Subtypes of Irritable Bowel Syndrome Based on Abdominal Pain/Discomfort Severity and Bowel Pattern

Abstract

INTRODUCTION IBS traditionally has been classified by stooling pattern (e.g., diarrhea-predominant). However, other patterns of symptoms have long been recognized, e.g., pain severity. Our objective was to examine the utility of subtyping women with IBS based on pain/discomfort severity as well as predominant bowel pattern. METHODS Women (n=166) with IBS completed interviews, questionnaires, and kept a diary for 28 days. Rome II questionnaire items eliciting past 3-month recall of hard and loose stools, and frequency and severity of abdominal pain or discomfort were used to classify participants into six subtypes - three bowel pattern categories by two pain/discomfort severity categories. Concordance of these subtypes with corresponding diary items was examined. Analysis of variance tested the relationship of bowel pattern and pain categories to measures of quality of life and symptoms. RESULTS There is moderate congruence of retrospective classification of bowel pattern and pain/discomfort severity subtypes with prospectively reported stool frequency and consistency and pain severity. Quality of life, impact of IBS on work and daily activities, and cognitive beliefs about IBS differed significantly based on abdominal pain/discomfort category but not on predominant bowel pattern. There is evidence of an interaction, with the effect of pain severity being strong in the IBS-diarrhea and IBS-mixed groups but absent in the IBS-constipation group. Similar results hold for most diary symptoms, except for those directly related to bowel pattern. CONCLUSIONS Overall distress of abdominal pain/discomfort is more strongly related to severity of abdominal pain/discomfort than is the predominant stool pattern in patients with IBS. Categorizing IBS patients by abdominal pain/discomfort severity in conjunction with predominant bowel pattern may be useful to clinicians and researchers in developing more effective management.

Prevalence of irritable bowel syndrome and health-related quality of life in adults aged 18 to 30 years in a Colombian University: an electronic survery

“…This partly explains the similarity in HR-QOL scores between the IBS-D, IBS-C, and IBS-M subtypes. However, the severity of abdominal pain or discomfort has a significant effect, larger than that of the subtype classification, on daily activities and beliefs about IBS, [52]. This supports the trend to include severity of IBS symptoms as an important dimension in therapy [53].…”

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“…However, based on clinical experience, patients with IBS-M are more difficult to treat. Other published studies also supported clinical difference in the various IBS-subtypes, with patients with IBS-M subtype posing more difficulties in the management[64-66]. Hence, there is a good chance that the difference observed would be valid.…”

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“…Heitkemper et al (27) have shown that the severity of abdominal pain/ discomfort has a stronger effect on the quality of life than altered bowel pattern in IBS female patients. Based on these findings the authors suggested that the categorization of IBS patients should include both abdominal pain/ discomfort severity and predominant bowel pattern.…”