it accounts for more than 50% of all cases.<ref name="pmid7714688">{{cite journal |vauthors=Hyams JS, Treem WR, Justinich CJ, Davis P, Shoup M, Burke G |title=Characterization of symptoms in children with recurrent abdominal pain: resemblance to irritable bowel syndrome |journal=J. Pediatr. Gastroenterol. Nutr. |volume=20 |issue=2 |pages=209–14 |year=1995 |pmid=7714688 |doi= |url=}}</ref><ref name="pmid15290263">{{cite journal |vauthors=El-Matary W, Spray C, Sandhu B |title=Irritable bowel syndrome: the commonest cause of recurrent abdominal pain in children |journal=Eur. J. Pediatr. |volume=163 |issue=10 |pages=584–8 |year=2004 |pmid=15290263 |doi=10.1007/s00431-004-1503-0 |url=}}</ref>
* In the Western pediatric population, [[Irritable bowel syndrome|IBS]] is the commonest cause of functional recurrent [[abdominal pain]] (RAP) as it accounts for more than 50% of all cases.<ref name="pmid7714688">{{cite journal |vauthors=Hyams JS, Treem WR, Justinich CJ, Davis P, Shoup M, Burke G |title=Characterization of symptoms in children with recurrent abdominal pain: resemblance to irritable bowel syndrome |journal=J. Pediatr. Gastroenterol. Nutr. |volume=20 |issue=2 |pages=209–14 |year=1995 |pmid=7714688 |doi= |url=}}</ref><ref name="pmid15290263">{{cite journal |vauthors=El-Matary W, Spray C, Sandhu B |title=Irritable bowel syndrome: the commonest cause of recurrent abdominal pain in children |journal=Eur. J. Pediatr. |volume=163 |issue=10 |pages=584–8 |year=2004 |pmid=15290263 |doi=10.1007/s00431-004-1503-0 |url=}}</ref>


===Developed and Developing countries===
===Developed and developing countries===
* In USA and Australia, 1 in every 10 people fulfill the Rome criteria  for [[Irritable bowel syndrome|IBS]].<ref name="pmid15862929">{{cite journal |vauthors=Cremonini F, Talley NJ |title=Irritable bowel syndrome: epidemiology, natural history, health care seeking and emerging risk factors |journal=Gastroenterol. Clin. North Am. |volume=34 |issue=2 |pages=189–204 |year=2005 |pmid=15862929 |doi=10.1016/j.gtc.2005.02.008 |url=}}</ref>
* In USA and Australia, 1 in every 10 people fulfill the Rome IV criteria  for [[Irritable bowel syndrome|IBS]].<ref name="pmid15862929">{{cite journal |vauthors=Cremonini F, Talley NJ |title=Irritable bowel syndrome: epidemiology, natural history, health care seeking and emerging risk factors |journal=Gastroenterol. Clin. North Am. |volume=34 |issue=2 |pages=189–204 |year=2005 |pmid=15862929 |doi=10.1016/j.gtc.2005.02.008 |url=}}</ref>
* In Asia, Africa and South America, [[Irritable bowel syndrome|IBS]] is becoming increasingly prevalent as a disease of urbanization and industrialization. This is due to increased access to health care, higher [[Stress (medicine)|stress]] levels and differing dietary choices. <ref name="pmid15916618">{{cite journal |vauthors=Gwee KA |title=Irritable bowel syndrome in developing countries--a disorder of civilization or colonization? |journal=Neurogastroenterol. Motil. |volume=17 |issue=3 |pages=317–24 |year=2005 |pmid=15916618 |doi=10.1111/j.1365-2982.2005.00627.x |url=}}</ref><ref name="pmid22309613">{{cite journal |vauthors=Grodzinsky E, Hallert C, Faresjö T, Bergfors E, Faresjö AO |title=Could gastrointestinal disorders differ in two close but divergent social environments? |journal=Int J Health Geogr |volume=11 |issue= |pages=5 |year=2012 |pmid=22309613 |pmc=3330019 |doi=10.1186/1476-072X-11-5 |url=}}</ref><ref name="pmid15916618">{{cite journal |vauthors=Gwee KA |title=Irritable bowel syndrome in developing countries--a disorder of civilization or colonization? |journal=Neurogastroenterol. Motil. |volume=17 |issue=3 |pages=317–24 |year=2005 |pmid=15916618 |doi=10.1111/j.1365-2982.2005.00627.x |url=}}</ref><ref name="pmid12548307">{{cite journal |vauthors=Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Löwik MR |title=Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey |journal=Eur J Clin Nutr |volume=57 |issue=1 |pages=128–37 |year=2003 |pmid=12548307 |doi=10.1038/sj.ejcn.1601503 |url=}}</ref><ref name="pmid28901578">{{cite journal |vauthors=Gwee KA, Ghoshal UC, Chen M |title=Irritable bowel syndrome in Asia: pathogenesis, natural history, epidemiology and management |journal=J. Gastroenterol. Hepatol. |volume= |issue= |pages= |year=2017 |pmid=28901578 |doi=10.1111/jgh.13987 |url=}}</ref><ref name="pmid2365186">{{cite journal |vauthors=Talley NJ, Phillips SF, Bruce B, Twomey CK, Zinsmeister AR, Melton LJ |title=Relation among personality and symptoms in nonulcer dyspepsia and the irritable bowel syndrome |journal=Gastroenterology |volume=99 |issue=2 |pages=327–33 |year=1990 |pmid=2365186 |doi= |url=}}</ref>
* In Asia, Africa and South America, [[Irritable bowel syndrome|IBS]] is becoming increasingly [[Prevalence|prevalent]] as a disease of urbanization and industrialization. This is due to increased access to health care, higher [[Stress (medicine)|stress]] levels and differing dietary choices. <ref name="pmid15916618">{{cite journal |vauthors=Gwee KA |title=Irritable bowel syndrome in developing countries--a disorder of civilization or colonization? |journal=Neurogastroenterol. Motil. |volume=17 |issue=3 |pages=317–24 |year=2005 |pmid=15916618 |doi=10.1111/j.1365-2982.2005.00627.x |url=}}</ref><ref name="pmid22309613">{{cite journal |vauthors=Grodzinsky E, Hallert C, Faresjö T, Bergfors E, Faresjö AO |title=Could gastrointestinal disorders differ in two close but divergent social environments? |journal=Int J Health Geogr |volume=11 |issue= |pages=5 |year=2012 |pmid=22309613 |pmc=3330019 |doi=10.1186/1476-072X-11-5 |url=}}</ref><ref name="pmid15916618">{{cite journal |vauthors=Gwee KA |title=Irritable bowel syndrome in developing countries--a disorder of civilization or colonization? |journal=Neurogastroenterol. Motil. |volume=17 |issue=3 |pages=317–24 |year=2005 |pmid=15916618 |doi=10.1111/j.1365-2982.2005.00627.x |url=}}</ref><ref name="pmid12548307">{{cite journal |vauthors=Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Löwik MR |title=Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey |journal=Eur J Clin Nutr |volume=57 |issue=1 |pages=128–37 |year=2003 |pmid=12548307 |doi=10.1038/sj.ejcn.1601503 |url=}}</ref><ref name="pmid28901578">{{cite journal |vauthors=Gwee KA, Ghoshal UC, Chen M |title=Irritable bowel syndrome in Asia: pathogenesis, natural history, epidemiology and management |journal=J. Gastroenterol. Hepatol. |volume= |issue= |pages= |year=2017 |pmid=28901578 |doi=10.1111/jgh.13987 |url=}}</ref><ref name="pmid2365186">{{cite journal |vauthors=Talley NJ, Phillips SF, Bruce B, Twomey CK, Zinsmeister AR, Melton LJ |title=Relation among personality and symptoms in nonulcer dyspepsia and the irritable bowel syndrome |journal=Gastroenterology |volume=99 |issue=2 |pages=327–33 |year=1990 |pmid=2365186 |doi= |url=}}</ref>


==References==
==References==

Latest revision as of 00:57, 3 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

Irritable bowel disease (IBS) is an extremely common disorder among the general population. The incidence of IBS is approximately 200 per 100,000 individuals worldwide. The prevalence of IBS is approximately 11,200 per 100,000 individuals worldwide. The prevalence of IBS varies with geographical and demographic distribution. Females are more commonly affected by IBS than males. The female to male ratio is approximately 1:2. The prevalence of IBS in USA and Europe is 10,000-20,000 per 100,000 individuals. In USA and Australia, 1 in every 10 people fulfill the Rome IV criteria for IBS. In Asia, Africa and South America, IBS is becoming increasingly prevalent as a disease of urbanization and industrialization. This is due to increased access to health care, higher stress levels and differing dietary choices.

Epidemiology and Demographics

Incidence

Prevalence

Age

  • IBS commonly affects individuals younger than 35 years of age.[18]
  • The incidence of IBS decreases with age.
  • The prevalence of IBS is 25% lower in individuals over 50 years of age.[15] [19]

Race

  • There is no racial predilection to IBS.[20]

Gender

  • Females are more commonly affected by IBS than males. The female to male ratio is approximately 1:2. This is due to social and biological factors.[21]

Social factors:

  • Females are predominantly affected by IBS as the likelihood of diagnosis of IBS is 2-3 times more in women as compared to men. This is because health care seeking behavior for symptoms is 4-5 times higher in women as compared to men.[16][22][23][24] [25][26][27]

Biological factors:

Children

  • In the Western pediatric population, IBS is the commonest cause of functional recurrent abdominal pain (RAP) as it accounts for more than 50% of all cases.[35][36]

Developed and developing countries

  • In USA and Australia, 1 in every 10 people fulfill the Rome IV criteria  for IBS.[37]
  • In Asia, Africa and South America, IBS is becoming increasingly prevalent as a disease of urbanization and industrialization. This is due to increased access to health care, higher stress levels and differing dietary choices. [6][38][6][39][7][40]

References

  1. ↑ 1.0 1.1 Choung RS, Locke GR (2011). "Epidemiology of IBS". Gastroenterol. Clin. North Am. 40 (1): 1–10. doi:10.1016/j.gtc.2010.12.006. PMID 21333897.
  2. ↑ Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA (1999). "Functional bowel disorders and functional abdominal pain". Gut. 45 Suppl 2: II43–7. PMC 1766683. PMID 10457044.
  3. ↑ Talley NJ, Spiller R (2002). "Irritable bowel syndrome: a little understood organic bowel disease?". Lancet. 360 (9332): 555–64. doi:10.1016/S0140-6736(02)09712-X. PMID 12241674.
  4. ↑ Boyce PM, Talley NJ, Burke C, Koloski NA (2006). "Epidemiology of the functional gastrointestinal disorders diagnosed according to Rome II criteria: an Australian population-based study". Intern Med J. 36 (1): 28–36. doi:10.1111/j.1445-5994.2006.01006.x. PMID 16409310.
  5. ↑ Corazziari E (2004). "Definition and epidemiology of functional gastrointestinal disorders". Best Pract Res Clin Gastroenterol. 18 (4): 613–31. doi:10.1016/j.bpg.2004.04.012. PMID 15324703.
  6. ↑ 6.0 6.1 6.2 Gwee KA (2005). "Irritable bowel syndrome in developing countries--a disorder of civilization or colonization?". Neurogastroenterol. Motil. 17 (3): 317–24. doi:10.1111/j.1365-2982.2005.00627.x. PMID 15916618.
  7. ↑ 7.0 7.1 Gwee KA, Ghoshal UC, Chen M (2017). "Irritable bowel syndrome in Asia: pathogenesis, natural history, epidemiology and management". J. Gastroenterol. Hepatol. doi:10.1111/jgh.13987. PMID 28901578.
  8. ↑ Quigley EM, Fried M, Gwee KA, Khalif I, Hungin AP, Lindberg G, Abbas Z, Fernandez LB, Bhatia SJ, Schmulson M, Olano C, LeMair A (2016). "World Gastroenterology Organisation Global Guidelines Irritable Bowel Syndrome: A Global Perspective Update September 2015". J. Clin. Gastroenterol. 50 (9): 704–13. doi:10.1097/MCG.0000000000000653. PMID 27623513.
  9. ↑ Agréus L, Svärdsudd K, Nyrén O, Tibblin G (1995). "Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time". Gastroenterology. 109 (3): 671–80. PMID 7657095.
  10. ↑ Husain N, Chaudhry IB, Jafri F, Niaz SK, Tomenson B, Creed F (2008). "A population-based study of irritable bowel syndrome in a non-Western population". Neurogastroenterol. Motil. 20 (9): 1022–9. doi:10.1111/j.1365-2982.2008.01143.x. PMID 18492027.
  11. ↑ Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L (2002). "Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire". Dig. Dis. Sci. 47 (1): 225–35. PMID 11837727.
  12. ↑ Heaton KW, O'Donnell LJ, Braddon FE, Mountford RA, Hughes AO, Cripps PJ (1992). "Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters". Gastroenterology. 102 (6): 1962–7. PMID 1587415.
  13. ↑ Jones R, Lydeard S (1992). "Irritable bowel syndrome in the general population". BMJ. 304 (6819): 87–90. PMC 1880997. PMID 1737146.
  14. ↑ Wilson S, Roberts L, Roalfe A, Bridge P, Singh S (2004). "Prevalence of irritable bowel syndrome: a community survey". Br J Gen Pract. 54 (504): 495–502. PMC 1324800. PMID 15239910.
  15. ↑ 15.0 15.1 Lovell RM, Ford AC (2012). "Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis". Clin. Gastroenterol. Hepatol. 10 (7): 712–721.e4. doi:10.1016/j.cgh.2012.02.029. PMID 22426087.
  16. ↑ 16.0 16.1 Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E (1993). "U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact". Dig. Dis. Sci. 38 (9): 1569–80. PMID 8359066.
  17. ↑ Grundmann O, Yoon SL (2010). "Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners". J. Gastroenterol. Hepatol. 25 (4): 691–9. doi:10.1111/j.1440-1746.2009.06120.x. PMID 20074154.
  18. ↑ Maxwell PR, Mendall MA, Kumar D (1997). "Irritable bowel syndrome". Lancet. 350 (9092): 1691–5. PMID 9400529.
  19. ↑ Tang YR, Yang WW, Liang ML, Xu XY, Wang MF, Lin L (2012). "Age-related symptom and life quality changes in women with irritable bowel syndrome". World J. Gastroenterol. 18 (48): 7175–83. doi:10.3748/wjg.v18.i48.7175. PMC 3544019. PMID 23326122.
  20. ↑ Haas JS, Phillips KA, Sonneborn D, McCulloch CE, Baker LC, Kaplan CP, Pérez-Stable EJ, Liang SY (2004). "Variation in access to health care for different racial/ethnic groups by the racial/ethnic composition of an individual's county of residence". Med Care. 42 (7): 707–14. PMID 15213496.
  21. ↑ Thompson WG (1997). "Gender differences in irritable bowel symptoms". Eur J Gastroenterol Hepatol. 9 (3): 299–302. PMID 9096434.
  22. ↑ Payne S (2004). "Sex, gender, and irritable bowel syndrome: making the connections". Gend Med. 1 (1): 18–28. PMID 16115580.
  23. ↑ Lovell RM, Ford AC (2012). "Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis". Am. J. Gastroenterol. 107 (7): 991–1000. doi:10.1038/ajg.2012.131. PMID 22613905.
  24. ↑ Kennedy TM, Jones RH, Hungin AP, O'flanagan H, Kelly P (1998). "Irritable bowel syndrome, gastro-oesophageal reflux, and bronchial hyper-responsiveness in the general population". Gut. 43 (6): 770–4. PMC 1727355. PMID 9824603.
  25. ↑ Voci SC, Cramer KM (2009). "Gender-related traits, quality of life, and psychological adjustment among women with irritable bowel syndrome". Qual Life Res. 18 (9): 1169–76. doi:10.1007/s11136-009-9532-9. PMID 19728159.
  26. ↑ Quigley EM, Bytzer P, Jones R, Mearin F (2006). "Irritable bowel syndrome: the burden and unmet needs in Europe". Dig Liver Dis. 38 (10): 717–23. doi:10.1016/j.dld.2006.05.009. PMID 16807154.
  27. ↑ Manning AP, Thompson WG, Heaton KW, Morris AF (1978). "Towards positive diagnosis of the irritable bowel". Br Med J. 2 (6138): 653–4. PMC 1607467. PMID 698649.
  28. ↑ Jackson NA, Houghton LA, Whorwell PJ, Currer B (1994). "Does the menstrual cycle affect anorectal physiology?". Dig. Dis. Sci. 39 (12): 2607–11. PMID 7995186.
  29. ↑ Walker EA, Katon WJ, Roy-Byrne PP, Jemelka RP, Russo J (1993). "Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease". Am J Psychiatry. 150 (10): 1502–6. doi:10.1176/ajp.150.10.1502. PMID 8379554.
  30. ↑ Heitkemper MM, Chang L (2009). "Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome?". Gend Med. 6 Suppl 2: 152–67. doi:10.1016/j.genm.2009.03.004. PMC 3322543. PMID 19406367.
  31. ↑ Goffaux P, Michaud K, Gaudreau J, Chalaye P, Rainville P, Marchand S (2011). "Sex differences in perceived pain are affected by an anxious brain". Pain. 152 (9): 2065–73. doi:10.1016/j.pain.2011.05.002. PMID 21665365.
  32. ↑ Rajindrajith S, Devanarayana NM (2012). "Subtypes and Symptomatology of Irritable Bowel Syndrome in Children and Adolescents: A School-based Survey Using Rome III Criteria". J Neurogastroenterol Motil. 18 (3): 298–304. doi:10.5056/jnm.2012.18.3.298. PMC 3400818. PMID 22837878.
  33. ↑ Dong L, Dingguo L, Xiaoxing X, Hanming L (2005). "An epidemiologic study of irritable bowel syndrome in adolescents and children in China: a school-based study". Pediatrics. 116 (3): e393–6. doi:10.1542/peds.2004-2764. PMID 16140684.
  34. ↑ Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006). "Childhood functional gastrointestinal disorders: child/adolescent". Gastroenterology. 130 (5): 1527–37. doi:10.1053/j.gastro.2005.08.063. PMID 16678566.
  35. ↑ Hyams JS, Treem WR, Justinich CJ, Davis P, Shoup M, Burke G (1995). "Characterization of symptoms in children with recurrent abdominal pain: resemblance to irritable bowel syndrome". J. Pediatr. Gastroenterol. Nutr. 20 (2): 209–14. PMID 7714688.
  36. ↑ El-Matary W, Spray C, Sandhu B (2004). "Irritable bowel syndrome: the commonest cause of recurrent abdominal pain in children". Eur. J. Pediatr. 163 (10): 584–8. doi:10.1007/s00431-004-1503-0. PMID 15290263.
  37. ↑ Cremonini F, Talley NJ (2005). "Irritable bowel syndrome: epidemiology, natural history, health care seeking and emerging risk factors". Gastroenterol. Clin. North Am. 34 (2): 189–204. doi:10.1016/j.gtc.2005.02.008. PMID 15862929.
  38. ↑ Grodzinsky E, Hallert C, Faresjö T, Bergfors E, Faresjö AO (2012). "Could gastrointestinal disorders differ in two close but divergent social environments?". Int J Health Geogr. 11: 5. doi:10.1186/1476-072X-11-5. PMC 3330019. PMID 22309613.
  39. ↑ Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Löwik MR (2003). "Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey". Eur J Clin Nutr. 57 (1): 128–37. doi:10.1038/sj.ejcn.1601503. PMID 12548307.
  40. ↑ Talley NJ, Phillips SF, Bruce B, Twomey CK, Zinsmeister AR, Melton LJ (1990). "Relation among personality and symptoms in nonulcer dyspepsia and the irritable bowel syndrome". Gastroenterology. 99 (2): 327–33. PMID 2365186.

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