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Background: Limited information is available about patterns of healthcare utilization for prevalent gastrointestinal conditions and their link to symptom burden. Aim: To identify patterns of healthcare utilization among outpatients with highly prevalent gastrointestinal conditions and define the link between healthcare utilization, symptom burden, and disease group. Methods: We randomly selected patients from the gastroenterology outpatient clinic at Princess Alexandra Hospital who had chronic gastrointestinal conditions such as constipation-predominant irritable bowel syndrome (IBS-C, n = 101), diarrhea-predominant IBS (IBS-D, n = 101), mixed IBS (n = 103), inflammatory bowel disease with acute flare (n = 113), IBD in remission (n = 103), and gastroesophageal reflux disease (n = 102). All had presented at least 12 months before and had a 12-month follow-up after the index consultation. Healthcare utilization data were obtained from state-wide electronic medical records over a 24-month period. Intensity of gastrointestinal symptoms was measured using the validated Structured Assessment of Gastrointestinal Symptoms (SAGIS) Scale. Latent class analyses (LCA) based on healthcare utilization were used to identify distinct patterns of healthcare utilization among these patients. Results: LCA revealed four distinct healthcare utilization patterns across all diagnostic groups: Group A: Emergency department utilizers, Group B: Outpatient focused care utilizers, Group C: Inpatient care utilizers and Group D: Inpatient care and emergency department utilizers. LCA groups with high emergency utilization were characterized by high gastrointestinal symptom burden at index consultation regardless of condition (Mean (standard deviation)) SAGIS score Group A: 24.63 (± 14.11), Group B: 19.18 (± 15.77), Group C: 22.48 (± 17.42), and Group D: 17.59 (± 13.74, p < 0.05). Conclusion: Distinct healthcare utilization patterns across highly prevalent gastrointestinal conditions exist. Symptom severity rather than diagnosis, likely reflecting unmet clinical need, defines healthcare utilization. [ABSTRACT FROM AUTHOR]

Issue Addressed: Colorectal cancer (CRC) screening through fecal occult blood testing (FOBT) has saved thousands of lives globally with multiple countries adopting comprehensive population wide screening programs. Participation rates in FOBT based CRC screening for the socially and economically disadvantaged remains low. The aim of this systematic review is to explore empirical evidence that will guide targeted interventions to improve participation rates within priority populations. Methods: PubMed, Embase, Scopus, Cinahl and PsycInfo were systematically searched from inception to 22 June 2022. Eligible studies contained qualitative evidence identifying barriers to FOBT based CRC screening for populations impacted by the social determinants of health. An inductive thematic synthesis approach was applied using grounded theory methodology, to explore descriptive themes and interpret these into higher order analytical constructs and theories. Results: A total of 8,501 publications were identified and screened. A total of 48 studies from 10 countries were eligible for inclusion, representing 2,232 subjects. Coding within included studies resulted in 30 key descriptive themes with a thematic frequency greater than 10%. Coded themes applied to four overarching, interconnected barriers driving inequality for priority populations: social, behavioural, economic and technical/interfaces. So What?: This study has highlighted the need for stronger patient/provider relationships to mitigate barriers to FOBT screening participation for diverse groups. Findings can assist health professionals and policy makers address the systemic exclusion of priority populations in cancer screening by moving beyond the responsibility of the individual to a focus on addressing the information asymmetry driving low value perceptions. [ABSTRACT FROM AUTHOR]

Background: Functional dyspepsia is characterised by chronic symptoms of post-prandial distress or epigastric pain not associated with defined structural pathology. Increased peripheral gut-homing T cells have been previously identified in patients. To date, it is unknown if these T cells were antigen-experienced, or if a specific phenotype was associated with FD. Objective: This study aimed to characterise T cell populations in the blood and duodenal mucosa of FD patients that may be implicated in disease pathophysiology. Methods: We identified duodenal T cell populations from 23 controls and 49 Rome III FD patients by flow cytometry using a surface marker antibody panel. We also analysed T cell populations in peripheral blood from 37 controls and 61 patients. Where available, we examined the number of duodenal eosinophils in patients and controls. Results: There was a shift in the duodenal T helper cell balance in FD patients compared to controls. For example, patients had increased duodenal mucosal Th2 populations in the effector (13.03 ± 16.11, 19.84 ± 15.51, p=0.038), central memory (23.75 ± 18.97, 37.52 ± 17.51, p=0.007) and effector memory (9.80 ±10.50 vs 20.53±14.15, p=0.001) populations. Th17 populations were also increased in the effector (31.74±24.73 vs 45.57±23.75, p=0.03) and effector memory (11.95±8.42 vs 18.44±15.63, p=0.027) subsets. Peripheral T cell populations were unchanged between FD and control. Conclusion: Our findings identify an association between lymphocyte populations and FD, specifically a Th2 and Th17 signature in the duodenal mucosa. The presence of effector and memory cells suggest that the microinflammation in FD is antigen driven. [ABSTRACT FROM AUTHOR]

Background: Psychological and lifestyle factors have been associated with gastrointestinal (GI) symptoms in individuals with diabetes mellitus, but it remains unclear whether they explain the relationship over time. We aimed to determine in two independent population‐based studies whether diabetes is an independent risk factor for GI symptoms at a 1‐ and 3‐year follow‐up, adjusting for these factors. Methods: In study 1, 1900 individuals completed a baseline and 1‐year follow‐up survey, while in study 2, 1322 individuals completed a baseline and 3‐year follow‐up survey. Both studies asked about self‐reported diagnoses of diabetes and GI symptoms over the previous 3 months. Psychological, lifestyle factors (body mass index [BMI], smoking) and age and sex were assessed. Key Results: The baseline prevalence of diabetes was 7.8% in Survey 1 and 8.9% in Survey 2. In a multivariate model that included age, sex, BMI, anxiety, depression and smoking status at follow‐up, reporting diabetes at baseline was an independent predictor of at least weekly early satiation (OR 1.58, 95% CI 1.05, 2.39, p = 0.03; OR = 1.67, 95% CI 1.14, 2.45, p = 0.009), fecal urgency (OR 1.44,95% CI 1.06, 1.95, p = 0.02; OR = 2.17, 95% CI 1.47, 3.22, p = 0.0001), > 3 bowel motions a day (OR 1.50, 95% CI 1.08, 2.07, p = 0.02; OR = 1.67, 95% CI 1.11, 2.51, p = 0.01), and loose stools (OR 1.40, 95% CI 1.04, 1.90, p = 0.03; OR = 1.68, 95% CI 1.13, 2.51, p = 0.01) at the 1‐ and 3‐year follow‐ups, respectively. Conclusions & Inferences: Diabetes is an independent risk factor for a greater frequency of early satiation and diarrhea, adjusting for lifestyle and psychological factors. [ABSTRACT FROM AUTHOR]

Background: Functional gastrointestinal disorders (FGID) are linked to a variety of potential causes, and treatments include reassurance, life-style (including diet), psychological, or pharmacologic interventions. Aims: To assess whether a multidisciplinary integrated treatment approach delivered in a dedicated integrated care clinic (ICC) was superior to the standard model of care in relation to the gastrointestinal symptom burden. Methods: A matched cohort of 52 consecutive patients with severe manifestation of FGID were matched with 104 control patients based upon diagnosis, gender, age, and symptom severity. Patients in the ICC received structured assessment and 12-weeks integrated treatment sessions provided as required by gastroenterologist and allied health team. Control patients received standard medical care at the same tertiary center with access to allied health services as required but no standardized interprofessional team approach. Primary outcome was reduction in gastrointestinal symptom burden as measured by the Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). Secondary outcome was reduction in anxiety and depressive symptoms as measured by the Hospital Anxiety and Depression Scale (HADS). Results: Mixed models estimated the within ICC change in SAGIS total as −9.7 (95% CI −13.6, −5.8; p < 0.0001), compared with −1.7 (95% CI −4.0, 0.6; p = 0.15) for controls. The difference between groups reached statistical significance, −7.6 (95% CI −11.4, −3.8; p < 0.0001). Total HADS scores in ICC patients were 3.4 points lower post-intervention and reached statistical significance (p = 0.001). Conclusion: This matched cohort study demonstrates superior short-term outcomes of FGID patients in a structured multidisciplinary care setting as compared to standard care. [ABSTRACT FROM AUTHOR]

In patients with primary sclerosing cholangitis (PSC), antimicrobial therapy with oral vancomycin (OV) is increasingly used to prevent progression of the liver disease and control concomitant ulcerative colitis (UC); however, there are concerns regarding the risk of development of vancomycin-resistant enterococci (VRE). Thus, we aimed to determine the incidence of VRE in PSC-UC patients. We conducted a retrospective study of PSC-UC patients, treated with OV at the Department of Gastroenterology at the Princess Alexandra Hospital. VRE testing was performed utilizing rectal swabs. We included 7 PSC-UC patients (age 22–53 years, 2 females) treated with OV with daily dose ranging from 250 to 1500 mg. All patients were treated for at least 6 months with OV (range 9–31 months, mean 32.1 months). All patients achieved complete clinical remission of the UC, with mean reduction of fecal calprotectin by 634 μg/mg (87.3%), mean reduction in the C-reactive protein by 21.9 mg/L (74.2%), and mean reduction in the total Mayo score by 9.3 (93.3%). With regard to the liver parameters, mean improvement in alkaline phosphatase enzyme and total bilirubin was −48.7 U/L (−19.7%) and −2.7 mg/dL (−19.6%), respectively. No patient treated with OV developed VRE or reported any adverse events. This cohort study including PSC-UC patients did not provide evidence for development of VRE, while treatment with vancomycin was associated with clinical and endoscopic remission of the UC. Larger, prospective trials are required to define the efficacy and safety of antimicrobial therapy in PSC-UC, while the risk of VRE appears small. [ABSTRACT FROM AUTHOR]

Background: Co‐occurring (overlapping) irritable bowel syndrome (IBS), functional dyspepsia (FD), and heartburn has been observed. However, whether it is a distinct entity has not been established, nor what clinical, demographic, lifestyle, and psychological traits are associated with it. This study sought to estimate the prevalence and temporal stability of this overlap and to identify features specific to it in order to gain some insights into the potential etiopathogenesis. Methods: Two waves of a survey to a population‐representative sample were conducted 3 years apart, recruiting 1312 individuals for this study. The chance‐expected probability of complete overlap (CO) was calculated and compared with the observed CO. A range of demographic, lifestyle factors, medical diagnoses, sleep quality, and psychological distress were tested to identify predictors of overlap using logistic regression. Key Results: CO was observed in 2.1% (95% confidence interval 1.9, 3.7) of the sample and was closely replicated in wave 2 at 2.0%. The observed CO was greater than expected by chance (0.2%) to a statistically significant extent (p < 0.001). Overlap between IBS subtypes, FD subtypes, and heartburn was also elevated above chance expectation. Individuals with CO were separately differentiated from others with respect to elevated rates of self‐reported medically diagnosed asthma, elevated psychological distress score, and elevated impact on sleep quality. The discrimination provided by these factors was further independent of age and sex. Conclusions and Inferences: Overlap between IBS, FD, and heartburn (GERD) appears to be a distinct entity that has a profile including psychological morbidity, sleep disturbance, and elevated rates of atopy. [ABSTRACT FROM AUTHOR]

Background: There is limited empirical evidence of the magnitude of the discrepancy between prospectively recorded gastrointestinal symptom burden and that reported in recall questionnaires. Further, potential sources of the discrepancy are largely unknown. This study sought to quantify the discrepancy and to evaluate the potential role of mood disorder and emotion regulation in the discrepancy. Methods: One hundred and forty nine subjects (mean age 20 years, 75% female) who met Rome IV criteria for irritable bowel syndrome and/or functional dyspepsia completed a 7‐day prospective recording of the symptoms on a smartphone implemented ecological momentary assessment app, and then on day 8 were asked to recall their symptoms for the preceding 7 days. Key Results: Gastrointestinal symptom burden assessed by recall was exaggerated relative to that recorded prospectively. The discrepancy was moderate for overall score (Cohen d = 0.52), abdominal pain (d = 0.61) and indigestion (d = 0.49). The discrepancy was generally larger among subjects who reported a physician diagnosis of a gastrointestinal condition with d = 0.87 for overall score and d = 0.89 for abdominal pain. A number of correlations between the discrepancy and psychological traits were identified, including neuroticism with diarrhea discrepancy (r = 0.23, p = 0.004) and visceral‐specific anxiety with abdominal pain discrepancy (r = −0.18, p = 0.03). There was no evidence of recency or Hawthorne (observer) effects. Conclusions and Inferences: Reports of gastrointestinal symptoms obtained via recall are likely to be exaggerated relative to the actual patient experience, particularly among healthcare seekers. While psychological traits are likely to play some role, much more needs to be understood about the discrepancy. [ABSTRACT FROM AUTHOR]

Functional gastrointestinal disorders (FGID) such as functional dyspepsia (FD) and irritable bowel syndrome (IBS) are highly prevalent and debilitating attributed to altered gut function and gut-brain interactions. FGID can be reliably diagnosed based upon the symptom pattern; but in the clinical setting FD or IBS a frequent diagnoses of exclusion after relevant structural causes of symptoms have been ruled out by appropriate testing. Thus far, there is no established biomarker for FGIDs. To address this limitation, we utilised multi-omics and chemometrics integration to characterise the blood plasma biochemistry in patients with IBS, FD, an overlap of FD/IBS, and controls using liquid chromatography-mass spectrometry (LC-MS) techniques. Cholesterol metabolism products Cholest-5,24-dien-3β-ol, 3-O-β-D-glucopyranoside, energy pathway metabolites, immunoglobulin-γ2 and immunoglobulin-κ, and carbonic anhydrase-1 proteins were particularly elevated in IBS. Furthermore, arginine and proline metabolisms, thyroid hormone synthesis, ferroptosis and, complementary and coagulation cascades were particularly upregulated in patients with IBS. Cer(d18:1/26:1(17Z)) and PI(14:0/22:1(11Z)) lipids were elevated in FD and FD-IBS but were depleted in IBS. Markers of central carbon metabolism and lipidome profiles allowed better discrimination and model predictability than metaproteome profile in healthy and FGID conditions. Overall, the multi-omics integration allowed the discrimination of healthy controls and FGID patients. It also effectively differentiated the biochemistry of FGID subtypes including FD, IBS and FD-IBS co-occurrence. This study points towards the possibility of multi-omics integration for rapid and high throughput analysis of plasma samples to support clinicians screen and diagnose patients with suspected FGIDs. [ABSTRACT FROM AUTHOR]

Background and Aims: Antimicrobial therapy improves symptoms in patients with irritable bowel syndrome (IBS), but the efficacy in functional dyspepsia (FD) is largely unknown. While FD and IBS frequently overlap, it is unknown if concomitant IBS in FD alters the response to antimicrobial therapy in FD. Thus, we aimed to assess and compare the effect of antimicrobial therapy on visceral sensory function and symptom improvement in FD patients with and without IBS. Methods: Adult patients with FD with or without IBS received rifaximin 550 mg BD for 10 days, followed by a 6-week follow-up period. The total gastrointestinal symptom score as measured by the SAGIS (Structured Assessment of Gastrointestinal Symptoms) questionnaire and subscores (dyspepsia, diarrhea, and constipation), symptom response to a standardized nutrient challenge and normalization of the glucose breath tests were measured. Results: Twenty-one consecutive adult patients with FD and 14/21 with concomitant IBS were recruited. Treatment with rifaximin resulted in a significant (p = 0.017) improvement in the total SAGIS score from 34.7 (± 15.4) at baseline to 26.0 (± 16.8) at 2 weeks and 25.6 (± 17.8) at 6 weeks post-treatment. Similarly, compared to baseline there was a statistically significant improvement in SAGIS subscores for dyspepsia and diarrhea (all p < 0.05) and effects persisted for 6 weeks post-treatment. Similarly, the symptom score (and subscores) following a standardized nutrient challenge improved significantly (p < 0.001) 2 weeks post-treatment. The presence of concomitant IBS did not significantly influence the improvement of symptoms after antibiotic therapy (all p > 0.5). Conclusions: In FD patients, the response to antimicrobial therapy with rifaximin is not influenced by concomitant IBS symptoms. [ABSTRACT FROM AUTHOR]

Summary: Background: Psychological distress, strongly associated with functional gastrointestinal disorders (FGIDS), likely plays a central role in the pathophysiology. The role of sleep disturbances in FGIDs is unclear, and an association with psychological factors is uncertain. Aim: To determine whether sleep disturbances are associated with irritable bowel syndrome (IBS) and functional dyspepsia (FD) and if a potential association is explained by psychological distress. Methods: Adult sample randomly selected from a region in New South Wales, Australia in 2015 who returned a follow‐up mail survey in 2018 (response rate, 60.5%) that contained questions on IBS, FD, sleep (MOS‐Sleep Scale) and psychological distress (Kessler 6 scale). Results: Among this population, 10.4% (95% CI 8.8‐12.2) and 17.9% (95% CI 15.9‐20.1) met Rome III criteria for IBS and FD, respectively. The prevalence of any sleep disturbance at least most of the time was common, with a significantly higher prevalence in FGID (IBS and/or FD) compared with the remaining population (41.8% vs 32.2%, P = 0.003). The total sleep problem index was significantly higher for IBS (OR = 1.71 [95% CI 1.29‐2.27], P < 0.0001) (IBS‐diarrhoea predominant and IBS‐mixed but not IBS‐constipation) and FD (OR = 1.80 [1.43‐2.26], P < 0.0001) (both epigastric pain syndrome and postprandial distress syndrome) even after adjusting for age, sex and psychological distress. Conclusion: Both IBS and FD, and most of their major subtypes except IBS‐C, are associated with a range of sleep disturbances. These sleep problems do not appear to be explained by psychological factors and may play an independent role in the pathophysiology. [ABSTRACT FROM AUTHOR]

Purpose of review: Functional dyspepsia (FD) is a highly prevalent condition affecting up to 12% of the US population. We reviewed the recent medical literature regarding therapeutic interventions and aimed to identify guidance for the most appropriate/effective treatment in patients presenting with FD. Recent findings: There are a variety of therapeutic interventions that have recently demonstrated clinical efficacy in placebo-controlled trials and subsequent systematic reviews and meta-analysis. Pharmacologic interventions include acid inhibition, prokinetics, antimicrobial interventions, and central nervous system acting drugs (with emphasis on tricyclic antidepressant). In addition, available data support the use of specific herbal preparations. However, while treatments may substantially improve symptoms in individual patients, for all effective (pharmacologic and non-pharmacologic) interventions, the gain over placebo is only small consistent with the concept that FD actually is caused by a variety of underlying mechanisms and the occurrence of spontaneous fluctuation of disease activity that may amplify 'placebo responses'. Summary: FD is a condition with a most likely multifaceted pathophysiology. Thus, it is unlikely that a single pharmacologic intervention will provide cure or even symptom relief for a large proportion of patients. While the symptom-based categorisation of FD (postprandial distress syndrome and epigastric pain syndrome) is intuitive, it remains to be established that the proposed categorisation translates into improved patient outcomes. The main problem is the considerable overlap of various symptom-based disease categories in severely affected patients. Considering the multifaceted pathophysiology of FD, it is likely that for patients with FD manifestations severely affecting quality of life, multiprofessional treatment approaches involving medical, mental health, and other allied health professionals are required. [ABSTRACT FROM AUTHOR]

Background: Patients presenting with gastrointestinal symptoms can be challenging in terms of determining etiology and management strategies. Identifying likely organic pathology is important since it can be treated and may result in further, long‐term harm to the patient if not treated. Currently, organic pathology is often identified via invasive procedures such as endoscopy or referral to a medical imaging service. We report on an approach that offers a first step at identifying patients with an organic gastrointestinal disease based on the SAGIS, a validated symptom questionnaire. Methods: 8,922 patients referred to a tertiary care hospital were classified as having either functional gastrointestinal disease or an organic gastrointestinal disease. A model was developed to distinguish organic from functional symptoms on one random split half of the sample and validated on the other half. The incremental benefit of including psychological conditions and extra‐gastrointestinal conditions was also evaluated. Key results: Functional gastrointestinal patients scored higher on average than organic patients on all dimensions of the SAGIS and reported higher rates of psychological and extra‐gastrointestinal conditions. All five dimensions of the SAGIS provided statistically independent discrimination of organic from functional diagnoses with good overall discrimination (AUC = 0.75). However, there was no noticeable incremental benefit of adding either psychological or extra‐gastrointestinal conditions. Model performance was highly reproducible. Conclusions and inferences: The proposed algorithm for identifying likely organic gastrointestinal disease applied to symptoms as recorded in the SAGIS questionnaire provides a useful tool for the clinician in deciding what or if further diagnostic testing is required. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Sharma et al papers. To view these articles, visit https://doi.org/10.1111/apt.16369 and https://doi.org/10.1111/apt.16910 [ABSTRACT FROM AUTHOR]

Psychological distress is associated with functional gastrointestinal disorders (FGIDs) including irritable bowel syndrome (IBS) and functional dyspepsia (FD) but only evidence from prospective longitudinal and treatment studies can indicate whether the link between FGIDs and psychological distress is causal. Emerging evidence suggests underlying biological mechanisms may explain the association of psychological distress with FGIDs. This review critically evaluates whether anxiety and/or depression and FGIDs are causally related including evidence for a temporal sequence, strength and specificity of the association, biological gradient, and biological plausibility. Accumulating evidence suggests that psychological factors are causal for symptoms in a subset of FGID patients and not explained by health care seeking behavior (brain-gut disorder). In other cases, psychological factors may arise secondary to intestinal disease (gut-brain disorder). Prospective population-based studies are needed in FGIDs other than IBS and FD to determine if a similar brain-gut and gut-brain syndrome exists. Treatment studies have not phenotyped FGIDs according to brain-gut versus gut-brain origins which may be important in understanding true treatment efficacy. Future research needs to unravel biological mechanisms that may explain the link between psychological factors and FGIDs but promising data in the area of the brain-gut–immune-microbe axis is emerging. [ABSTRACT FROM AUTHOR]

Summary: Background: Small intestinal bacterial overgrowth may play a role in gastrointestinal and non‐gastrointestinal diseases. Aims: To use quantitative polymerase chain reaction (qPCR) to determine and compare bacterial loads of duodenal biopsies in asymptomatic controls, and patients with functional gastrointestinal disorders (FGIDs) and inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease (CD). To define effects of gastric acid inhibition on bacterial load, explore links of bacterial load and gastrointestinal symptoms in response to a standardised nutrient challenge and compare bacterial load with glucose breath test results. Methods: In 237 patients (63 controls, 84 FGID and 90 IBD), we collected mucosal samples under aseptic conditions during endoscopy extracted and total DNA. Bacterial load metric was calculated utilising qPCR measurements of the bacterial 16S rRNA gene, normalised to human beta‐actin expression. Standard glucose breath test and nutrient challenge test were performed. Results: The duodenal microbial load was higher in patients with FGID (0.22 ± 0.03) than controls (0.07 ± 0.05; P = 0.007) and patients with UC (0.01 ± 0.05) or CD (0.02 ± 0.09), (P = 0.0001). While patients treated with proton pump inhibitors (PPI) had significantly higher bacterial loads than non‐users (P < 0.05), this did not explain differences between patient groups and controls. Bacterial load was significantly (r = 0.21, P < 0.016) associated with the symptom response to standardised nutrient challenge test. Methane, but not hydrogen values on glucose breath test were associated with bacterial load measured utilising qPCR. Conclusions: Utilising qPCR, a diagnosis of FGID and treatment with PPI were independently associated with increased bacterial loads. Increased bacterial loads are associated with an augmented symptom response to a standardised nutrient challenge. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence of self-reported non-coeliac wheat sensitivity (SR-NCWS) and factors associated with its onset and resolution; to describe the prevalence of factors associated with gluten avoidance.Design: Longitudinal cohort study; analysis of responses to self-administered validated questionnaires (Digestive Health and Wellbeing surveys, 2015 and 2018).Setting, Participants: Subset of an adult population sample randomly selected in 2015 from the electoral rolls for the Newcastle and Gosford regions of New South Wales.Main Outcome Measures: Prevalence of SR-NCWS (2015, 2018) and incidence and resolution of SR-NCWS, each by demographic and medical factors; prevalence of gluten avoidance and reasons for gluten avoidance (2018).Results: 1322 of 2185 eligible participants completed the 2018 survey (response rate, 60.5%). The prevalence of SR-NCWS was similar in 2015 (13.8%; 95% CI, 12.0-15.8%) and 2018 (13.9%; 95% CI, 12.1-15.9%); 69 of 1301 respondents (5.3%) reported developing new onset (incident) SR-NCWS between 2015 and 2018 (incidence, 1.8% per year). Incident SR-NCWS was significantly associated with a diagnosis of functional dyspepsia, and negatively associated with being male or older. Gluten avoidance was reported in 2018 by 24.2% of respondents (20.5% partial, 3.8% complete avoidance); general health was the most frequent reason for avoidance (168 of 316 avoiders, 53%). All 13 participants with coeliac disease, 56 of 138 with irritable bowel syndrome (41%), and 69 of 237 with functional dyspepsia (29%) avoided dietary gluten.Conclusions: The prevalence of SR-NCWS was similar in 2015 and 2018. Baseline (2015) and incident SR-NCWS (2018) were each associated with functional gastrointestinal disorders. The number of people avoiding dietary gluten exceeds that of people with coeliac disease or SR-NCWS, and general health considerations and abdominal symptoms are the most frequently reported reasons for avoidance. [ABSTRACT FROM AUTHOR]

Summary: Background: Current data on small intestinal bacterial overgrowth (SIBO) in patients with inflammatory bowel diseases (IBD) are controversial. Aim: To conduct a systematic review and meta‐analysis to determine the prevalence of SIBO in patients with ulcerative colitis (UC) and Crohn's disease (CD). Methods: Electronic databases were searched up to May 2018 for studies reporting prevalence of SIBO in IBD patients. The prevalence rate of SIBO among IBD patients and the odds ratio (OR) and 95% CI of SIBO in IBD patients compared with controls were calculated. Results: The final dataset included 11 studies (1175 adult patients with IBD and 407 controls), all utilising breath test for diagnosis of SIBO. The proportion of SIBO in IBD patients was 22.3% (95% CI 19.92‐24.68). The OR for SIBO in IBD patients was 9.51 (95% CI 3.39‐26.68) compared to non‐IBD controls, and high in both CD (OR = 10.86; 95% CI 2.76‐42.69) and UC (OR = 7.96; 95% CI 1.66‐38.35). In patients with CD, subgroup analysis showed the presence of fibrostenosing disease (OR = 7.47; 95% CI 2.51‐22.20) and prior bowel surgery (OR = 2.38; 95% CI 1.65‐3.44), especially resection of the ileocecal valve, increased the odds of SIBO. Individual studies suggest that combined small and large bowel disease but not disease activity may be associated with SIBO. Conclusions: Overall, there is a substantial increase in the prevalence of SIBO in IBD patients compared to controls. Prior surgery and the presence of fibrostenosing disease are risk factors for SIBO in IBD. [ABSTRACT FROM AUTHOR]

Summary: Background: The pathogenesis of functional GI disorders (FGIDs) is uncertain. However, underlying immune activation and psychological distress has been documented in irritable bowel syndrome (IBS) and functional dyspepsia (FD). Epidemiological data from the UK suggest that FGIDs are linked to atopy and certain autoimmune diseases but this has not been confirmed. Aim: To test if allergic or autoimmune diseases are independently associated with FGIDs, irrespective of psychological distress in a large population based study. Methods: A total of 3542 people (mean age 57.9 years and 52.7% females) randomly selected from the Australian population, returned a mail survey (response rate = 43%). The survey asked about a physician diagnosis of autoimmune disease (scleroderma, psoriasis, rheumatoid arthritis and diabetes mellitus) or allergic conditions (asthma, food, pollen and/or animal allergy). The questionnaire assessed psychological distress and Rome III criteria for FD and IBS. Results: Asthma, food, pollen and animal allergies, psoriasis and rheumatoid arthritis were univariately significantly associated with IBS and FD. Food allergy (OR = 1.66; 95% CI = 1.15‐2.40, P = 0.007), psoriasis (OR = 1.81; 95% CI = 1.19‐2.74, P = 0.006) and rheumatoid arthritis (OR = 1.68; 95% CI = 1.15‐2.4, P = 0.007) were independent risk factors for IBS, controlling for age, gender and psychological distress. In FD, asthma (OR = 1.32; 95% CI = 1.04‐1.68, P = 0.025) and food allergy (OR = 1.78; 95% CI = 1.28‐2.49, P = 0.001) were independent predictors, controlling for age, sex and psychological distress. Conclusions: There is evidence that both atopic and autoimmune diseases are risk factors for FGIDs, independent of psychological distress, differing in IBS and FD. This provides evidence that different peripheral pathways may be involved in the pathogenesis of certain FGIDs. [ABSTRACT FROM AUTHOR]

Background: According to Rome IV criteria, functional dyspepsia (FD) and irritable bowel syndrome (IBS) are distinct functional gastrointestinal disorders (FGID); however, overlap of these conditions is common in population-based studies, but clinical data are lacking.Aims: To determine the overlap of FD and IBS in the clinical setting and define risk factors for the overlap of FD/IBS.Methods: A total of 1127 consecutive gastroenterology outpatients of a tertiary center were recruited and symptoms assessed with a standardized validated questionnaire. Patients without evidence for structural or biochemical abnormalities as a cause of symptoms were then categorized based upon the symptom pattern as having FD, IBS or FD/IBS overlap. Additionally, this categorization was compared with the clinical diagnosis documented in the integrated electronic medical records system.Results: A total of 120 patients had a clinical diagnosis of a FGID. Based upon standardized assessment with a questionnaire, 64% of patients had FD/IBS overlap as compared to 23% based upon the routine clinical documentation. In patients with severe IBS or FD symptoms (defined as symptoms affecting quality of life), the likelihood of FD/IBS overlap was substantially increased (OR = 3.1; 95%CI 1.9-5.0) and (OR = 9.0; 95%CI 3.5-22.7), respectively. Thus, symptom severity for IBS- or FD symptoms were significantly higher for patients with FD/IBS overlap as compared to patients with FD or IBS alone (p all < 0.01). Age, gender and IBS-subtype were not associated with overlap.Conclusion: In the clinical setting, overlap of FD and IBS is the norm rather than the exception. FD/IBS overlap is associated with a more severe manifestation of a FGID. [ABSTRACT FROM AUTHOR]

Background and Aim A previous UK study showed that 6.1% of patients with diarrhea-predominant irritable bowel syndrome (IBS-D) had evidence of severe pancreatic exocrine insufficiency (PEI), but these findings need replication. We aimed to identify the prevalence of PEI based on fecal elastase stool testing in consecutive outpatients presenting with chronic unexplained abdominal pain and/or diarrhea and/or IBS-D. Methods Patients aged over 40 years presenting to hospital outpatient clinics from six sites within Australia with unexplained abdominal pain and/or diarrhea for at least 3 months and/or IBS-D were studied. Patients completed validated questionnaires and donated a stool sample in which elastase concentration was measured by ELISA. A concentration of < 100 mcg/g stool represented severe and < 200 mcg/g mild to moderate PEI. Patients whose fecal elastase was < 200 mcg/g underwent testing for pancreatic pathology with an endoscopic ultrasound or abdominal CT. Results Two hundred eighteen patients (mean age of 60 years, 29.4% male) were studied. PEI was found in 4.6% (95% CI 2.2-8.3%) ( n = 10), with five patients (2.3% (95% CI 0.8-5.3%) having severe PEI. Only male sex and heavy alcohol use were significantly associated with abnormal versus normal pancreatic functioning. Of seven patients who underwent endoscopic ultrasound or CT, two had features indicative of chronic pancreatitis. Conclusion One in 50 patients with IBS-D or otherwise unexplained abdominal pain or diarrhea have an abnormal fecal elastase, but unexpected pancreatic insufficiency was detected in only a minority of these. This study failed to confirm the high prevalence of PEI among patients with unexplained GI symptoms previously reported. [ABSTRACT FROM AUTHOR]

Introduction: Case control studies suggest an inverse association between Helicobacter pylori (H. pylori) and Crohn's disease (CD). It is possible this could be accounted for by confounders such as antibiotic therapy. Analyzing the geographic distribution of H. pylori and the links with the incidence and prevalence of CD would be an alternative approach to circumvent these confounders.Methods: The literature was searched for studies published between 1990 and 2016 that reported incidence or prevalence data for CD in random population samples in developed countries (GDP per capita >20,000 USD/year). Corresponding prevalence studies for H. pylori in these same regions were then sought matched to the same time period (±6 years). The association between the incidence and prevalence of CD and H. pylori prevalence rates were assessed before and after adjusting for GDP and life expectancy.Results: A total of 19 CD prevalence and 22 CD incidence studies from 10 European countries, Japan, USA, and Australia with date-matched H. pylori prevalence data were identified. The mean H. pylori prevalence rate was 43.4% (range 15.5-85%), and the mean rates for incidence and prevalence for CD were 6.9 and 91.0/100,000 respectively. The incidence (r = -0.469, p < 0.03) and prevalence (r = -0.527, p = 0.02) of CD was inversely and significantly associated with prevalence of H. pylori infection.Conclusions: Our data demonstrate a significant inverse association between geographic distribution of H. pylori and CD. Thus, it is highly unlikely that the findings of previous case control studies were simply due to confounding factors such as concomitant antibiotic use in CD patients. [ABSTRACT FROM AUTHOR]

Functional dyspepsia is relatively common yet poorly understood. The best accepted diagnostic criteria are the Rome III criteria. The epidemiology, healthcare seeking rates, impact and pathophysiology are reviewed with a focus on women. Treatment is limited with no clearly established regimen currently recommended. Duodenal eosinophilia may be found in a subset. Proton pump inhibitors and prokinetic agents represent the standard therapeutic regimen after Helicobacter pylori infection has been eliminated. Some novel agents such as the prokinetic acotiamide appear promising; however, the need for a safe and efficacious treatment remains largely unmet. This review also describes the currently available management options for functional dyspepsia. [ABSTRACT FROM AUTHOR]

The article presents a study on epidemiological evidence for brain-gut and gut-brain syndromes. It discusses the psychological comorbidity with functional gastrointestinal disorder (FGID), the tendency for anxiety and depression to raise sympathetic and lower parasympathetic tone in the autonomic nervous system (ANS) in the brain-gut communication and the excessive production of TNF-α and other cytokines due to a microbe-gene-inflammation interaction under the gut-brain communication.

Background: Quality of life is impaired in some people with IBS, but the level of symptoms that may drive this impairment is unclear.Aims: We aimed to identify whether current frequency and severity cut-offs for IBS-type symptoms are associated with a clinically meaningful impairment of quality of life in the community.Methods: People who met modified Rome III criteria for IBS (n = 201) and controls (n = 1,904) were assessed. Frequency of IBS symptoms was grouped a priori into 'less frequent' (not at all and sometimes) and 'more' frequent (often, very often and almost always). Severity of abdominal pain was grouped into 'mild' (very mild and mild) and severe (moderate, severe and very severe). Mental and physical functioning was measured using the valid SF-12, with 'normal' functioning (defined as a score of >43 and >48) and 'impaired' functioning (defined as a score of ≤43 and ≤48), respectively. Psychological variables were assessed via valid self-report.Results: Having 'more' versus 'less' severe abdominal pain (OR = 9.41; 95% CI 1.17-75.43, P = 0.03) and 'more' versus 'less' frequent diarrhoea (OR = 2.19; 95% CI 1.13-4.26, P = 0.02) along with increasing age (OR = 1.03; 95% CI 1.01-1.05, P = 0.003) were significant independent predictors of having impairment in physical functioning. In terms of psychological factors, having higher levels of depression (OR = 1.61; 95% CI 1.36-1.91) and somatic distress (OR = 1.17; 95% CI 1.09-1.27) were independently associated with mental and physical impairment, respectively.Conclusion: The current frequency and severity threshold cut-offs for IBS symptoms in the Rome III criteria are associated with a clinically meaningful impairment of quality of life in community subjects with IBS. [ABSTRACT FROM AUTHOR]

Background: Quality of life is impaired in some people with IBS, but the level of symptoms that may drive this impairment is unclear. Aims: We aimed to identify whether current frequency and severity cut-offs for IBS-type symptoms are associated with a clinically meaningful impairment of quality of life in the community. Methods: People who met modified Rome III criteria for IBS ( n = 201) and controls ( n = 1,904) were assessed. Frequency of IBS symptoms was grouped a priori into 'less frequent' (not at all and sometimes) and 'more' frequent (often, very often and almost always). Severity of abdominal pain was grouped into 'mild' (very mild and mild) and severe (moderate, severe and very severe). Mental and physical functioning was measured using the valid SF-12, with 'normal' functioning (defined as a score of >43 and >48) and 'impaired' functioning (defined as a score of ≤43 and ≤48), respectively. Psychological variables were assessed via valid self-report. Results: Having 'more' versus 'less' severe abdominal pain (OR = 9.41; 95% CI 1.17-75.43, P = 0.03) and 'more' versus 'less' frequent diarrhoea (OR = 2.19; 95% CI 1.13-4.26, P = 0.02) along with increasing age (OR = 1.03; 95% CI 1.01-1.05, P = 0.003) were significant independent predictors of having impairment in physical functioning. In terms of psychological factors, having higher levels of depression (OR = 1.61; 95% CI 1.36-1.91) and somatic distress (OR = 1.17; 95% CI 1.09-1.27) were independently associated with mental and physical impairment, respectively. Conclusion: The current frequency and severity threshold cut-offs for IBS symptoms in the Rome III criteria are associated with a clinically meaningful impairment of quality of life in community subjects with IBS. [ABSTRACT FROM AUTHOR]

The article presents a study on the relationship of anxiety and depression using older Australian women as the instrument. It states that age is a factor for the occurrence of such emotions. The Goldberg Anxiety and Depression Scale (GADS) will constitute simple responses with a monthly monitoring of the respondents feeling.

Background: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, although infrequently the subject of systematic research in this age group. One important limitation is the lack of a widely accepted instrument to measure dimensional anxiety in both normal old people and old people with mental health problems seen in various settings. Accordingly, we developed and tested of a short scale to measure anxiety in older people.Methods: We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week perspective and a dichotomous response scale.Results: Cronbach's alpha for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test-retest reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly classified with a specificity of 84% and a sensitivity of 75%.Conclusions: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD. [ABSTRACT FROM AUTHOR]

The article reports on the prevalence of anxiety disorders on elderly people and the development of a short scale to measure anxiety in older people. Anxiety is considered as one of the most common psychiatric problems experienced by older people. However, the instruments used in measuring anxiety disorders are not well designed. As a result, a short scale measurement of anxiety is developed.

Background/Aims: Why abuse is associated with irritable bowel syndrome and functional dyspepsia remains unclear but other psychosocial factors may be important. We hypothesized that other psychosocial variables may confound the association. Methods: 207 subjects identified from a previous population survey who also met Rome I criteria for IBS (n = 156) or functional dyspepsia (n = 51) were included in the study. Controls (n = 100) did not report having any abdominal pain in a previous population survey. Sexual, physical, emotional/verbal abuse as a child (≤13 years) and adult (≥14 years) was assessed using validated self-report questions. Other psychological variables were assessed via validated self-report. Results: Adulthood abuse was significantly more common in IBS and/or functional dyspepsia (40%) compared with healthy controls (25%). Abuse was not an independent predictor for IBS or functional dyspepsia when psychological and buffering factors were controlled for in the analyses. Having a diagnosis of depression and using a self-controlling coping style were significantly associated with having a history of abuse. Conclusions: Abuse occurring as an adult was significantly associated with IBS and/or functional dyspepsia, but it was not an important factor when psychosocial factors were controlled for in these disorders. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In a population-based study of 207 subjects with irritable bowel syndrome (IBS) or functional dyspepsia (FD) and controls (n = 100), we aimed to determine whether dimensions of abnormal illness behavior from the Abnormal Illness Behaviour Questionnaire and aspects of social learning of illness behavior from the Social Learning of Illness Behaviour scale were independent predictors of health care seeking for IBS and FD. Results showed that dimensions of abnormal illness behavior and aspects of social learning of illness behavior (encouragement, reinforcement, and modeling) did not significantly differentiate between consulters and nonconsulters with IBS and/or FD. The Disease Conviction scale (OR = 1.55; 95% CI, 1.15-2.09) of the Abnormal Illness Behaviour Questionnaire was an independent predictor of having a diagnosis of IBS and/or FD, independent of age and gender, psychiatric diagnoses, and symptom severity. We conclude that a belief in the presence of serious pathology characterizes community subjects with IBS and FD, but not health care seeking. [ABSTRACT FROM AUTHOR]

: ObjectivesPsychological treatments are considered to be useful in the irritable bowel syndrome (IBS), although the evidence is based on small, often flawed trials. Although cognitive behavior therapy (CBT) and relaxation therapy have both been promising, we hypothesized that CBT would be superior to relaxation and standard care alone in IBS patients. The objective of this study was to test this assumption by comparing the effects of cognitive behavior therapy with relaxation therapy and routine clinical care alone in individuals with IBS.: MethodsPatients (n = 105) with Rome I criteria for IBS were recruited from advertisement (n = 51) and outpatient clinics (n = 54); those patients with resistant IBS were not included. A randomized controlled trial with three arms (standard care for all groups plus either CBT or relaxation) for 8 wk was conducted, which applied blinded outcome assessments using validated measures with 1 yr of follow-up. The primary outcome for this study was bowel symptom severity.: ResultsOf 105 patients at the commencement of treatment, the mean bowel symptom frequency score for the whole sample was 21.1 and at the end of treatment had fallen to 18.1; this persisted at the 52-wk follow-up, with a significant linear trend for scores to change over time (F = 39.57 p < 0.001). However, there were no significant differences among the three treatment conditions. Significant changes over time were found for physical functioning (F = 4.37, p < 0.001), pain (F = 3.12, p < 0.05), general health (F = 2.71, p < 0.05), vitality (F = 2.94, p < 0.05), and the social functioning scales on the Medical Outcomes Study Short Form 36 (F = 4.08, p < 0.05); however, all three arms showed similar improvement. There were significant reductions in anxiety, depression, and locus of control scales, but no significant differences among the treatment groups were detected.: ConclusionCognitive behavior and relaxation therapy seem not to be superior to standard care alone in IBS. [Copyright &y& Elsevier]

: ObjectiveLittle is known about the natural history of functional GI symptoms, including what factors influence GI symptom patterns and health care seeking for them over the long term. We aimed to determine whether psychological factors play a role in the development and long-term course of these symptoms.: MethodsA random sample of community subjects (n = 361) who reported having unexplained abdominal pain for ≥1 month in a previous population survey were included in the study. Controls (n = 120) were defined as not having abdominal pain for ≥1 month from this initial survey. Subjects were prospectively followed up via a questionnaire every 4 months over a 12-month period. The questionnaire asked about the presence of GI symptoms over the past week and psychological distress over the past 3 wk (psychological caseness being defined as a score of ≥2 of 12 on the General Health Questionnaire). The number of visits made to a physician or medical specialist over the past 4 months was evaluated.: ResultsGI symptoms were common among community controls and subjects with abdominal pain. Similar onset and disappearance rates were observed for the majority of GI symptom categories, accounting for the stability of the prevalence rates over a 1-yr period. Changes in a state measure of psychological distress were not significantly associated with changes in GI symptom status between the 4- and 8-month (r = 0.14, p = 0.08) and 8- and 12-month (r = 0.02, p = 0.77) follow-ups. Baseline psychological distress, however, was an independent predictor of having persistent GI symptoms, including abdominal pain, bloating, and constipation, and frequently seeking health care for GI symptoms over 1 yr.: ConclusionsPsychological distress levels do not seem to be important in explaining GI symptom change over a 1-yr period. Psychological distress, however, is linked to having persistent GI symptoms and frequently seeking health care for them over time. Clinicians should consider psychological factors in the treatment of this subset of irritable bowel syndrome patients. [Copyright &y& Elsevier]

OBJECTIVES:Functional GI disorders (FGIDs) are common in clinical practice, but little is known about the epidemiology of these disorders in the general population. We aimed to determine the prevalence, association with psychological morbidity, and health care seeking behavior of FGIDs in the population.METHODS:A random sample of subjects (n = 4500) aged ≥18 yr and representative of the Australian population were mailed a validated questionnaire. For these subjects we measured all Rome I GI symptoms and physician visits over the past 12 months, as well as neuroticism, anxiety, depression, and somatic distress.RESULTS:The response rate for the study was 72%. The prevalence of any FGID was 34.6%, and 62.1% of these subjects had consulted a physician. There was considerable overlap of the FGIDs (19.2% had more than two disorders). Independent predictors for an FGID diagnosis were neuroticism, somatic distress, anxiety, bowel habit disturbance, abdominal pain frequency, and increasing age. However, psychological morbidity did not independently discriminate between consulters and nonconsulters with an FGID.CONCLUSIONS:More than one third of the general population have one or more FGIDs. There seems to be a modest link between psychological morbidity and FGIDs, although other unknown factors seem to be more important in explaining health care seeking for these disorders. [Copyright &y& Elsevier]

Presents a study which examined the nature of executive processing in working memory as a core deficit in attention deficit hyperactivity disorder (ADHD) as distinct from deficits associated with reading disability. Information on ADHD; Use of the random generation task; Measures of phonological loop functioning.

OBJECTIVES: Health care use is a costly outcome of the irritable bowel syndrome (IBS) and nonulcer dyspepsia (NUD), but the predictors of this behavior remain poorly defined. We aimed to systematically review the literature to determine which symptoms and psychosocial factors drive health care seeking in these disorders. METHODS: A broad based MEDLINE and Current Contents search between 1966 and 2000 identified 44 relevant publications. References from these articles were also reviewed. RESULTS: The literature suggests that symptom severity is an important factor, but only explains a small proportion of the health care seeking behavior associated with these disorders in population-based studies. Psychosocial factors including life event stress, psychological morbidity, personality, abuse and abnormal illness attitudes and beliefs have been found to characterize those that seek help versus those that do not. The role of other psychosocial factors such as social support, coping style and knowledge about illness are as yet undetermined. CONCLUSIONS: A model for health care seeking for IBS and NUD, with an emphasis on psychosocial factors is presented, but remains to be tested. [ABSTRACT FROM AUTHOR]

Studies the effect of questionnaire length and lottery inducement on the overall response rate of mail surveys. Related studies on response rate; Methodology; Results and discussion.

OBJECTIVES: It has been suggested that the variation in the prevalence of irritable bowel syndrome (IBS) may be due to the application of different diagnostic criteria. New criteria for IBS have been proposed (Rome II). It is unknown whether persons meeting different criteria for IBS have similar psychological and symptom features. The aim of this study was to measure the prevalence of IBS according to Manning and Rome definitions of IBS and to evaluate the clinical and psychological differences between diagnostic categories. METHODS: A total of 4500 randomly selected subjects, with equal numbers of male and female subjects aged ≥ 18 yr and representative of the Australian population, took part in this study. Subjects were mailed a questionnaire (response rate, 72%). Characteristics measured were gastrointestinal symptoms over the past 12 months, neuroticism and extroversion (Eysenck Personality Questionnaire), anxiety and depression (Delusions-Symptoms-States Inventory), mental and physical functioning (SF-12), and somatic distress (Sphere). RESULTS: The prevalence for IBS according to Manning, Rome I, and Rome II was 4.4% (95% confidence interval [CI] = 3.5-5.1%), 6.9% (CI 6.0-7.8%), and 13.6% (CI 12.3-14.8%), respectively. Only 12 persons with Rome I did not also meet Rome II criteria; 196 persons with Manning criteria did not meet Rome II cut-offs. Having IBS regardless of which criteria were used was significantly associated with psychological morbidity, but psychological factors were not important in discriminating between diagnostic categories. However, pain and bowel habit severity independently discriminated between diagnostic groups. CONCLUSIONS: IBS is a relatively common disorder in the community. The new Rome II criteria may be unnecessarily restrictive in practice. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The impact of functional gastrointestinal disorders (FGIDs) on quality of life is unknown. We aimed to evaluate whether FGIDs impair quality of life in terms of mental and physical functioning in patients and nonpatients. METHODS: A random sample of 4500 subjects, representative of the Australian population, were mailed a questionnaire on gastrointestinal symptoms in the past 12 months. Quality of life was assessed using the valid SF-12, in which the lower the scores, the greater the impairment of quality of life. The response rate was 72%. RESULTS: Among those fulfilling Rome I criteria for a diagnosis of a FGID (n = 1006) versus those not having a FGID (n = 1904) (healthy controls), there was a significant association with impaired mental (43.9 vs 48.1) and physical (47.7 vs 51.6) functioning. Mental functioning (43.3 vs 44.9) and physical functioning (46.0 vs 50.5) was significantly more impaired in patients versus nonpatients with a FGID. Furthermore, nonpatients with a FGID had more impaired mental and physical functioning than healthy controls. CONCLUSION: FGIDs impair quality of life, particularly in those that consult for health care. [ABSTRACT FROM AUTHOR]