Subgroups of IBS patients are characterized by specific, reproducible profiles of GI and non‐GI symptoms and report differences in healthcare utilization: A population‐based study

Abstract

Background In a previous clinical sample of IBS patients, subgroups characterized by profiles of GI and non‐GI symptoms were identified. We aimed to replicate these subgroups and symptom associations in participants fulfilling IBS diagnostic criteria from a population‐based study and relate them to healthcare utilization. Methods An Internet‐based health survey was completed by general population adults from United States, Canada, and UK. Respondents fulfilling IBS diagnosis (Rome III and IV) were analyzed for latent subgroups using Gaussian mixture model analysis. Symptom measures were derived from validated questionnaires: IBS‐related GI symptoms (Rome IV), extraintestinal somatic symptoms (PHQ‐12), and psychological symptoms (SF‐8). Key Results A total of 637 respondents fulfilled Rome III criteria (average age 46 years, range 18‐87, 66% females) and 341 Rome IV criteria (average age 44, range 18‐77, 64% female) for IBS. Seven subgroups were identified in the Rome III cohort, characterized by profiles of GI symptoms (constipation‐related, diarrhea‐related, and mixed, respectively), and further distinguished by the presence or absence of non‐GI comorbidities. The Rome IV cohort showed five similar but less distinct subgroups with a preponderance of mixed symptom profiles. Higher severity of non‐GI comorbidities was associated with more frequent healthcare visits and medication usage. Conclusions and Inferences In line with previous findings in a clinical IBS cohort, we were able to identify population‐based subgroups characterized by a combination of GI symptoms with the additional distinction made by varying severity of non‐GI symptoms and with differences in healthcare utilization.

Illuminating an Invisible Epidemic: A Systemic Review of the Clinical and Economic Benefits of Early Diagnosis and Treatment in Inflammatory Disease and Related Syndromes

“…IBS patients are currently diagnosed based on the Rome criteria, with Rome IV being the latest version, consisting of a combination of symptom-based criteria, which sometimes is supplemented by diagnostic tests that must show no abnormal findings [97]. A diagnosis of IBS is formed on the basis of persistent abdominal pain, usually in the lower abdomen, that is related to defecation accompanying a change in stool frequency or form [97,98]. Most IBS patients are classified depending on the predominant stool pattern they exhibit; IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), and those that suffer from both stool patterns (IBS-M) [97,99].…”

“…A diagnosis of IBS is formed on the basis of persistent abdominal pain, usually in the lower abdomen, that is related to defecation accompanying a change in stool frequency or form [97,98]. Most IBS patients are classified depending on the predominant stool pattern they exhibit; IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), and those that suffer from both stool patterns (IBS-M) [97,99].…”

Susceptibility to diarrhea is related to hemodynamic markers of sympathetic activation in the general population

“…Our results agree with a previous review, which showed that IBS patients from the general population, when studied as a whole group, did not differ in heart rate variability compared to healthy controls [25], which may be explained by differences in psychological and somatic symptoms among IBS subjects who seek medical care versus non-consulters [26]. However, several studies have shown signs of autonomic dysfunction in IBS, with differences according to subgroups of IBS [4,13,14,25], disease duration [27], or severity of symptoms [28]. Although apparently demonstrating conflicting results, most studies have shown increased sympathetic and decreased parasympathetic activity, the same pattern as in the organism's response to stress [8,25].…”

“…Another strength is the adjustment for confounders, and that linear regression analysis was only calculated for significant correlations in the Spearman's correlation test. To record specific symptoms on a VAS scale is important, since registration of symptoms or not is not enough [28]. By calculation of all GI symptoms together, alterations found to be associated with specific symptoms may be equalized.…”

Extragastrointestinal Symptoms and Sensory Responses During Breath Tests Distinguish Patients With Functional Gastrointestinal Disorders

“…Several population- or disease-based studies using complex statistical modeling of symptoms associated with functional syndromes have distinguished oligo- and multisymptomatic patient subgroups ( 3 , 4 , 8 ). The subgroups with wide multiorgan symptoms have different demographic, cognitive, quality-of-life, and healthcare utilization characteristics than those with few- or single-organ symptoms ( 4 , 13 ). It would be of practical significance to understand, whether the distinction between the subgroups is explained by different underlying mechanisms.…”