What is the effect of race on Irritable Bowel Syndrome (IBS)?

From the Guidelines

Race has a complex and multifaceted influence on the prevalence and presentation of Irritable Bowel Syndrome (IBS), with White individuals tend to have higher reported rates of IBS compared to other racial groups, particularly in Western countries 1.

Key Findings

• Research suggests that the relationship between race and IBS is influenced by a combination of genetic factors, cultural differences in symptom reporting, dietary patterns, stress levels, and socioeconomic factors that affect healthcare access 1.
• Some studies indicate that Asian populations may experience different symptom patterns, with less abdominal pain but more upper gastrointestinal symptoms, while Black and Hispanic individuals in the US appear to have lower diagnosed rates of IBS 1.
• However, these differences may reflect healthcare inequities rather than actual prevalence differences, highlighting the need for healthcare providers to consider these nuances when diagnosing and treating IBS across diverse populations 1.

Clinical Implications

• It is essential for healthcare providers to be aware of the potential impact of race on IBS prevalence and presentation, and to consider the complex interplay of factors that contribute to these differences 1.
• By taking a comprehensive and culturally sensitive approach to diagnosis and treatment, healthcare providers can help ensure equitable care for patients with IBS from diverse racial backgrounds 1.
• Healthcare providers should prioritize a patient-centered approach, explaining the mechanisms of action, potential side effects, and rationale for treatment choices, and involving patients in the decision-making process to improve patient understanding and acceptance of a diagnosis of IBS 1.

From the Research

Racial Differences in Irritable Bowel Syndrome (IBS)

• The prevalence of IBS alone, un-investigated dyspepsia (UD) alone, and "overlap syndrome" (OS) varies among African Americans and Caucasian Americans, with OS being 2.5 times more likely to occur among Caucasians compared to African Americans 2.
• A study found that among African Americans, UD patients were younger and more likely to have children compared to OS patients, while marital status, education, and household income were not a factor among Caucasians 2.
• The impact of IBS on health-related quality of life (HRQOL) is similar between non-white and white IBS patients, with non-white IBS patients reporting similar decrements in HRQOL compared to white IBS patients after controlling for age, gender, income, and education level 3.
• Non-white IBS patients experience impairment in vitality, role limitations-physical, and bodily pain, and have significantly worse HRQOL compared to the general US population and patients with selected chronic diseases such as GERD, diabetes mellitus, and ESRD 3.

Cultural and Socioeconomic Factors

• IBS may be subject to cultural variables that differ in different parts of the globe, with local belief systems, psychological pressures, and acceptance or resistance to a mind-body paradigm affecting the illness experience of patients 4.
• Symptom patterns may differ significantly between different geographic locations, highlighting the importance of "cultural competence" on the part of healthcare professionals in caring for patients of diverse cultural backgrounds 4.
• Racial disparities in the care of patients with IBS, including potential referral biases and differing patterns of healthcare utilization, can impact clinical outcomes and highlight the need for a unified approach to addressing these disparities 5.

Diagnostic Criteria and Symptom Clusters

• The Manning criteria for diagnosing IBS have equal applicability to both genders and to African-Americans as well as to Caucasians, with three core symptoms (loose stools and more frequent bowel movement with onset of pain, pain relieved by defecation) forming a cluster corresponding to IBS in all subgroups 6.
• Factor analysis has identified symptom clusters that are consistent across subgroups, with three of the six Manning symptoms rarely correlating with the others and potentially not being useful for making a diagnosis of IBS 6.