title: Prevalence, symptom patterns and management of episodic diarrhoea in the community: a population-based survey in 11 countries.
abstract: BACKGROUND
  The extent of episodic diarrhoea in the community is relatively unknown.
  
  
  OBJECTIVE
  To ascertain the prevalence, symptoms and management behaviours associated with self-reported diarrhoea across 11 countries.
  
  
  METHODS
  Community screening surveys were conducted using quota sampling of respondents to identify a nationally representative sample of individuals suffering from 'episodic' diarrhoea (occurring once a month or more often). Second-phase in-depth surveys provided data on epidemiology, symptoms, attributed causes and management of episodic diarrhoea.
  
  
  RESULTS
  A total of 11 508 phase 1 and 6613 phase 2 surveys were completed. The prevalence of self-reported episodic diarrhoea ranged from 16% to 23% across the 11 countries. The majority of episodic diarrhoea sufferers were female (57%) and were not diagnosed with pre-existing irritable bowel syndrome (IBS); IBS diagnosis ranged from 9% in Mexico to 44% in Italy. Diarrhoea was frequently attributed to anxiety/stress, food-related causes, gastrointestinal 'sensitivity' and menstruation. Accompanying symptoms included 'stomach pain/cramping' (35-62%), 'stomach grumbling' (29-68%) and 'wind' (18-74%). The proportion of episodic sufferers who reported treating their symptoms with remedies or medications ranged between 46% in Belgium and Canada and 90% in Mexico.
  
  
  CONCLUSIONS
  A substantial proportion of the population in middle- to high-income countries report episodic diarrhoea in the absence of a pre-existing diagnosis. These symptoms are likely to be associated with substantial social and economic costs, and have implications on how best to configure and guide self-led, pharmacist-led and primary care management.
authors.affiliation: School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Stockton-on-Tees, UK.
authors.forename: A P S
authors.initials: AP
authors.lastname: Hungin
authors.affiliation: Incite, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Paxman
authors.affiliation: Johnson & Johnson Ltd, Maidenhead, UK.
authors.forename: K
authors.initials: K
authors.lastname: Koenig
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dalrymple
authors.affiliation: Right Medicine Pharmacy Ltd., Stirling, Scotland.
authors.forename: N
authors.initials: N
authors.lastname: Wicks
authors.affiliation: Johnson & Johnson Ltd, Maidenhead, UK.
authors.forename: J
authors.initials: J
authors.lastname: Walmsley
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult