Understanding Cultural Differences and Attitudes toward GI Disorders

Gastrointestinal (GI) disorders—diseases that affect the organs of the digestive tract—are quite common in the U.S. However, research has pointed to the prevalence of GI disorders among individuals of certain ethnicities. In this article, we will touch upon a few such disorders and understand how genetics, diet, and culture can influence who develops the disease.

Categories of GI Disorders

There are two broad categories of GI disorders: Structural and Functional. 

Functional GI disorders

Functional GI disorders are a result of the GI tract not moving efficiently. In functional disorders, the GI tract may appear normal on imaging but does not ‘function’ normally. They may result in:

  • Constipation
  • Nausea
  • Gas
  • Abdominal pain
  • Food poisoning
  • Bloating
  • Diarrhea
  • Irritable Bowel Syndrome (IBS)
  • Gastroesophageal Reflux Disease (GERD)
  • Celiac disease

A host of factors can affect how your GI tract functions, including but not limited to:

  • Low fiber diet
  • High amount of dairy in the diet
  • Not drinking enough water
  • Lack of exercise
  • Changes in your routine or some other form of stress
  • Resisting bowel movement, maybe due to hemorrhoids
  • Overuse of antidiarrheals and certain other medications
  • Pregnancy
  • Genetics/your family’s GI health
  • Autoimmune disorders

Structural GI Disorders

Structural GI disorders result from a bowel that may not look normal on examination and consequently doesn’t function well. These may result in:

  • Constipation
  • Hemorrhoids
  • Diverticulitis
  • Colon polyps or cancer
  • Inflammatory Bowel Disease (IBD): this includes Crohn’s disease, ulcerative colitis, and indeterminate colitis
  • Infection
  • Fistulae – abnormal connections between GI tract to other parts of the anatomy
Click the image to tell us about your GI disorder.

Genes and GI Disorders

If you are aware of your family’s health history and the presence of GI conditions among close relatives, then you can preemptively make lifestyle and dietary choices to lower your risk or manage your condition better. You could also undergo screening tests—if available and after speaking to your doctor—to understand your risk of developing specific GI diseases. The following conditions may develop because you are genetically predisposed, or susceptible:

  • Inflammatory Bowel Disease (IBD)
  • Celiac disease
  • Lynch syndrome: This condition can increase your chances of developing cancers of the small intestine, large intestine (colon), stomach, liver, gall bladder, brain, and skin. Women with Lynch syndrome may be at higher risk of developing ovarian or uterine cancer. 
  • Familial adenomatous polyposis: Higher risk of developing colon polyps at a younger age, with a risk of young-onset cancer
  • Juvenile polyposis syndrome: Non-cancerous polyps develop by age 20. Patients are at an increased risk of digestive tract cancers. 

One can argue that genetics and culture group together similarly, and influence each other. Cultural influences have been shown to play a vital role on how GI disorders are viewed, managed, and treated. For example, IBS patients across the globe report symptoms that vary based on their geographic location: Italians reported the highest abdominal pain while Indians reported the lowest pain; Italians also reported highest bloating; Mexicans reported highest constipation; Chinese reported the highest diarrhea. Obviously, dietary differences (arguably cultural) can influence organ function.

Cultural Differences in GI Disorder Experience

A study of IBS prevalence among Hispanic and non-Hispanic white populations in Texas found that Hispanics populations self-medicate more to relieve bowel issues and often had a poorer understanding of their overall health situation. The researchers believed that this could influence their healthcare behavior and their perception of bowel function, in turn affecting GI function.  

“Celiac disease is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications.” – Celiac.org

Researchers at the Celiac Disease Center at Columbia University did a cross-sectional study on patients in the U.S. who were sorted based on their ethnicity into North/South Indian, East Asian, Hispanic, Middle Eastern, Jewish, and other Americans. Biopsy samples collected from these patients were analyzed for the presence of villous atrophy—a condition where the tentacle-like structures along the wall of our small intestine are eroded. Among all the ethnicities that populated their database, the researchers found the highest prevalence of this condition among persons from the Punjab region of India. It’s interesting that historically, wheat-based bread is a staple for the residents of Punjab (Northwestern India), whereas rice is a staple for those living in South India.

Stigma and Mental Health

GI disorders can be extremely stressful as they can restrict a person’s diet, cause severe symptoms, influence their ability to work or interact with others, and affect overall well being. IBD, for example, was found to be the most stigmatized of seven diseases that included HIV and genital herpes, although overall knowledge about the condition seems to be low. 

Support from family members and friends is of utmost importance, as are patient-friendly resources that can provide guidance and help you manage your condition. Below are a few good resources:

Feature image: Tionna F is a patient living with Crohn’s disease and an ostomy and is a cherished member of the #PatientsRisingFam. She graciously gave us permission to use this image as part of our #REALPatientImage project.

Surabhi Dangi-Garimella, Ph.D.

Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.

This article is part of our ongoing project to better understand how Inflammatory Bowel Disease experiences are different in People of Color. We are conducting a survey with several partners from the IBD community including

The project is funded with kind support from Takeda and Janssen.

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