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

Abstract

SummaryBackgroundConventionally, irritable bowel syndrome (IBS) is subgrouped using predominant stool form, yet it is a complex disorder, with multiple biopsychosocial contributors. We previously derived and validated a latent class model subgrouping people with IBS into seven clusters based on gastrointestinal and extraintestinal symptoms and psychological profile.AimsTo conduct longitudinal follow‐up examining the natural history and prognostic value of these clusters.MethodsParticipants completed a 12‐month follow‐up questionnaire. We applied our model to these data, comparing cluster membership between the two time points in those still meeting Rome IV criteria at follow‐up, including stratifying the analysis by predominant stool pattern, and level of psychological burden, at baseline. We examined whether baseline cluster predicted the course of IBS, and whether starting new treatment was associated with changing cluster.ResultsEight hundred and eleven participants met Rome IV criteria for IBS at baseline, of whom 452 (55.7%) responded, and 319 (70.6%) still met Rome IV criteria for IBS at follow‐up. Of these, 172 (53.9%) remained in the same IBS cluster as at baseline and 147 changed cluster. Cluster membership stratified according to psychological comorbidity was more stable; 84% of those in a cluster with high psychological burden at baseline remained in such a cluster at follow‐up. People in clusters with high psychological burden at baseline had more severe symptoms (P < 0.001), received a higher mean number of subsequent treatments (P < 0.001), and were more likely to consult a doctor than people in clusters with low psychological burden (P < 0.001). There was no significant association between starting a new treatment and changing cluster at follow‐up.ConclusionsLongitudinal follow‐up demonstrated little transition between clusters with respect to psychological burden, and these appeared to predict disease course. Directing treatment according to cluster, including earlier use of psychological therapies, and exploring how this approach influences outcomes in IBS, should be examined.

Characteristics of, and natural history among, individuals with Rome IV functional bowel disorders

“…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 research register allowing individuals with IBS to participate in research. We have previously reported data from the individuals with confirmed irritable bowel syndrome (IBS), according to the Rome III or IV criteria, in this cohort 18,28‐31 . People aged ≥18 years were eligible and there were no exclusions, other than an inability to understand written English.…”

“…We have previously reported data from the individuals with confirmed irritable bowel syndrome (IBS), according to the Rome III or IV criteria, in this cohort. 18,[28][29][30][31] People aged ≥18 years were eligible and there were no exclusions, other than an inability to understand written English. We invited individuals, via email and post, between December 2017 and December 2018.…”

Latent class analysis does not support the existence of Rome IV functional bowel disorders as discrete entities

“…We have reported data from the individuals who met Rome IV or III criteria for IBS in this cohort previously. 12,[16][17][18][19] 2.2 | Data collection and synthesis…”

The symptom burden of Irritable Bowel Syndrome in tertiary care during the COVID‐19 pandemic

“… 2 Recent data suggest that these symptom clusters have long‐term prognostic significance. 3 Those with a high psychological symptom burden at baseline have higher symptom severity, are more likely to be refractory to treatments, more likely to seek consultations, 4 and are more likely to be referred to tertiary care.…”