Original contributionNatural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study
Introduction
Many persons in the Western world are troubled by abdominal pain or bowel habit disturbances; such complaints are reported by up to one in two people in cross-sectional population-based studies 1, 2, 3, 4. Functional upper and lower GI symptoms have been grouped by investigators into several syndromes based on clinical experience, including symptomatic gastroesophageal reflux disease (GERD), dyspepsia, and irritable bowel syndrome (IBS) (5). Depending on the definitions applied, the prevalence observed in previous population-based studies for GERD has ranged on average from 15% to 25% 6, 7, 8, 9, 10, whereas for dyspepsia the prevalence has been 15% to 40% 1, 3, 11, 12, 13, and for IBS 10% to 20% 13, 14, 15.
Irrespective of the definition used, the societal costs of these conditions are considerable 16, 17, although only a fraction of all sufferers seek medical care each year 3, 18, 19, 20, 21, and some never do 20, 22. Up to one in 20 of all consultations in primary health care are for dyspepsia 23, 24, and prescription rates of over 90% have been reported in general practice 16, 25. One third of the consulters are sooner or later referred to a specialist (26), and functional abdominal disorders constitute up to one third of all consultations to gastroenterologists (27). We also know that many of the drugs used are unhelpful 28, 29, 30. Detailed data on the long-term natural history of the functional GI disorders are lacking, yet such knowledge is vital. Identifying who with functional abdominal disorders will continue to have chronic symptoms and who will lose or change their symptoms would aid in planning interventions.
Symptoms of reflux in outpatients are known to persist for at least 10 yr in up to three quarters of patients (31). Similarly, symptoms in patients with functional dyspepsia (32) and IBS are usually chronic 33, 34. However, these observations are based on small numbers of persons who have sought health care, which may be attributable to selection bias as most subjects with these conditions are not consulters (20). Little population-based data are available on the natural history of the functional GI disorders. In particular, there remains a lack of long-term follow-up population-based data.
In this study, we aimed to explore the long-term natural history of symptomatic GERD, dyspepsia, and IBS in a randomly selected general population. The prevalence, symptom stability over time within each of these symptom groups, and the change in main symptom profile over time was studied by means of a validated questionnaire mailed to the same population on three occasions over 7 yr.
Section snippets
Setting
In January, 1988, the municipality of Östhammar had 21,338 inhabitants living in either urban (67%) or rural (33%) areas. The distribution by age, gender, family size, income, occupational category, and other socioeconomic variables was similar to the national average (35), and 96% of the residents were Swedish citizens.
Sampling
By using the computerized national population register, a representative sample was drawn (February, 1988), consisting of all Swedish citizens born between 1909 and 1969 (i.e.,
Demographic data
There were no statistically significant differences in mean age and gender distribution between all responders in the three surveys, and the 843 who were responders to all three questionnaires (Table 1). Among these 843 persons, there were 397 (47.1%) men and 446 (52.9%) women [reflecting the pattern in the Swedish population (42)]. The results suggest that there was no sampling bias.
Prevalence of symptom profiles in the three samples
The 3-month period prevalence of the symptom profiles in each of the studies is shown in Table 2. More than half
Discussion
To our knowledge, this is the first report of the natural history of symptomatic GERD and functional GI disorders in a representative population with three observation points over 7 yr. It confirms that abdominal disorders are highly prevalent in the community. GERD had a stable prevalence over 7 yr, whereas the prevalence of dyspepsia based on criteria similar to Rome II (43) decreased with advancing age. IBS increased with age as well as over time irrespective of aging. Although there was a
Acknowledgements
This study was supported in part by The Medical Faculty of Uppsala University and Uppsala County Council, Sweden. We thank Nicci Keeling for assistance with Figure 2.
References (72)
- et al.
Dyspepsia and dyspepsia subgroupsA population-based study
Gastroenterology
(1992) - et al.
Prevalence and clinical spectrum of gastroesophageal refluxA population-based study in Olmsted County, Minnesota
Gastroenterology
(1997) - et al.
Irritable bowel syndrome and dyspepsia in the general populationOverlap and lack of stability over time
Gastroenterology
(1995) - et al.
Medical costs in community subjects with irritable bowel syndrome
Gastroenterology
(1995) Controlled treatment trials in the irritable bowel syndromeA critique
Gastroenterology
(1988)- et al.
Symptoms in gastro-oesophageal reflux disease
Lancet
(1990) - et al.
AGA technical reviewEvaluation of dyspepsia. American Gastroenterological Association
Gastroenterology
(1998) - et al.
Functional bowel disorders in apparently healthy people
Gastroenterology
(1980) - et al.
Symptoms of irritable bowel syndrome in a British urban communityConsulters and nonconsulters
Gastroenterology
(1992) - et al.
Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction
Gastroenterology
(1982)
Gastrointestinal symptoms and subjects cluster into distinct upper and lower groupings in the communityA four nations study
Am J Gastroenterol
Recurrent abdominal painA potential precursor of irritable bowel syndrome in adolescents and young adults
J Pediatr
Dyspepsia in England and Scotland
Gut
The epidemiology of abdominal symptomsPrevalence and demographic characteristics in a Swedish adult population. A report from the Abdominal Symptom Study
Scand J Gastroenterol
Identification of upper and lower gastrointestinal symptom groupings in an urban population
Gut
Symptomatic gastroesophageal refluxIncidence and precipitating factors
Am J Dig Dis
Manometric oesophageal function, acid perfusion test and symptomatology in a 55-year-old general population
Clin Physiol
Heartburn and globus in apparently healthy people
Can Med Assoc J
The prevalence of symptoms suggestive of esophageal disorders
Scand J Gastroenterol
Mave-tarmsymptomer blandt 40-årige i Glostrup. En epidemiologisk undersøgelse. (Gastrointestinal symptoms among 40-year olds in Glostrup. An epidemiological study.)
Ugeskr Laeger
Peptic ulcer and non-ulcer dyspepsia—a disease and a disorder
Scand J Prim Health Care
Irritable bowel syndrome in the general population
BMJ
Irritable bowel syndrome in a communitySymptom subgroups, risk factors, and health care utilization
Am J Epidemiol
Economic costs of functional dyspepsia
PharmacoEconomics
Dyspepsia in the communityA follow-up study
Br J Clin Pract
U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact
Dig Dis Sci
Socio-economic factors, health care consumption and rating of abdominal symptom severity. A report from the abdominal symptom study
Fam Pract
Dyspepsia in consulters and non-consultersPrevalence, health-care seeking behaviour and risk factors
Eur J Gastroenterol Hepatol
Predictors of health care seeking for irritable bowel syndromeA population based study
Gut
The diagnosis and therapy survey, October–March 1983, health care consumption and current drug therapy in Sweden with respect to the clinical diagnosis of gastritis
Scand J Gastroenterol
Clinical economics reviewGastrointestinal disease in primary care
Aliment Pharmacol Ther
Prescribing patterns for dyspepsia in primary careA prospective study of selected general practitioners
Aliment Pharmacol Ther
Functional dyspepsiaA classification with guidelines for diagnoses and management
Gastroenterol International
Geographical differences in the prevalence of dyspepsia
Scand J Gastroenterol
The “epigastric distress syndrome.” A possible disease entity identified by history and endoscopy in patients with nonulcer dyspepsia
J Clin Gastroenterol
Cited by (227)
Assessing the post-treatment therapeutic effect of tongxie in irritable bowel syndrome: A randomized controlled trial
2022, Complementary Therapies in MedicineCitation Excerpt :This huge burden is mainly because of IBS’s high recurrence.9 More than 50% of patients were still symptomatic with IBS, and a further 25% of the patients had minor IBS symptoms after 1 and 7 years.10 Therefore, one outstanding issue is how long the therapeutic effects might maintain after the treatment (post-treatment therapeutic effects, or PTTE).
The Natural History of Chronic Unexplained Gastrointestinal Disorders and Gastroesophageal Reflux During 20 Years: A US Population-Based Study
2021, Mayo Clinic ProceedingsCitation Excerpt :Understanding the natural course of the disease is helpful to provide proper care for patients, in particular for patients with chronic disease, who may have long-lasting symptoms. A few studies including our previous study have found that the overall prevalence of chronic unexplained GI symptoms mostly attributed to FGIDs remained stable over time,7,8,41,42 but interestingly, the transition from one FGID to another FGID seemed to be high in these community-based studies. Our findings during a much longer time frame are also consistent with past studies, in which transition of GI symptoms appears to be the rule with observation for decades of time, challenging the concept that FGIDs are stable conditions.
Distinguishing between functional dyspepsia and gastroparesis: Does it matter?
2020, Gastroparesis: Pathophysiology, Clinical Presentation, Diagnosis and TreatmentPrevalence of Histological Gastritis in a Community Population and Association with Epigastric Pain
2024, Digestive Diseases and SciencesThe Disease Spectrum and Natural History of Patients With Abdominal Bloating or Distension: A Longitudinal Study
2024, Journal of Neurogastroenterology and Motility
- †
Deceased.