BACKGROUND & AIMS: It has been suggested that irritable bowel syndrome (IBS) and functional dyspepsia represent the same disease entity, the irritable gut. The aim of this study was to test the stability, consistency, and relevance of the current classification in the entire, unselected population of persons with gastrointestinal and/or abdominal symptoms, including those who had not consulted physicians. METHODS: Sequential postal questionnaires were sent to 1290 representative persons (age range, 20-79 years) sampled from the population. Questions were asked about the prevalence of 24 gastrointestinal and/or abdominal symptoms and the site and type of abdominal pain, if any. RESULTS: The prevalence of dyspepsia was 14% (32% if predominant reflux symptoms and concomitant IBS symptoms were included), and the prevalence of IBS was 12.5%. The 3-month incidence rates of reflux, dyspepsia, and IBS among previously symptomless persons were 0.5, 8, and 2 per 1000, respectively. Of persons with IBS, 87% also fulfilled the dyspepsia criteria, and the overlap between dyspepsia subgroups was more than 50%. The use of stricter criteria did not eliminate this overlap. Over a 1-year period, approximately 50% changed their symptom profile. Principal component analysis did not show any natural clustering of the symptoms. CONCLUSIONS: The separation of functional gastrointestinal symptoms into dyspepsia, its subgroups, and IBS may be inappropriate.

Adult↗

PubMed1995

Helicobacter pylori seropositivity among Swedish adults with and without abdominal symptoms. A population-based epidemiologic study.

BACKGROUND: The role of Helicobacter pylori in functional dyspepsia is unclear. The aim of this population-based study was to determine whether the prevalence of H. pylori infection is higher among people with dyspepsia or irritable bowel syndrome (IBS) than among symptomless persons after control for age, sex, and socioeconomic status. METHODS: In a postal questionnaire we asked a representative sample (20-79 years; n = 1260) from a Swedish municipality about abdominal symptoms in the preceding 3 months. A randomly selected subsample, 50 with dyspepsia, 50 with IBS, and 50 symptomless, matched with regard to age, sex, and education, were tested for the presence of IgG antibodies to H. pylori, using the HM-CAP immunoassay. RESULTS: Fifty-five persons (38%) were H. pylori-seropositive. The seroprevalence among dyspeptics (33%) did not exceed that in healthy people (48%) or in those reporting IBS (33%). The prevalence increased with age and with lower social class, but the latter association disappeared when age was taken into account. Neither sex nor symptom intensity predicted Helicobacter seropositivity. CONCLUSION: Our data are incompatible with an important aetiologic role for H. pylori in functional dyspepsia.

Age Distribution↗

PubMed1994

The epidemiology of abdominal symptoms: prevalence and demographic characteristics in a Swedish adult population. A report from the Abdominal Symptom Study.

The prevalence of abdominal symptoms was studied by means of a postal questionnaire sent to a representative sample (n = 1290) of the adult population of a Swedish municipality. The subjects were asked about the occurrence of 35 abdominal symptoms during the preceding 3 months. The participation rate was 89.6%, and 54.3% of the responders reported at least one discomforting abdominal symptom. The overall prevalence rate was significantly higher in women than in men, and the highest rate (75%) was found among young women. The average number of symptoms per individual was also significantly higher in women. The overall prevalence rate in women decreased significantly with age, irrespective of menopause. The prevalence of most individual symptoms decreased with age and/or was higher in women. However, the prevalence of symptoms indicative of gastro-oesophageal reflux disease did not vary with age or sex. The prevalence of symptoms usually regarded as ominous did not increase with age; in some instances it even decreased. With the exception of reflux symptoms and night pain, the apparent disappearance with increasing age implies that most of the complaints are of functional origin.

Abdominal Pain↗

PubMed1993

Socio-economic factors, health care consumption and rating of abdominal symptom severity. A report from the abdominal symptom study.

A study of the abdominal/gastrointestinal symptom panorama in relation to socio-economic factors and health care consumption in the general population was performed in Osthammar, Sweden. A postal questionnaire was sent to a representative sample of the adult population (n = 1260). The response rate was 87%. The responders with symptoms (52.1%) subjectively rated their illness on visual analogue scales. All responders were classified as asymptomatic or having 'minor' or 'major' abdominal symptoms. Those having dyspepsia, reflux or irritable bowel syndrome were also ranked as 'minors' or 'majors'. The proportion of subjects with abdominal/gastrointestinal complaints decreased with age, mainly due to a decrease of 'major' symptoms. Also, the proportion of complainers increased among the more educated. Those on sick leave and students had more and worse symptoms than the others, despite the former seldom stating abdominal discomfort as the main reason for sick listing. Fifty-five per cent of all persons reporting abdominal/gastrointestinal symptoms had at some time consulted a doctor because of such complaints, the proportion increasing with severity, as did drug consumption and the rate of previous abdominal operations, with appendectomy as an exception. The results show that it is possible to rank the illness along a severity dimension among persons with abdominal/gastrointestinal complaints in epidemiological research.

Abdominal Pain↗

PubMed1993

Reproducibility and validity of a postal questionnaire. The abdominal symptom study.

OBJECTIVE: To find out whether it is possible to examine abdominal/gastrointestinal symptoms by a postal questionnaire. DESIGN: In the Abdominal Symptom Study a postal questionnaire was sent to a representative sample of adults (n = 1290) on two occasions, one year apart. The questionnaire was sent a third time to a subsample (n = 110), and to another sample (n = 213) who had not seen the questionnaire before. A subsample (n = 150 of the 1290) was subjected to a medical interview and examination. SETTING: The municipality of Osthammar, Sweden. PARTICIPANTS: A sample (9.3%) of all Swedish citizens (20-79 yrs) in the municipality. MAIN OUTCOME MEASURE: Reproducibility and validity of a postal questionnaire. RESULTS: The response rate was 90%. Roughly 50% of the study population reported abdominal symptoms. The reproducibility of the results was satisfactory, as was the validity of the questionnaire evaluated by medical interview and examination. Non-responders did not report more symptoms than responders. CONCLUSION: It is possible to examine abdominal/gastrointestinal symptoms with a postal questionnaire. The questionnaire used in The Abdominal Symptom Study seems to be useful for this purpose.

Abdominal Pain↗

PubMed1991

Cost-benefit analysis of non-pharmacological treatment of hypertension.

In this study a non-pharmacological treatment (NPT) programme and conventional drug treatment of hypertension was compared in a cost-benefit analysis. The NPT programme involved 400 patients and was conducted at 8 health centres during the period 1984-1986. It consisted of monthly visits by a nurse, visits by a doctor every 6 months, home blood pressure (BP) measurements, dietary advice, relaxation, physical activity, etc. The patients were also followed up for 2 years after the study to assess whether the programme still worked, and whether future treatment costs were affected. The treatment costs were about SEK 5300 higher per patient for the NPT programme. The benefits, in the form of reduced treatment costs for the period 1986-1988 and willingness to pay (WTP) for the NPT programme, were about SEK 3200. Thus the NPT programme resulted in a loss of about SEK 2100 per patient. However, a longer follow-up period is needed for any specific conclusions to be drawn about the costs and benefits of the NPT programme, as compared with conventional drug treatment.

Adult↗