Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study, 2020, Sperber et al

[Andy]

Background & Aims: Although functional gastrointestinal disorders (FGIDs), now called disorders of gut–brain interaction, have major economic effects on healthcare systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33 countries on 6 continents.

Methods: Data were collected via the internet in 24 countries, personal interviews in 7 countries, and both in 2 countries, using the Rome IV diagnostic questionnaire, Rome III irritable bowel syndrome questions, and 80 items to identify variables associated with FGIDs. Data collection methods differed for internet and household groups, so data analyses were conducted and reported separately.

Results: Among the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.7% persons who completed the internet surveys (95% CI, 40.2– 41.1) and 20.9% of persons who completed the household surveys. FGIDs were more prevalent among women than men, based on responses to the internet survey (odds ratio, 1.7; 95% CI, 1.6–1.7) and household survey (odds ratio, 1.4; 95% CI, 1.3–1.5). FGIDs were associated with lower quality of life and more frequent doctor visits. Proportions of subjects with irritable bowel syndrome were lower when the Rome IV criteria were used, compared with the Rome III criteria, in the internet survey (4.1% vs 10.1%) and household survey (1.5% vs 3.5%).

Conclusions: In a large-scale multi-national study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and healthcare use. Although the absolute prevalence was higher among internet respondents, similar trends and relative distributions were found in people who completed internet vs personal interviews.

Direct link to pre-print PDF, https://www.gastrojournal.org/article/S0016-5085(20)30487-X/pdf

 

[Arnie Pye]

I wanted to get some idea of the type of questions in the Rome questionnaires but I couldn't find examples of any of the questions, so I'm trying to interpret this paper in a void. The questionnaires themselves are licensed by the Rome Foundation, so they aren't freely available, people using them have to buy a license.

https://theromefoundation.org/questionnaires/

My biggest problem with the paper is the selection of the subjects. I didn't think about it beyond that.

In the paper itself it says on page 14 that they eliminated people from their samples with known diseases like Crohn's Disease or ulcerative colitis or several other conditions. It also says that no independent medical evaluation was done. So how could the researchers know they didn't include subjects in their research with undiagnosed Crohn's, or undiagnosed peptic ulcers, or some other "acceptable" (i.e. not functional) physical problem? How could they know that the investigation the subjects had previously had for their gut/bowel problems was adequate and thorough? Patients with all sorts of bowel/gut problems could have been included in their samples who would get labelled as having a functional disorder when in reality they had never even had the appropriate tests or adequate investigation. The patients who had had little or no investigation of their gut/bowel problems were not excluded from the samples as far as I can tell.

 

[Hutan]

Conclusions: In a large-scale multi-national study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and healthcare use.

Among the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.7% persons who completed the internet surveys (95% CI, 40.2– 41.1) and 20.9% of persons who completed the household surveys.

While 'in a large-scale multi-national study, we found that more than 40% of persons world-wide have FGIDs' is technically true, that sounds an awful lot like '40% of people worldwide have FGIDs'.

Why include that 'world-wide' when you have already explained your study is multi-national, unless you want to somehow suggest that maybe 3 billion people have FGIDs? And that therefore FGID experts are very useful and important?

When surveyed via the Internet, 49% of the entire adult female population across the six continents surveyed met the diagnostic criteria for one or more of the FGIDs

And the same with '49% of the entire adult female population across the six continents surveyed'.

I agree @Arnie Pye. It looks as though someone needs to explain selection bias to these researchers.

In countries where most adults use the Internet, a secured online survey (accessible only to pre-selected invited participants) was conducted using population samples provided by a professional company (Qualtrics, LLC., Provo, Utah, USA) who awarded participant points redeemable for gifts.

Who are the people sitting around, available to sell their data for a twentieth of a $20 gift voucher? It's probably not going to be very healthy people who earn a really good salary. I know I never even thought about doing a paid survey until I got ME/CFS. I didn't see that issue mentioned in that report as even a small problem. To the contrary, the authors sounded very excited about how wonderful using the Qualtrics service had been.

 

[rvallee]

now called disorders of gut–brain interaction

And the evidence for that gut-brain interaction is?

Ah, right, my bad, doesn't need any, it's the default explanation. Talk about setting yourself up for failure.

 

[alktipping]

no scientific investigation can be done through surveys on line or via written media this is of course just more of the same tripe dressed up for the gullible masses to waffle about .

 

[Hutan]

no scientific investigation can be done through surveys on line or via written media

Oh, I don't know about that.

I have conducted my own multi-national online analysis based on the comments in this thread. I have found:

When given the opportunity to comment via the Internet, 100% of the entire adult population in countries spanning the world who commented concluded that the 'Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study' is a load of tosh.