Even though medical knowledge is becoming more and more internationally homogenized in the age of world-wide online journal access and ever-increasing international collaborations in training and research, there are still major differences between countries in how particular health problems are typically treated. Apart from such obvious factors as varying availability of certain medications and unequal healthcare resources and healthcare access, more subtle factors like cultural differences in the outlook on a problem or health-care seeking habits may influence treatment patterns.
Very little is known about how IBS treatment varies across countries, because cross-cultural studies that use the same questionnaires and methods to directly compare healthcare practices in multiple countries have been lacking. Yesterday, however, Dr. Motoyori Kanazawa from the Tohoku University Graduate School of Medicine in Sendai, Japan, presented the results of such a study at DDW. The study was conducted in collaboration with our team at UNC-Chapel Hill. Kanasawa and his colleagues in Sendai surveyed 376 adult IBS patients in Japan within two weeks after their doctor visit for IBS in primary care and GI clinics, using a set of detailed questionnaires to ask about the medical care the patients received and their experiences with the healthcare visit. They compared those responses to answers from 1762 adult U.S. IBS patients in a large HMO in the Seattle area who had completed the same questionnaire set in a previous study (I was one of the investigators in that U.S. survey). This provided a unique opportunity for direct comparison of the typical medical care provided for IBS in the countries, especially since the average IBS symptom severity of the patients in the two samples was the same.
The results were interesting and thought-provoking. In the U.S., recommendations for diet adjustment were by far the most common interventions for IBS (recommended by doctors to 63.8% of the patients), but this was much less common in Japan (27.7%). In contrast, the most common of all types of treatment for IBS in Japan were motility agents, which are drugs specifically designed to influence the movement of the muscles of the intestines. Those medications were not even available for prescription by the U.S. doctors in the HMO studied, and therefore obviously not used with the U.S. patients.
Other significant treatment differences found in the study were that Japanese patients received anti-diarrheal medications twice as commonly as the U.S. patients, while U.S. patients conversely received laxatives more often than in their Japanese counterparts. Medication to treat anxiety was prescribed much more often for Japanese than for U.S. patients, and especially for women (more than a third of female IBS patients in Japan were given medication for anxiety). IBS patients in the U.S. were more likely than Japanese patients to be advised to exercise.
There were also a number of close similarities in treatment patterns between the countries. In both countries, one-third of all the patients were treated with antispasmodic medications; about 2 out of every 5 patients in both countries were advised to reduce life stress; and anti-depressant drugs were used to treat 13% of patients in each country.
Apart from treatments, interesting differences also emerged between countries in patient experiences with the doctor encounter. Japanese IBS patients were more likely than U.S. patients to receive education about the nature of IBS (97%, versus only 56% of the U.S. patients) and reassurance (74% versus 48%). Japanese patients reported greater confidence in their doctor’s treatment recommendations (88% vs. 66% on a 0-100% scale) and somewhat greater satisfaction with treatment than the U.S. patients (73% versus 65%).
The reasons for the many differences observed in this study are largely unclear. However, the availability of certain medications in Japan but not in the U.S. obviously affects treatment patterns substantially. Cultural differences that traditionally grant physicians greater respect in Japan may explain greater confidence in doctor recommendations to some degree, although the far greater tendency to explain IBS to patients may also contribute there. And higher obesity rates in the U.S. may make American doctors more likely to recommend exercise and diet adjustment than their Japanese colleagues.
“Medical Care for Irritable Bowel Syndrome (IBS) in Japan Compared to the U.S.” Motoyori Kanazawa1, 2, William E. Whitehead2, Olafur S. Palsson2, Marsha J. Turner2, Masae Shinozaki1, Yusuke Okuyama3, Shin Fukudo1 1Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; 2UNC Center for Functional GI and Motility Disorders, Chapel Hill, NC; 3Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
Presented Saturday, May 19 Digestive Disease Week, San Diego.