Prevalence of abdominal and pelvic surgeries in patients with irritable bowel syndrome: comparison between Caucasian and African Americans

Abstract

Background: Although controversial, studies suggest that irritable bowel syndrome (IBS) is associated with an increased risk of abdominal and pelvic surgeries. However, the role of race in this interaction has not been defined. We studied the prevalence of appendectomy, cholecystectomy, and hysterectomy among African American patients with IBS among the population at large and compared it with the Caucasians residing in same area.

Methods: A total of 990 adults from 9 different sites in the Jackson, Mississippi, metropolitan area (670 African Americans and 320 Caucasians), completed self-administered questionnaires providing sociodemographic information and details regarding bowel habits and associated symptoms for diagnosing the IBS, based on ROME II criteria. We recorded the patient's name, age, sex, race, history of smoking, and history of surgeries. Subjects with a history of IBD and gastrointestinal cancer were excluded. The prevalence of appendectomy and hysterectomy was compared between IBS patients and non-IBS control subjects.

Results: One thousand ninety-nine, or 84%, of those distributed were returned. On checking the exclusion and inclusion criteria, we eliminated 109 subjects. The reasons for elimination of 109 subjects included incomplete questionnaires and incorrect marking of questionnaires that resulted in invalid data. Overall, there was significantly higher prevalence of appendectomy (15.3% vs 5.1%) and cholecystectomy (6.6% vs 3.4%) but not hysterectomy (21.1% vs 17.6%; P = NS) among Caucasian Americans as compared with African Americans. The prevalence of appendectomy among IBS patients (n = 95) versus non-IBS subjects (n = 895) was not statistically significant (10.5% vs 8.2%; OR, 1.3; 95% CI, 0.7 to 2.7; P = 0.43). The prevalence of cholecystectomy in the 2 groups was also similar (5.3% vs 4.4%). Likewise, there was no statistically significant difference for the prevalence of hysterectomy among females IBS patients versus non-IBS females (23.3% vs 18.2%; OR, 1.4; 95% CI, 0.8 to 2.4; P = 0.29). Comparing the prevalence of these surgeries in with IBS patients (African Americans versus Caucasian Americans), we found significant difference in the prevalence of appendectomy to be 1.9% vs 21.4% (P < 0.01). In contrast, there was no difference in the prevalence of cholecystectomy or hysterectomy. Logistical regression suggested that race but not IBS was a significant factor in the prevalence of various surgeries.

Conclusions: Based on responses to ROME II criteria questionnaire administered to community at large, IBS is not associated with greater prevalence of abdominal and pelvic surgeries. Caucasians are more likely to have these surgeries irrespective of whether they have IBS or not. Our study does not exclude the possibility that there may indeed be association between IBS and surgeries if only the IBS patients seeking health care are considered.