Lower Gastrointestinal Tract Functional Disorders: Prevalence and Symptoms Characteristics in Outpatient Gastroenterology Clinic

Research Article

Austin J Gastroenterol. 2015;2(4): 1047.

Lower Gastrointestinal Tract Functional Disorders: Prevalence and Symptoms Characteristics in Outpatient Gastroenterology Clinic

Mahamane Sani LA¹*, Liu Jinsong¹ and Mahaman Yacoubou AR²

¹Department of Gastroenterology, Huazhong University of Science and Technology, China

²Department of Pathology and Pathophysiology, Huazhong University of Science and Technology, China

*Corresponding author: Mahamane Sani LA, Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST) Wuhan/China, 13 Hang Kong Road, Wuhan, Hubei, P.R. China

Received: March 24, 2015; Accepted: April 23, 2015; Published: April 30, 2015


Background: Worldwide digestive diseases are common in population. Functional Gastrointestinal Disorders (FGIDs) consist of a collection of chronic or recurrent symptoms attributed to the gastrointestinal tract that can range from esophagus to rectum and cannot be explained by structural or biochemical abnormalities. FGIDs are defined essentially by symptoms association and almost few limited tests are required to provide their diagnosis.

Objectives: The principal objective of this study was to evaluate the prevalence of FGIDs (Functional Abdominal Pain and Functional Bowel Disorders) and to investigate the possible associations between age, sex, psychological factors, drugs intake and FGIDs.

Method: Through a cross sectional study, a total of 1002 symptomatic patients without previous diagnosis of disease in who after consulting in outpatient clinic were prescribed colonoscopy completed a validated questionnaire. FGIDs were diagnosed according to Rome III diagnostic criteria.

Results: The mean age was 43.72 years, 55% (552) of subjects were males and 45% (450) females. The prevalence of overall Functional GI disorders was 55.7% and that by specific FGID was as follows: IBS 24.95%, functional constipation 22.75 %, functional diarrhoea 21.05 %, functional bloating 28.94%, unspecified functional bowel disorder 11.87% and functional abdominal pain 24.75%. Around 10% of subjects are “unclassified patients”. The overlapping syndrome among FGIDs (multiple FGIDs) is high and represents 72.04% with patients having 2 coexisting FGID 29.39%, 3 coexisting FGID 25.04% and more than 3 coexisting FGID 17.56%. Subjects having history of psychological event and drugs intake represent 51.5% and 16.37% respectively.

Conclusion: FGIDs were common in this study, as do their overlapping what deserve greater attention. There is influence of age, gender, psychological factors and drugs intake on FGIDs occurrence and symptoms modulations.

Keywords: Prevalence; LGITFDs; Colonoscopy; Rome III criteria; Psychological factors, Drugs intake


FB: Functional Bloating; FD: Functional Diarrhea; FC: Functional Constipation; FUBD: Functional Unspecified Bowel Disorder; FAP: Functional Abdominal Pain; FBD/FBDs: Functional Bowel Disorder/ Functional Bowel Disorders; FGID/FGIDs: Functional Gastrointestinal Disorder/ Functional Gastrointestinal Disorders; IBS: Irritable Bowel Syndrome; GI: Gastrointestinal; LGIT: Lower Gastrointestinal Tract; LGITFDs: Lower Gastrointestinal Tract Functional Disorders


Worldwide digestive diseases are common in population. Digestion is a complex process from mouth to anus, combining anatomic, mechanical, hormonal, enzymatic, neurologic factors. Although multiple factors affect the food behaviour: ethnicity, geography, environment, race, but the most important are availability, hygiene and quality of food in order to obtain a well balanced diet. Digestive disorders can range from mild to severe and from acute to chronic. They can be accompanied with pain or not in one hand and benign or malignant in the other hand.

Functional Gastrointestinal Disorders (FGIDs) consist of a collection of chronic or recurrent symptoms attributed to the gastrointestinal tract that can range from oesophagus to rectum and cannot be explained by structural or biochemical abnormalities [1]. These symptoms develop from abnormalities in gastrointestinal functionality which could be motility, increased nerve sensitivity of the intestinal tract or dysregulation of the brain-gut nerve pathways. Symptoms produced can be any combination of: nausea, vomiting, heartburn chest, abdominal or rectal pain or discomfort, diarrhoea, or constipation. When these GI symptoms persist for a certain period of time (3 months, 6 months, 1 year) according to specific diagnostic criteria of a functional GI disorder (Manning, Kruis, or Rome I, II, III) and in the absence of alarming symptoms and organic lesions, they are diagnosed as a FGID. FGIDs are defined essentially by symptoms association and almost few limited tests are required to provide their diagnosis. Functional disorders had existed long ago in the populations, but not diagnosed at that time because of lack of sensitive means of diagnostic evaluations. The increasing progress in medical science especially in Imagery (CT, Ultrasound, Endoscopy, MRI, ERCP, etc.) and Histochemestry with development of biological markers for tumour detection as well as in Pathology, Biology, and Biochemistry have improved and increased the diagnosis in Gastroenterology’s domain. So, after exhaustion of all means of diagnostic without any obvious evidence of disease or lesion with the persistence of patient’s symptoms we could consequently sustain the diagnosis of FGID in contrast to organic disease. It is of great importance to precise that nowadays FGIDs are recognized as independent entities in gastroenterology clinic, so the classical opposition of functional to organic is misleading as it is limiting the understanding of this vast domain.

The GI functional disorders are gaining magnitude due to drastic changes of living conditions and diet habits (alimentary industry, large pesticides using, expansion of GMOs food in the base diet). The link between food intake and symptom induction is recognized [2]. Also, hygiene of life is decreasing in population because of inactivity, obesity, tobacco, alcohol, flavourings and industrial colorant abuse, over-the-counter drugs abuse. This phenomenon plays an important role in digestive health deterioration.

Otherwise, the current development in gastroenterology science accompanied with more availability of gastroenterologists, new tools and techniques for gastrointestinal disease diagnosis should also be considered in the increased rate of FGID since it allows more investigative studies and improves diagnostic accuracy [3].

Additionally, FGIDs are gaining interest worldwide and this through the increase of related scientific publications, and the sensitization by media and internet [4].

FGIDs are highly prevalent disorders; indeed, up to 35% of the world population suffers from FGIDs accounting for about 40% of gastroenterology consultations and 12% of primary care practice [5]. However, FGIDs vary depending on the type of symptom and for the most common the median prevalence was 11% for IBS, 13.4 % for FD, above 15% for constipation worldwide [6], but also according to countries, geographic locations, sociocultural and sociodemographic features. For instance, prevalence rates were 55.24 % in china [7], 61.7% in Canada [8], 33% in Australia [9].

Although several epidemiologic studies have been conducted around the world, of note is the large disparities in the prevalence and incidence of FGIDs. More, epidemiologic knowledge is paramount and mandatory before leading off any disease diagnosis in clinical practice. Based on this observation, in this study we will address two (2) major categories among the FGIDs according to Rome III classification: Functional Bowel Disorders (FBDs) and Functional Abdominal Pain (FAP).


Type of study

It is a cross-sectional prospective study about 1002 observations using a self administered questionnaire and colonoscopy findings record during a period of 4 months in the Endoscopic Centre 1 of Union Hospital in Wuhan/China.

Inclusion criteria: patient undergoing colonoscopy in Endoscopic Centre 1 without any organic diseases diagnosis, willing to participate voluntarily.

Exclusion criteria were:

1. Normal colonoscopy findings that do not fulfill Rome III criteria (=“unclassified patients”)

2. Having an organic or structural disease diagnostic

3. Colonoscopy incomplete examination


Randomly selected 1027 patients of all ages and sex who were admitted for colonoscopy at the endoscopic center 1 of outpatient gastroenterology clinic in Union Hospital, a university hospital of Huazhong University of Science and Technology (Wuhan) from July to October 2014 were recruited in the study before undergoing their examination. All patients complained of GI symptoms for a certain period of time and all were referred by a gastroenterologist for diagnostic colonoscopy after a consultation. Out of the 1027 respondents we obtain 1002 valid questionnaires for the study. The 25 questionnaires were removed because they did not complete their colonoscopy. FGIDs are defined by the presence of GI symptoms for at least 3 days per month in the last 3 months with symptom onset of at least 6 months before diagnosis. Then coupled a colonoscopic examination, minimal blood testing (CBC, ESR, CRP, fecal occult blood and calprotectin tests, and thyroid function) and presence or not of alarm symptoms in their diagnostic work-up.

All the patients have an educational background that allows them to complete the modified Rome III Chinese questionnaire. After explaining the study scope, a formal consent of patients was obtained before they get enrolled in the study, then patients’ anonymity was preserved. Approval of the ethic committee of Union Hospital was obtained for the present study.


Three (3) different forms of the questionnaire have been tested in a small sample initially until we obtain the validated questionnaire for the study. A questionnaire in Chinese was designed and validated for the present study. The questionnaire includes multiple sets of questions, and 3 of them were designed to assess FGIDs according to the Rome III criteria. The functional disorders identified by the questionnaire included IBS, functional abdominal pain, functional abdominal bloating, functional diarrhea, functional constipation and unspecified functional bowel disorder and a FGID is defined as having FBDs, FAP or both. The others questions included were: demographic information (name, age, and sex), drugs intake history, psychological history, chief complaint, stools form and alarm symptoms.

The patients answered the question by themselves or if necessary with the assistance of a trained doctor or assistant. The completion of the questionnaire took an average of 15 minutes. When questions are misunderstood the interviewer explains and helps to confirm the answer. Patients were also helped with Bristol stools scale large pictures to identify their stools form.Then all respondents colonoscopy findings were recorded in the questionnaire later. Those with individual bowel symptoms unaccompanied by other symptoms that fulfilled the criteria for a syndrome were classified as unspecified functional bowel disorder.


Normal colonoscopy findings is defined when the total colon was checked and no lesions was found. The lesions that defined organic disease are classified as follows: hemorrhoids, polyps, colorectal cancer, colitis, diverticulosis, UC, CD, melanosis coli, ileitis, erythema and erosions, miscellaneous, colon varices, active bleeding, proctitis, and sigmoiditis. Incomplete colonoscopy is defined as a partial examination of colon.

Data analysis

Statistical analyses were carried out using SPSS software version 20.0 (SPSS Inc., Chicago, IL, USA). Continuous variables were presented as mean ± standard deviation, and categorical data were presented as numbers and percentages in descriptive statistics, and 95% as CI. The difference and relationship between variables were evaluated using chi square, correlation and regression tests. A drown P = 0.05 was considered as statistically significant in two-tailed calculation.


The age groups 41-50 is the more representative of the sample and females are slightly older than males. Put together the age class (31- 60) represents 72.35% of the population (Table 1).