Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data

Donnachie, Ewan; Schneider, Antonius; Enck, Paul

doi:10.1038/s41598-020-66685-4

Cited by 19 publications

(16 citation statements)

References 43 publications

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“…11 Somatisation in IBS is associated with increased frequency and severity of abdominal pain, reduced productivity, increased healthcare utilisation and costs. 59,153 Symptoms of somatic syndromes significantly overlap, 154 and they share multiple similarities with IBS; (1) diagnosed based on experts consensus and symptoms based criteria (2) lack of diseasespecific biochemical markers (3) poor quality of life and reduced productivity (4) high prevalence of psychological comorbidities and mood disorders (5) significant healthcare utilisation. However, the debate remains whether these somatic syndromes represent a single disorder or multiple distinct conditions.…”

Section: Somatisationmentioning

confidence: 99%

Review article: Physical and psychological comorbidities associated with irritable bowel syndrome

Shiha

Aziz

2021

Aliment Pharmacol Ther

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Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders encountered by physicians in primary and secondary care. Patients with IBS commonly present with various extraintestinal complaints, which account for a substantial clinical and economic burden. The common extraintestinal comorbidities associated with IBS include anxiety, depression, somatisation, fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, interstitial cystitis, sexual dysfunction and sleep disturbance. The presence of comorbidity in IBS poses a diagnostic and therapeutic challenge with patients frequently undergoing unnecessary investigations and interventions, including surgery. This review discusses the different physical and psychological comorbidities associated with IBS, the shared pathophysiological mechanisms and potential management strategies.

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Section: Somatisationmentioning

confidence: 99%

Review article: Physical and psychological comorbidities associated with irritable bowel syndrome

Shiha

Aziz

2021

Aliment Pharmacol Ther

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“…The data have been used extensively for health services and medical research. [16][17][18][19][20] They cover all statutorily insured outpatients in the German federal state of Bavaria, which corresponds to approximately 85% of the Bavarian population whereas 15% of patients are privately insured, mostly civil servants and people with an income higher than €56 250 per year (2016). Furthermore, we only included patients aged ≥18 years, as children are mainly coordinated by paediatricians, and patients with residential address in Bavaria.…”

Section: Methodsmentioning

confidence: 99%

Impact of the abolition of copayments on the GP-centred coordination of care in Bavaria, Germany: analysis of routinely collected claims data

et al. 2020

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ObjectivesIn 2012, Germany abolished copayment for consultations in ambulatory care. This study investigated the effect of the abolition on general practitioner (GP)-centred coordination of care. We assessed how the proportion of patients with coordinated specialist care changed over time when copayment to all specialist services were removed. Furthermore, we studied how the number of ambulatory emergency cases and apparent ‘doctor shopping’ changed after the abolition.DesignA retrospective routine data analysis of the Bavarian Association of Statutory Health Insurance Physicians, comparing the years 2011 and 2012 (with copayment), with the period from 2013 to 2016 (without copayment). Therefore, time series analyses covering 24 quarters were performed.SettingPrimary care in Bavaria, Germany.ParticipantsAll statutorily insured patients in Bavaria, aged ≥18 years, with at least one ambulatory specialist contact between 2011 and 2016.Primary and secondary outcome measuresPrimary outcome was the percentage of patients with GP-coordinated care (every regular specialist consultation within a quarter was preceded by a GP referral). Secondary outcomes were the number of ambulatory emergency cases and apparent ‘doctor shopping’.ResultsAfter the abolition, the proportion of coordinated patients decreased from 49.6% (2011) to 15.5% (2016). Overall, younger patients and those living in areas with lower levels of deprivation showed the lowest proportions of coordination, which further decreased after abolition. Additionally, there were concomitant increases in the number of ambulatory emergency contacts and to a lesser extent in the number of patients with apparent ‘doctor shopping’.ConclusionsThe abolition of copayment in Germany was associated with a substantial decrease in GP coordination of specialist care. This suggests that the copayment was a partly effective tool to support coordinated care. Future studies are required to investigate how the gatekeeping function of GPs in Germany can best be strengthened while minimising the associated administrative overhead.

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“…Phycological disorders are prominent in FSS patients, with 25% of IBS and 51% of FM patients being diagnosed with depression or anxiety in the 5 years pre-diagnosis [ 6 ]. Studies demonstrate an overlap in IBS and mood disorders in FM patients having similar neurobiological alterations [ 4 ].…”

Section: Neuro-immune Modulation In Fssmentioning

confidence: 99%

“…The theory that FSS is a subset of post-infectious syndrome with chronic symptoms emerging post-viral or bacterial infection is popular. The role of such pathogenesis in cases of FSS has not yet been proven [ 6 ]. Indeed, the aetiology of FSS has not been fully elucidated but several factors are believed to contribute to the incidence of FSS with the nervous system and musculoskeletal systems affected.…”

Section: Introductionmentioning

confidence: 99%

The Role of Neuro-Immune Interaction in Chronic Pain Conditions; Functional Somatic Syndrome, Neurogenic Inflammation, and Peripheral Neuropathy

Meade

Garvey

2022

IJMS

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Functional somatic syndromes are increasingly diagnosed in chronically ill patients presenting with an array of symptoms not attributed to physical ailments. Conditions such as chronic fatigue syndrome, fibromyalgia syndrome, or irritable bowel syndrome are common disorders that belong in this broad category. Such syndromes are characterised by the presence of one or multiple chronic symptoms including widespread musculoskeletal pain, fatigue, sleep disorders, and abdominal pain, amongst other issues. Symptoms are believed to relate to a complex interaction of biological and psychosocial factors, where a definite aetiology has not been established. Theories suggest causative pathways between the immune and nervous systems of affected individuals with several risk factors identified in patients presenting with one or more functional syndromes. Risk factors including stress and childhood trauma are now recognised as important contributors to chronic pain conditions. Emotional, physical, and sexual abuse during childhood is considered a severe stressor having a high prevalence in functional somatic syndrome suffers. Such trauma permanently alters the biological stress response of the suffers leading to neuroexcitatory and other nerve issues associated with chronic pain in adults. Traumatic and chronic stress results in epigenetic changes in stress response genes, which ultimately leads to dysregulation of the hypothalamic-pituitary axis, the autonomic nervous system, and the immune system manifesting in a broad array of symptoms. Importantly, these systems are known to be dysregulated in patients suffering from functional somatic syndrome. Functional somatic syndromes are also highly prevalent co-morbidities of psychiatric conditions, mood disorders, and anxiety. Consequently, this review aims to provide insight into the role of the nervous system and immune system in chronic pain disorders associated with the musculoskeletal system, and central and peripheral nervous systems.

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Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data

Cited by 19 publications

References 43 publications

Review article: Physical and psychological comorbidities associated with irritable bowel syndrome

Review article: Physical and psychological comorbidities associated with irritable bowel syndrome

Impact of the abolition of copayments on the GP-centred coordination of care in Bavaria, Germany: analysis of routinely collected claims data

The Role of Neuro-Immune Interaction in Chronic Pain Conditions; Functional Somatic Syndrome, Neurogenic Inflammation, and Peripheral Neuropathy

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