A146 AGA ABSTRACTS

856

PREVALENCE OF IRRITABLE BOWEL SYNDROME IN FAMI­LIES OF PATIENTS WITH IBS.G. Richard Locke, Jamshid S. Kalantar, Sara L. Fett, Carol T. Van Dyke,Yvonne Romero, Alan R. Zinsmeister, Mayo Clin, Rochester, MN.

Background: In a previous study, people who reported having a familymember with abdominal pain or bowel problems were found to be twice aslikely to have symptoms of irritable bowel syndrome (mS). Aim: Todetermine if relatives of patients with IBS are at higher risk of having IBS.Methods: Patients with IBS were identified from the Mayo Clinic ms class(n=91) and the Mayo Clinic medical index (n=90). The patient and theirspouse were asked to complete a valid symptom survey and provide thenames and addresses of their immediate family members (parents, brothers,sisters). The relatives were then sent a symptom survey to complete bymail. An IBS diagnosis was made by applying the Rome criteria to theresponses on the survey. The prevalence of having at least one familymember with IBS was compared between the patients' and spouses'families in a logistic regression model which included age, gender andsomatic symptom score as covariates. Results: 74 patients and 62 spousesprovided data about their families; however, only 124 had living relatives.Surveys were sent to the 419 relatives and 248 (59%) responded. Theresponse rate among the relatives of the patients was higher than that of thespouses (65% versus 52%, OR 1.8). Surveys were returned by 57 parentsand 191 siblings. Responses were received from at least one member of 95(77%) of the 124 families. The prevalence of IBS in at least one familymember was 19% in the patients' families versus 10% in the families of thespouse. 31 patient-spouse pairs had data from both families. In thismatched analysis, the prevalence was 23% in the patients' families versus13% in the spouses' families. Families with more females and highersomatic symptom scores had a higher prevalence of IBS (p<0.05). Afteradjusting for age, gender, and somatic symptom score, IBS symptoms werenot more common in the families of the patients as compared to spouses.Conclusions: The twofold higher prevalence of IBS in families of mspatients is similar to our previous work; however, this is explained bysomatization. Further study of the environment of IBS patients' families iswarranted.

857

THE PATH TO A DIAGNOSIS OF IRRITABLE BOWEL SYN­DROME: A POPULATION-BASED STUDY.G. Richard Locke, Barbara P. Yawn, Peter C. Wollan, Susan Bertram,Margary Kurland, Eva Lydick, Mayo Clin, Rochester, MN; Olmsted MedCtr, Rochester, MN; Smith, Kline & Beecham, Collegeville, PA.

Community surveys have shown that 10% of the population report symp­toms of irritable bowel syndrome (IBS). It is not clear, however, whatpercentage of these people actually receive an IBS diagnosis. Aim: Toexamine healthcare seeking and subsequent diagnoses among people withIBS symptoms in the community. Methods: Using the data resources of theRochester Epidemiology Project, a valid symptom survey was mailedbetween 1988 and 1993 to an age- and gender-stratified random sample ofOlmsted County, Minnesota, residents aged 30 to 64 years. 644 (72%) of893 eligible subjects responded. Based on responses to the symptomsurvey, three groups were identified: people with symptoms of ms byRome criteria (lBS), people with IBS symptoms not meeting Rome criteria(near IBS) and people without significant GI symptoms. Subjects wereselected at random from these groups and their medical records reviewedfor the years 1988-1998. For each visit, the chief complaint and finaldiagnosis were recorded. Results: The medical records of 213 subjects havebeen reviewed. Mean age was 50 years and 55% were female. 71 subjectshad IBS by Rome criteria, 84 had "near IBS" and 58 had no GI symptoms.Every subject had a medical visit of some type during the study period. Thesubjects had a mean of 1.7 GI related visits over the ten-year period (range0-24). GI related visits were more common among those in the IBS group(mean number of visits 2.9). Among the 71 with IBS on the questionnaire,47 (66%) had been seen by a physician for GI related symptoms, and 18(25%) of the 71 had received an IBS diagnosis. IBS clinical diagnoses werealso made in 10% with near IBS and 9% of controls. People with msdiagnoses had higher numbers of GI related visits (mean 3.9). Only 1patient with IBS on the questionnaire was found to have another disorderto explain their bowel symptoms. Many received reflux or dyspepsiaoriented diagnoses without reference to their bowel symptoms. Conclu­sions: About two-thirds of people with IBS symptoms seek medical care,and less than half of those seeking care receive an IBS diagnosis. Physi­cians need to be more aware of the fact that their patients may have IBS.

GASTROENTEROLOGY Vol. US. No.4

858

DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF PA·TIENTS WITH IRRITABLE BOWEL SYNDROME (IRS) FROMTHREE PRACTICE SETTINGS.George F. Longstreth, Christopher J. Hawkey, John Ham, Roger H. Jones,Emeran A. Mayer, Jorgen Naesdal, Ingalill K. Wilson, Ingela K. Wiklund,Dept of Gastroenterology, Kaiser Permanente Med Ctr, San Diego, CA;Div of Gastroenterology, Univ Hosp, Nottingham, United Kingdom; CentSurg, Rugby, United Kingdom; Dept of Gen Practice & Primary Care,GKT Sch of Med, London, United Kingdom; Div of Digest Diseases,UCLA Sch of Medicine, Los Angeles, CA; AstraZeneca R&D Molndal,Molndal, Sweden.

Background: Patients with IBS represent a large patient population primar­ily treated in general practice. Since IBS lacks biological markers ofdisease activity it is important to have a comprehensive understanding ofthe specific characteristics of this patient population. Aim: To describe andcompare the demographic and clinical characteristics of three groups ofms patients recruited into studies aimed to mimic the conduct of clinicaltrials in IBS. Patients and methods: In total, 245 patients with moderate tosevere IBS symptoms fulfilling the Rome I criteria were investigated atthree different healthcare settings: I) tertiary care at Kaiser PermanenteMedical Centre in the US (52 patients), 2) through advertisement for IBSclinical trials at UCLA in the US (72 patients), and primary care in the UK(121 patients). Results: The three different patient populations were similarwith regard to the following characteristics: most patients were female(77%) and the mean age was 45 years. A majority of the patients (92%) hadhad IBS symptoms for at least a year and 57% for at least 5 years. Duringthe week preceding investigation, 53% of the patients reported symptomson at least 5 days. A higher proportion of the patients in the UK (27%) hada family history ofIBS than at Kaiser (19%) and UCLA (13%). Similarly,the percentage of patients who associated their first episode of IBS withgastroenteritis was higher in the UK (17%) than at Kaiser (6%) and UCLA(8%). During the preceding year, as many as 98% of the patients at Kaiserhad consulted a doctor for their IBS symptoms whilst the correspondingpercentages at UCLA was 43% and in the UK 78%. The most commonlyused drugs at Kaiser during the preceding year were analgesics (83%) andacid suppression drugs (60%). At UCLA analgesics (32%) and antidepres­sants (29%) were most commonly used and in the UK it was antispasmod­ics (59%) and analgesics (39%). Alternative treatment such as acupuncturewas used by 4% of the patients at Kaiser, 17% at UCLA and 16% in theUK. Conclusions: Despite the different referral settings and differentcountries, the demographic characteristics were surprisingly similar with amajority of IBS patients being young to middle-aged females with a historyof IBS symptoms for more than five years. Previous treatment differedbetween the three clinical settings with a higher prescription of analgesicsat Kaiser (US) and more frequent use of antispasmodics in the UK, whilstthe highest use of antidepressants was found at UCLA (US).

859

PAEDIATRIC IRS 5 TO 13 YEARS LATER: NOT A VANISHINGENTITY.Fabio Pace, G. Zuin, S. Di Giacomo, E. Ceriani, P. Molteni, M. Fontana,G. Bianchi Porro, Dept Gastroenterology and Dept Paediatrics, L SaccoUniv Hosp, Milan, Italy.

Background Few data are available concerning the fate and the naturalhistory of paediatric patients with chronic abdominal pain (CAP) or irri­table bowel syndrome (IBS) within years after presentation of symptoms.Aim of study We have conducted a retrospective survey on paediatricpopulation attending our paediatric department as outpatients for CAPand/or IBS to assess whether an IBS symptomatic pattern, according to theRome criteria, was also present in their early adult life. Methods andpatients We retrieved all the files concerning outpatients attending ourpaediatric unit for CAP or IBS during the period from January 1986 toDecember 1995. These patients were interviewed by a structured question­naire assessing the presence of present symptoms involving the gastroin­testinal system. Results 52 paediatric outpatients during the decade 1986­1995 were observed with CAP or IBS. At the end of the follow up period,15 out of 52 patients 29%) still presented symptoms attributable to IBS. Ofthese, 67% showed prevalently abdominal pain and 33% discomfort.Intensity and severity of symptoms were in the majority of cases mild.Patients with post-paediatric IBS exhibited significantly more sibling withIBS 6/15 vs 6/37) and more extraintestinal GI symptoms (47% vs 13.5%)than patients without (p < 0.05). Conclusions In our study we demonstratethat about 30% of paediatric patients with CAP or IBS will develop mildto moderate IBS symptoms during their early adult life. Since the preva­lence of IBS is estimated to be about 10 to 20%, we conclude thatpaediatric CAP or IBS do significantly increase the chance of adult IBS.Also, the former are correlated with a higher familial symptoms aggrega­tion and with more frequent extraintestinal GI symptoms during early adultlife.