Type, Rather Than Number, of Mental and Physical Comorbidities Increases the Severity of Symptoms in Patients With Irritable Bowel Syndrome

Abstract

BACKGROUND Irritable bowel syndrome (IBS) has significant mental and physical comorbidities. However, little is known about the day-to-day burden these comorbidities place on quality of life (QOL), physical and mental function, distress, and symptoms of patients. METHODS We collected cross sectional data from 175 patients with IBS, diagnosed based on Rome III criteria (median age, 41 y; 78% women), referred to 2 specialty care clinics. Patients completed psychiatric interviews, a physical comorbidity checklist, the IBS symptom severity scale, the IBS quality of life instrument, the brief symptom inventory, the abdominal pain intensity scale, and the SF-12 health survey. RESULTS Patients with IBS reported an average of 5 comorbidities (1 mental, 4 physical). Subjects with more comorbidities reported worse QOL after adjusting for confounding variables. Multiple linear regression analyses indicated that comorbidity type was more consistently and strongly associated with illness burden indicators than disease counts. Of 10, 296 possible physical–mental comorbidity pairs, 6 of the 10 most frequent dyads involved specific conditions (generalized anxiety, depression, back pain, agoraphobia, tension headache, insomnia). These combinations were consistently associated with greater illness and symptom burdens (QOL, mental and physical function, distress, more severe symptoms of IBS, pain). CONCLUSIONS Comorbidities are common among patients with IBS. They are associated with distress and reduced QOL. Specific comorbidities are associated with more severe symptoms of IBS.

THE PREVALENCE AND CLINICAL CHARACTERISTICS OF PRIMARY HEADACHE IN IRRITABLE BOWEL SYNDROME: a subgroup of the functional somatic syndromes

“…IBS affects 15%-23% of the general population and is the most common reason for patients and generalists to consult gastroenterologists In addition, our data showed that the percentage of IBS diagnosis and PH is in accordance with other studies. IBS affects 15%-23% of the general population and is the most common reason for patients and general practitioners to consult gastroenterologists (6,20,26,29,31,39,42) . Globally, the percentage of adult population with an active headache disorder is 47%.…”

“…However, IBS is also often accompanied by another extra-intestinal symptoms, as asthma and cerebral pain symptoms as primary headache. The pathophysiology mechanisms suggest that IBS patients with one or more somatic comorbitdities might represent a separate sub-group (6,17,20,29,39,42) .…”

“…Psychiatric disorders,especially major depression, anxiety, and somatoform disorders, occur frequently. The nongastrointestinal nonpsychiatric disorders with the best documented association are fibromyalgia, chronic fatigue syndrome, temporomandibular joint disorder and chronic pelvic pain (1,5,20) . In addition, IBS is often accompanied by other extra-intestinal symptoms, as asthma and cerebral pain symptoms as primary headache (39) .…”

“…The high prevalence of comorbidities in IBS patients has led investigators to develop hypothesis regarding underlying pathophysiologic mechanisms linking these disorders (1,19,25,36,41) . Possibles common pathogenetic mechanisms of IBS and migraine consider the role of brain-gut axis, as well as neuroimmune and neuroendocrine interactions (3,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) . Serotonin as a major neurotransmitter of the gastrointestinal tract plays a relevant role in the IBS (4,10,36) .…”

Screening for psychosocial factors in patients with irritable bowel syndrome

“…Anxiety is the most common psychological complaint among patients with severe IBS 37 . Anxiety can increase attention to somatic symptoms, lead to more frequent health-care utilization, and impact family and social relationships.…”