Cultural Factors Influencing Functional Gastrointestinal Disorders in the East

Abstract

Culture forms an integral aspect of environmental factors which influences disease presentation and clinical outcomes in functionalgastrointestinal disorders (FGIDs). In this review, the role of culture in FGIDs in the East is briefly explored with regards to symptompresentation and diagnostic issues, lifestyle and cultural habits, epidemiology, and healthcare seeking behavior. In both functionaldyspepsia and irritable bowel syndrome, symptom presentation and disease sub-typing in Asians are known to differ from their Western counterparts, possibly relating to cultural dietary practices and from cultural perception of symptoms. Dietary patterns, together with defecating practices are explored as factors contributing to a lower prevalence of constipation in the East. An urban-rural difference in the prevalence of FGIDs in Asia is attributed to a change in dietary patterns in rapidly developing urban communities, together with an increased level of psychological morbidity. Lastly, cultural attitudes towards traditional/local remedies, variation in healthcare systems, anxiety regarding organic disease, and religious practices have been shown to influence healthcare seeking behavior among FGID patients in the East.

Keywords: Asia; Culture; Dyspepsia; Epidemiology; Irritable bowel syndrome.

Figure 1

Fiber intake and intestinal transit: East vs West. Adapted from Rahman et al.

Figure 2

Anxiety (A) and quality of life (B) in Asian functional dyspepsia (FD): rural vs urban. EQ-5D, EuroQol 5 dimensions. Adapted from Mahadeva et al.,

Figure 3

Medical consultation for functional dyspepsia: rural vs urban. Adapted from Mahadeva et al.