Global Prevalence, Characterization, and Impact of Functional Bowel Disorders

Functional bowel disorders (FBDs) are common and have a profound impact on many aspects of life. However, little is known about their prevalence and impact in different parts of the world.

We used internet data (26 countries) from the Rome Foundation Global Epidemiology Study to define the current prevalences of FBD and the association with psychological and nongastrointestinal somatic symptoms, quality of life, demographics, medical history, and healthcare utilization. We also investigated effects of changes in irritable bowel syndrome (IBS) criteria from Rome III to IV in 14 countries.

Rome IV criteria for any FBD were fulfilled by 33.2%, with functional constipation being the most common diagnosis (11.7%) followed by unspecified FBD (8.7%). Altered bowel habits was the most common qualifying symptom for unspecified FBD, while abdominal pain contributed particularly to the negative health impact. Individuals with FBD had more nongastrointestinal somatic and psychological symptoms, reduced quality of life, and increased healthcare utilization, most pronounced in IBS and opioid-induced constipation. Findings were similar across world regions and countries. The major contributor to lower Rome IV, vs Rome III, IBS prevalence (4.1% vs 10.1%) was the change in symptom frequency threshold for abdominal pain and/or discomfort. Minor alterations in IBS criteria influenced prevalence rates, but all versions showed associations with deleterious health impact.

FBDs are common globally with minor differences across regions and countries and with prominent effects on health and daily life. Relatively minor diagnostic criteria changes can affect IBS prevalence rates substantially, but the negative health impact remains.