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. Aim: 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.