Anxiety‐related factors associated with symptom severity in irritable bowel syndrome

Abstract

Background Gastrointestinal symptom‐specific anxiety and somatization have both been associated with higher symptom severity in patients with irritable bowel syndrome (IBS); however, this relationship has not been explored fully. Moreover, the performance of the visceral sensitivity index (VSI) for measuring gastrointestinal symptom‐specific anxiety has not been examined in a UK population. We conducted a cross‐sectional survey to examine these issues. Methods Gastrointestinal symptom‐specific anxiety was measured using the VSI, and somatization was measured via the patient health questionnaire‐12 (PHQ‐12) in adults from the UK community with Rome IV‐defined IBS. Exploratory factor analysis was performed on the VSI, prior to subsequent analyses, to establish its factor structure. Multiple regression analysis was used to determine the relationship between demographic features, different factors of the VSI, somatization, and IBS symptom severity. Key Results A total of 811 individuals with IBS provided complete data. Factor analysis of the VSI revealed a three‐factor structure, accounting for 47% of the variance. The first of these VSI factors and the PHQ‐12 were both strongly and independently associated with IBS symptom severity, for the group as a whole and for all four IBS subtypes. Most VSI items concerned with overt gastrointestinal symptom‐specific anxiety loaded onto the other two VSI factors that were not associated with symptom severity. Conclusions and Inferences The factor structure of the VSI requires further investigation. Our findings cast doubt on the central role of gastrointestinal symptom‐specific anxiety as a driver for symptom severity in IBS. Awareness of both gastrointestinal and extra‐intestinal symptoms, however, is strongly associated with symptom severity.

Longitudinal follow‐up of a novel classification system for irritable bowel syndrome: natural history and prognostic value

“…This was a 12‐month follow‐up study of individuals who self‐identified as having IBS registered with three organisations in the United Kingdom and who agreed to participate in a previous study published elsewhere 19,23,24 . These were the IBS network, the registered charity for people living with the condition, TalkHealth, an online social health community providing information about various medical conditions, and ContactMe‐IBS, a dedicated register allowing individuals with IBS not receiving specialist care currently to participate in research.…”

“…19 published elsewhere. 19,23,24 These were the IBS network, the registered charity for people living with the condition, TalkHealth, an online social health community providing information about various medical conditions, and ContactMe-IBS, a dedicated register allowing individuals with IBS not receiving specialist care currently to participate in research. Briefly, we contacted participants via email and post, inviting them to complete an online questionnaire.…”

British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

“…33 Altered activation of brain regions responsible for cognitive processing and emotional and autonomic responses to visceral and somatic stimuli are seen in IBS, consistent with visceral hypersensitivity, hypervigilance and symptom-related anxiety. 34 Some patients with IBS have compromised central inhibitory regulation of visceral and somatic stimuli. 35 Modulating activity of the brain regions responsible for visceral pain using various therapies has been shown to improve IBS symptomatology.…”

Identifying a biological signature of prenatal maternal stress

“…Notably, stress is implicated in the pathogenesis of IBS, with its trademark symptoms, including intestinal sensitivity, motility and permeability as well as mucosal immune activation each shown to be exacerbated in the presence of psychological stresses (25). It is also well established that rates of psychiatric disorders, particularly anxiety and depression, are elevated among patients with IBS (26,27).…”