title: Irritable bowel syndrome: an international study of symptoms in eight countries.
abstract: OBJECTIVE
  This report is a preliminary comparative study of irritable bowel syndrome symptoms in eight countries, USA, Mexico, Canada, England, Italy, Israel, India, and China. We also assessed global symptom patterns and correlations and relationships to several psychosocial variables.
  
  
  METHODS
  Two hundred and thirty-nine participants completed a bowel symptom scale composed of four symptoms, abdominal pain or discomfort, bloating, diarrhea, and constipation as well as two psychosocial questionnaires, quality of relationship and attribution of symptoms to physical or emotional factors.
  
  
  RESULTS
  Pain score in Italy, with the least urban population, was significantly higher than six of the seven other countries whereas it was lowest in India and England. Bloating was highest in Italy and constipation was highest in Mexico, both significantly higher than five other countries. Diarrhea was higher in China than five other countries. All significance values were P<0.05. Globally, diarrhea was less common than constipation, P<0.001 and bloating significantly correlated with constipation as well with pain, P<0.05. Composite analysis of psychosocial variables and symptoms indicated that family conflict correlated directly, P<0.05, whereas family support correlated indirectly, P<0.01, with pain and bloating. Pain, bloating and diarrhea were significantly attributed to physical etiology, P<0.01, whereas only diarrhea was attributed to emotional cause, P<0.05.
  
  
  CONCLUSIONS
  This study suggests that there are significant variations in irritable bowel syndrome symptoms in different geographic locations around the world. Various hypotheses that may explain our data such as cultural beliefs, gut contamination, urban and rural location, dietary practice, and psychosocial factors should be further investigated.
authors.affiliation: Division of Gastroenterology, Mt. Sinai School of Medicine, New York University, New York, USA. cgerson@yahoo.com
authors.forename: Charles D
authors.initials: CD
authors.lastname: Gerson
authors.forename: Mary-Joan
authors.initials: MJ
authors.lastname: Gerson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Awad
authors.forename: Abhijit
authors.initials: A
authors.lastname: Chowdhury
authors.forename: Christine
authors.initials: C
authors.lastname: Dancey
authors.forename: Pierre
authors.initials: P
authors.lastname: Poitras
authors.forename: Piero
authors.initials: P
authors.lastname: Porcelli
authors.forename: Ami
authors.initials: A
authors.lastname: Sperber
authors.forename: Wei-An
authors.initials: WA
authors.lastname: Wang
mesh_terms: D015746:Abdominal Pain / Q000208:ethnology / Q000209:etiology / Q000523:psychology; D000328:Adult; D001294:Attitude to Health; D003248:Constipation / Q000208:ethnology / Q000209:etiology / Q000523:psychology; D003431:Cross-Cultural Comparison; D003967:Diarrhea / Q000208:ethnology / Q000209:etiology / Q000523:psychology; D004522:Educational Status; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000208:ethnology* / Q000209:etiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D011603:Psychophysiology; D012423:Rural Health / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data