Introduction
Abdominal pain is a common symptom in clinical settings, but its prevalence and impact on individuals in the global population are poorly understood.
Aims & Methods
We aimed to use the population-based Rome Foundation Global Epidemiology Study (RFGES)1 dataset to assess the prevalence and burden of abdominal pain in the global population. Data from all 54127 individuals in 26 countries covering 6 world regions (Asia, Middle East, Eastern Europe, Western Europe, North America, and Latin America) surveyed via the Internet (49.1% females; mean age 43.7 years, range 18-97) were included in the analyses. The survey included the Rome IV diagnostic questionnaire, the PROMIS Global-10 quality of life (QoL) questionnaire, the Patient Health Questionnaire PHQ-4 (anxiety and depression), and questions about medical history and healthcare utilization. Survey respondents who reported pain anywhere in the abdomen in the past 3 months were classified as abdominal pain cases, and all others as controls.
Results
Abdominal pain was reported by 51.9% (95% CI: 51.4, 52.3) of people in the global sample. The prevalence was higher among women than men [59.6% (59.0, 60.1) vs. 44.4% (43.8, 45.0)], and declined across age groups: 60.5% (59.8, 61.2) for ages 18 to 34, 54.6% (53.8, 55.4) for ages 35 to 49 years, 45.5% (44.6, 46.4) for 50-64 years, and 37.7% (36.7, 38.7) for 65+ years. Abdominal pain prevalence varied markedly between world regions, from a low of 41.2% (40.2, 42.2) in Asia to a high of 66.5% (65.3, 67.7) in Eastern Europe. Among the 26 individual countries, it ranged from 32.1% (30.2, 33.9) in Japan to 69.3% (67.2, 71.3) in Egypt.
Individuals with abdominal pain were twice as likely as controls to meet criteria for one or more of the 22 disorders of brain-gut interaction (DGBI) assessed [54.2% (53.6, 54.8) vs. 25.0% (24.5, 25.5)] and more than twice as likely to report a history of organic gastrointestinal disorders: [9.8% (9.4, 10.1) vs. 4.2% (3.9, 4.4)]; p<0.0001 for both. However, 38.9% of people with abdominal pain neither met DGBI criteria nor had organic GI disease history.
People with abdominal pain had significantly lower physical and mental quality of life scores than controls, showed more impairment in work productivity and life activities, were more likely to have ever visited a doctor because of a bowel problem, and more likely to visit doctors frequently (at least monthly) for any health reasons. They also more commonly reported being concerned about their bowel functioning. For details see Table 1.
Conclusion
Abdominal pain affects half the adult global population, including many people who have no GI disorders. It is more common in women, younger individuals, and people in non-Asian countries. Having abdominal pain is associated with poorer quality of life, impaired work and life functioning, increased psychological symptoms and greater healthcare utilization. These findings underscore that abdominal pain, as a symptom rather than only as a part of diagnosed disorders, warrants attention by healthcare services and researchers to better address unmet needs of sufferers.
Table 1. Quality of life, life functioning, psychological symptoms and healthcare utilization among people with versus without pain anywhere in the abdomen (all LSmean differences p<0.0001).
|
Characteristic
| Abdominal pain
(n=28065)
| No abdominal pain
(n=26062)
| Effect size
(Cohen’s d or h) |
Physical QoL score (PROMIS Global-10); LSmean, SE
| 13.7 (0.02)
| 15.3 (0.02)
| d=0.64
|
Mental QoL score (PROMIS Global-10); LSmean, SE
| 12.8 (0.02)
| 14.3 (0.02)
| d=0.46
|
Anxiety score (PHQ-4); LSmean, SE
| 1.8 (0.01)
| 0.9 (0.01)
| d=0.60
|
Depression score (PHQ-4); LSmean, SE
| 1.8 (0.01)
| 0.9 (0.01)
| d=0.57 |
Moderately or greatly concerned about their bowel functioning; % (95% CI)
| 62.3% (61.7, 62.9)
| 28.8% (28.3, 29.4)
| h=0.69 |
Have ever consulted a doctor about a GI problem; % (95% CI)
| 47.1% (46.5, 47.7)
| 21.8% (21.3, 22.3)
| h=0.54
|
Work productivity impairment (WPAI); LSmean, SE
| 14.0 (0.26)
| 5.8 (0.27)
| d=0.46
|
Non-work life activity impairment (WPAI); LSmean, SE
| 21.6 (0.26)
| 10.4 (0.26)
| d=0.47
|
References
1. Sperber et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021 Jan;160(1):99-114.e3. doi: 10.1053/j.gastro.2020.04.014.
Disclosure
BBDF, CA and RL are currently employees of Opella, a Sanofi company and may hold shares or stock options in the company. OSP receives licensing fees from MetaMe Health. MS has received unrestricted research grants from BioGaia; served as consultant/advisory board member for Biocodex, Tillotts, BioGaia, Renapharma, and AlfaSigma; and served on speakers' bureau for Tillotts, Takeda, Biocodex, Sanofi, Abbvie, Janssen Immunology, Pfizer, BioGaia, Renapharma, Mayoly and Bromatech. JT has given scientific advice to Aclipse, Adare, AlfaSigma, Bio-Codex, Clasado, Danone, Falk, FitForMe, Ironwood, Kyowa Kirin, Menarini, Promed, Ricordati, Takeda, Tsumura and Truvion Pharmaceuticals; received research support from Biohit, Kiowa Kirin, ProMed, Sofar, Takeda and Tsumura; and served on the speaker bureau for Abbott, Bio-Codex, Mayoly, Menarini, ProMed, Reckitt-Benckiser, Schwabe, Takeda, Thai Meiji and Truvion Pharmaceuticals. JH, DAD, ADS and SIB have no conflicts of interest to declare.
