The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis

Abstract

Aim: To determine whether a combination of mood and personality factors together with illness beliefs and behaviours predict the onset of irritable bowel syndrome (IBS) post gastroenteritis, as suggested by the cognitive behavioural model of IBS. Methods: Primary care patients with a positive test for Campylobacter gastroenteritis, and no previous history of IBS or serious bowel conditions were recruited into this prospective study (n = 620). Participants completed a questionnaire at the time of infection, which included standardised measures of mood, perceived stress, perfectionism, negative illness beliefs and illness behaviours. Participants completed follow-up questionnaires designed to determine whether they met the Rome criteria for IBS 3 and 6 months after initial infection. Results: A total of 49 participants met the criteria for IBS at both follow-up points. Logistic regressions indicated that those who developed IBS had significantly higher levels of perceived stress (1.10, 95% CI 1.02 to-1.15), anxiety (1.14, 95% CI 1.05 to 1.23), somatisation (1.17, 95% CI 1.02 to 1.35) and negative illness beliefs (1.14, 95% CI 1.03 to 1.27) at the time of infection than those who did not develop IBS. Patients with IBS were also significantly more likely to remain active in the face of their acute symptoms until they felt forced to rest (all-or-nothing behaviour) (1.09, 95% CI 1.03 to 1.16), and significantly less likely to initially rest in response to their acute illness (0.93, 95% CI 0.88 to 0.97). Depression and perfectionism were not associated with the onset of IBS. Conclusions: Results suggest that patients with high stress and anxiety levels are more prone to develop IBS after a bout of gastroenteritis. Additional risk factors include a tendency to interpret illness in a pessimistic fashion and to respond to symptoms in an all-or-nothing manner.

An illness-specific version of the Revised Illness Perception Questionnaire in patients with atrial fibrillation (AF IPQ-R): Unpacking beliefs about treatment control, personal control and symptom triggers

“…Specific personal control behaviours may involve relinquishing activities (avoidance), contributing to poorer perceived QoL. Previous research indicates that engaging in avoidance behaviours is associated with illness-chronicity and mortality in patients with heart failure and irritable bowel syndrome (Murberg, Furze, & Bru, 2004;Spence & Moss-Morris, 2007). While the current study indicates that AF patients believe specific behaviours can control symptoms, further research is needed to examine whether AF patients actually engage in these specific behaviours, and if so, should identify potential helpful behaviours which may improve QoL.…”

Mechanisms of Stress-induced Visceral Pain

“…22,23 A subset of IBS patients display a low grade chronic inflammation, and there is also evidence that following an enteric infection and combined with stressful life events, there is an increased risk of developed post-infectious IBS. [24][25][26][27] Clearly, the immune system and inflammatory processes are modulated by the HPA and autonomic nervous systems. In support, IBS patients also show increased number and reactivity of mast cells.…”

Risks for Celiac Disease: Bacteria Make It Three

“…The finding by Riddle et al [2] that recent campylobacter infection is associated with an increased risk of developing celiac disease adds to a growing body of evidence that antecedent campylobacter infection increases the risk of a number of diseases, for example irritable bowel syndrome (IBS) [10]. Furthermore, their description of altered permeability consequent to an infectious insult as a potential mechanistic factor in the development of celiac disease [2] reflects a growing awareness that campylobacter compromises the integrity of the intestinal barrier [11].…”