51
|
Edman JS, Greeson JM, Roberts RS, Kaufman AB, Abrams DI, Dolor RJ, Wolever RQ. Perceived Stress in Patients with Common Gastrointestinal Disorders: Associations with Quality of Life, Symptoms and Disease Management. Explore (NY) 2017; 13:124-128. [PMID: 28094229 PMCID: PMC6252255 DOI: 10.1016/j.explore.2016.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE AND METHODS Research supports relationships between stress and gastrointestinal (GI) symptoms and disorders. This pilot study assesses relationships between perceived stress, quality of life (QOL), and self-reported pain ratings as an indicator of symptom management in patients who self-reported gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). RESULTS In the full sample (n = 402) perceived stress positively correlated with depression (r = 0.76, P < .0001), fatigue (r = 0.38, P < .0001), sleep disturbance (r = 0.40, P < .0001), average pain (r = 0.26, P < .0001), and worst pain (r = 0.25, P < .0001). Higher perceived stress also correlated with lower mental health-related QOL. Similar correlations were found for the participants with GERD (n = 188), IBS (n = 132), and IBD (n = 82). Finally, there were significant correlations in the GERD cohort between perceived stress, and average pain (r = 0.34, P < .0001) and worst pain (r = 0.29, P < .0001), and in the IBD cohort between perceived stress, and average pain (r = 0.32, P < .0001), and worst pain (r = 0.35, P < .01). CONCLUSIONS Perceived stress broadly correlated with QOL characteristics in patients with GERD, IBS, and IBD, and their overall QOL was significantly lower than the general population. Perceived stress also appeared to be an indicator of symptom management (self-reported pain ratings) in GERD and IBD, but not IBS. While future research using objective measures of stress and symptom/disease management is needed to confirm these associations, as well as to evaluate the ability of stress reduction interventions to improve perceived stress, QOL and disease management in these GI disorders, integrative medicine treatment programs would be most beneficial to study.
Collapse
Affiliation(s)
- Joel S Edman
- Nutrition Sciences Department, Drexel University, Philadelphia, PA.
| | - Jeffrey M Greeson
- Department of Psychology, College of Science and Mathematics, Rowan University, Glassboro, NJ
| | | | | | - Donald I Abrams
- UCSF Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA
| | - Rowena J Dolor
- Division of General Internal Medicine, Duke University Medical Center, Durham, NC
| | - Ruth Q Wolever
- Osher Center for Integrative Medicine, Vanderbilt University, Schools of Medicine and Nursing, Nashville, TN
| |
Collapse
|
52
|
Simrén M, Palsson OS, Heymen S, Bajor A, Törnblom H, Whitehead WE. Fecal incontinence in irritable bowel syndrome: Prevalence and associated factors in Swedish and American patients. Neurogastroenterol Motil 2017; 29:10.1111/nmo.12919. [PMID: 27581702 PMCID: PMC5276715 DOI: 10.1111/nmo.12919] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/15/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fecal incontinence (FI) is a prevalent but poorly recognized problem in the general population with profound negative effects on daily life. The prevalence of FI in irritable bowel syndrome (IBS) and its association with clinical, demographic, and pathophysiological factors remain largely unknown. METHODS One US (n=304) and one Swedish (n=168) patient cohort fulfilling Rome III criteria for IBS completed Rome III diagnostic questions on FI and IBS symptoms, and questionnaires on IBS symptom severity, quality of life, anxiety and depression, and work productivity impairment. The patients also underwent assessments of colorectal sensitivity and motility. KEY RESULTS Fecal incontinence ≥ one day per month was reported by 19.7% (USA) and 13.7% (Sweden) of IBS patients. These proportions rose to 43.4% and 29.8% if patients with less frequent FI were included. Fecal incontinence prevalence was higher in older age groups, with a clear increase above age 40. Irritable bowel syndrome patients with FI reported greater overall IBS symptom severity, more frequent and loose stools, and greater urgency. Negative effects of FI on quality of life, psychological distress, and work productivity were demonstrated. No associations were found between colorectal physiology and FI. CONCLUSIONS & INFERENCES Fecal incontinence is common in IBS patients, and similar to previous general population reports, the major risk factors for FI in IBS are older age, rectal urgency, and loose, frequent stools. When IBS patients have comorbid FI, the impact on quality of life, psychological symptoms, and work impairment appears greater.
Collapse
Affiliation(s)
- Magnus Simrén
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Olafur S. Palsson
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steve Heymen
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Antal Bajor
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, Department of Internal Medicine, Södra Älvsborgs Sjukhus, Borås, Sweden
| | - Hans Törnblom
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - William E. Whitehead
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
53
|
Abstract
Somatic symptom disorder (SSD) is a common disorder encountered in pediatric medicine. It involves the presentation of physical symptoms that are either disproportionate or inconsistent with history, physical examination, laboratory, and other investigative findings. SSDs result in significant impairment with considerable increase in healthcare utilization, school absenteeism, and the potential for unnecessary diagnostic evaluation and treatment intervention. Patients and families often feel dismissed and may worry that a serious condition has been missed. Primary care providers are frequently frustrated due to a lack of a successful approach to patients and families impacted by SSD. The result is often a cycle of disability, frustration and missed opportunities for collaboration towards enhanced patient functionality. This review summarizes the current evidence-based understanding, as well as insights from clinician experience, on the evaluation and management of pediatric SSD.
Collapse
|
54
|
Leue C, Kruimel J, Vrijens D, Masclee A, van Os J, van Koeveringe G. Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis. Nat Rev Urol 2016; 14:153-163. [PMID: 27922040 DOI: 10.1038/nrurol.2016.227] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Functional urological and gastrointestinal disorders are interrelated and characterized by a chronic course and considerable treatment resistance. Urological disorders associated with a sizeable functional effect include overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Poor treatment outcomes might be attributable to untreated underlying psychological and psychiatric disorders, as the co-occurrence of functional urological and gastrointestinal disorders with mood and anxiety disorders is common. The hypothetical bladder-gut-brain axis (BGBA) is a useful framework under which this interaction can be studied, suggesting that functional disorders represent a sensitized response to earlier threats such as childhood adversity or previous traumatic events, resulting in perceived emotional and bodily distress - the symptoms of functional disorders. Psychological and physical stress pathways might contribute to such alarm falsification, and neuroticism could be a risk factor for the co-occurrence of functional disorders and affective conditions. Additionally, physical threat - either from external sources or internal sources such as infection - might contribute to alarm falsification by influencing body-brain crosstalk on homeostasis and, therefore, affecting mood, cognition, and behaviour. Multidisciplinary research and an integrated care approach is, therefore, required to further elucidate and remediate functional urological and gastrointestinal polymorphic phenotypes.
Collapse
Affiliation(s)
- Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Joanna Kruimel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Adrian Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| |
Collapse
|
55
|
Taft TH, Riehl M, Sodikoff JB, Kahrilas PJ, Keefer L, Doerfler B, Pandolfino JE. Development and validation of the brief esophageal dysphagia questionnaire. Neurogastroenterol Motil 2016; 28:1854-1860. [PMID: 27380834 PMCID: PMC5340311 DOI: 10.1111/nmo.12889] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Esophageal dysphagia is common in gastroenterology practice and has multiple etiologies. A complication for some patients with dysphagia is food impaction. A valid and reliable questionnaire to rapidly evaluate esophageal dysphagia and impaction symptoms can aid the gastroenterologist in gathering information to inform treatment approach and further evaluation, including endoscopy. METHODS 1638 patients participated over two study phases. 744 participants completed the Brief Esophageal Dysphagia Questionnaire (BEDQ) for phase 1; 869 completed the BEDQ, Visceral Sensitivity Index, Gastroesophageal Reflux Disease Questionnaire, and Hospital Anxiety and Depression Scale for phase 2. Demographic and clinical data were obtained via the electronic medical record. The BEDQ was evaluated for internal consistency, split-half reliability, ceiling and floor effects, and construct validity. KEY RESULTS The BEDQ demonstrated excellent internal consistency, reliability, and construct validity. The symptom frequency and severity scales scored above the standard acceptable cutoffs for reliability while the impaction subscale yielded poor internal consistency and split-half reliability; thus the impaction items were deemed qualifiers only and removed from the total score. No significant ceiling or floor effects were found with the exception of 1 item, and inter-item correlations fell within accepted ranges. Construct validity was supported by moderate yet significant correlations with other measures. The predictive ability of the BEDQ was small but significant. CONCLUSIONS & INFERENCES The BEDQ represents a rapid, reliable, and valid assessment tool for esophageal dysphagia with food impaction for clinical practice that differentiates between patients with major motor dysfunction and mechanical obstruction.
Collapse
Affiliation(s)
- Tiffany H. Taft
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago Illinois USA
| | - Megan Riehl
- University of Michigan, Division of Gastroenterology
| | - Jamie B. Sodikoff
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago Illinois USA
| | - Peter J. Kahrilas
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago Illinois USA
| | - Laurie Keefer
- Icahn School of Medicine, Mount Sinai Medical Center, Susan and Leonard Feinstein IBD Center
| | - Bethany Doerfler
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago Illinois USA
| | - John E. Pandolfino
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago Illinois USA
| |
Collapse
|
56
|
Kanuri N, Cassell B, Bruce SE, White KS, Gott BM, Gyawali CP, Sayuk GS. The impact of abuse and mood on bowel symptoms and health-related quality of life in irritable bowel syndrome (IBS). Neurogastroenterol Motil 2016; 28:1508-17. [PMID: 27151081 PMCID: PMC5042818 DOI: 10.1111/nmo.12848] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/11/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common abdominal pain disorder without an organic explanation. Abuse histories (physical, sexual, emotional) are prevalent in IBS. While abuse relates to mood disorders (depression and anxiety) also common in IBS, the influence of abuse on gastrointestinal (GI) symptoms and health-related quality of life (HRQOL) and its independence from psychological symptom comorbidity has not been studied. METHODS Consecutive GI outpatients completed the ROME III Research Diagnostic Questionnaire and questionnaires on trauma (Life-Stress Questionnaire), mood (Beck Depression/Anxiety Inventories), somatic symptoms (PHQ-12), and HRQOL (SF-36). Current GI symptom severity and bother were assessed using 10-cm Visual Analog Scales. KEY RESULTS 272 ROME-defined IBS (47.6 ± 0.9 years, 81% female) and 246 non-FGID (51.6 ± 1.0 years, 65% female) subjects participated. IBS patients reported greater rates of physical, sexual, and emotional abuse (p < 0.006 each), and higher depression, anxiety, and somatic symptoms (p < 0.001). Greater bowel symptom bother (7.4 ± 0.2 vs 6.7 ± 0.2, p = 0.040), severity (7.7 ± 0.2 vs 6.5 ± 0.2, p < 0.001), recent symptomatic days (9.8 ± 0.4 vs 8.5 ± 0.3, p = 0.02), and poorer HRQOL (40.9 ± 2.3 vs 55.5 ± 1.7, p < 0.001) were noted in IBS with abuse. Abuse effects were additive, with greater IBS symptom severity and poorer HRQOL noted in cases with multiple forms of abuse. Mediation analyses suggested that abuse effects on GI symptoms and HRQOL were partially mediated by mood. CONCLUSIONS & INFERENCES Abuse experiences common among IBS sufferers are associated with reports of greater GI symptoms and poorer HRQOL, particularly in those with multiple forms of abuse; this relationship may be partially mediated by concomitant mood disturbances.
Collapse
Affiliation(s)
- Navya Kanuri
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin Cassell
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Steven E. Bruce
- Center for Trauma Recovery, University of Missouri-St. Louis, Missouri, USA
| | - Kamila S. White
- Center for Trauma Recovery, University of Missouri-St. Louis, Missouri, USA
| | - Britt M. Gott
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C. Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gregory S. Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA,Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA,Gastroenterology Section, John Cochran Veterans Affairs Medical Center, University of Missouri-St. Louis, Missouri, USA
| |
Collapse
|
57
|
The Development of Irritable Bowel Syndrome: A Prospective Community-Based Cohort Study. Am J Gastroenterol 2016; 111:1320-9. [PMID: 27377523 DOI: 10.1038/ajg.2016.255] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/14/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It remains controversial whether psychosocial burden is an independent predictor of irritable bowel syndrome (IBS) or occurs concurrently as an epiphenomenon. Here we prospectively examine the individual contribution of psychosocial risk factors, demographic factors, somatic symptoms, and gastrointestinal infection within a non-clinical, IBS-free population before infection occurred. METHODS A prospective community-based cohort study including a consecutive sample of healthy participants with an elevated risk of developing gastrointestinal infection during long-distance travel was conducted. Potential predictive factors were investigated using validated self-report scales pre-travel, 1 week after return, and 7 months post-travel. IBS was assessed using the ROME-III Diagnostic Questionnaire. RESULTS Of the 1,964 eligible long-distance travelers, 1,464 responded at follow-up directly after their journey, and 1,190 participants completed the study 7 months post-journey. Fifty-three percent of study completers were female, mean age was 39.9 (s.d.=15.7) years. The mean travel duration was 40.8 (s.d.=52.8) days, and 43.3% (95% confidence interval (CI)=40.4-46.1%) of participants experienced at least moderate infectious travelers' diarrhea. The incidence of newly developed IBS 7 months post-travel was 7.2% (95%CI=5.8-8.6%). In multivariate analyses, female gender, vulnerability to diarrhea under stress, baseline somatic symptom burden, baseline illness anxiety, diarrhea within the 4 months pre-travel, and travelers' diarrhea during the journey significantly predicted IBS post-travel. CONCLUSION This study indicates that gastrointestinal infection as well as predisposing factors such as female gender, vulnerability to diarrhea under stress, illness anxiety, and somatic symptom burden predict the development of IBS. The results indicate the necessity of simultaneously addressing both somatic and psychological needs in patients with IBS as early as possible.
Collapse
|
58
|
Reed-Knight B, Claar RL, Schurman JV, van Tilburg MAL. Implementing psychological therapies for functional GI disorders in children and adults. Expert Rev Gastroenterol Hepatol 2016; 10:981-4. [PMID: 27356273 DOI: 10.1080/17474124.2016.1207524] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Functional GI disorders (FGIDs) are common in adults and children. Psychological factors play an important role in the onset and maintenance of FGIDs and in explaining the associated disability. Psychological treatments such as Cognitive Behavioral Therapy and Hypnotherapy have been found efficacious in FGIDs but Integrating psychological treatments into traditionally medically-oriented care can be challenging. AREAS COVERED This review outlines the case for integrating psychological therapies into medical care for FGIDs and examine various models of integrated care that can be adapted to fit specific practice scenarios. Expert commentary: We advise integrating a psychologist in the care and treatment planning of every patient. Clinic-specific needs dictate how integrated care for patients with FGIDs can be delivered.
Collapse
Affiliation(s)
- Bonney Reed-Knight
- a Children's Healthcare of Atlanta , Department of Pediatrics Emory University School of Medicine, and GI Care for Kids , Atlanta , GA , USA
| | - Robyn Lewis Claar
- b Department of Medicine , University of North Carolina, Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders , Chapel Hill , NC , USA
| | | | - Miranda A L van Tilburg
- b Department of Medicine , University of North Carolina, Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders , Chapel Hill , NC , USA
| |
Collapse
|
59
|
Kanazawa M, Miwa H, Nakagawa A, Kosako M, Akiho H, Fukudo S. Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan. Biopsychosoc Med 2016; 10:19. [PMID: 27274765 PMCID: PMC4893246 DOI: 10.1186/s13030-016-0070-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/16/2016] [Indexed: 12/18/2022] Open
Abstract
Background Abdominal bloating is a common symptom in patients with irritable bowel syndrome with constipation (IBS-C). However, it is not included among the required items in the Rome III diagnostic criteria for IBS. Little is known about an impact of abdominal bloating seen in patients with IBS-C. Using a large population-based sample, the aim of the present study was to investigate what is the most bothersome symptom in subjects with IBS-C. Methods An Internet survey of 30,000 adults drawn from the general public throughout Japan was conducted to identify subtypes of IBS using the Rome III diagnostic questionnaire. Consecutively, the screened subjects with IBS-C and the same number of age- and sex-matched non-IBS subjects who were randomly selected as controls were asked to answer a questionnaire on the degree of anxiety they experienced in their daily lives, thoughts about bowel habit, and their dominant gastrointestinal symptoms together with exacerbation factors (for IBS-C only). Results The screening survey showed that the prevalence of overall IBS was 16.5 % (female 17.4 %, male 15.5 %) and that 2.8 % met the criteria for IBS-C, 4.5 % for IBS with diarrhea (IBS-D) and 8.2 % for mixed IBS (IBS-M). Seven hundred and fifty-nine of 835 (90.9 %) subjects with IBS-C and 746 of 830 (89.9 %) control subjects completed the consecutive questionnaire. IBS-C subjects felt a higher degree of anxiety in their daily lives (p < 0.01) and considered bowel habit to be an indicator of health (p < 0.01) to a greater extent than control subjects. In IBS-C, the degree of anxiety was significantly associated with abdominal discomfort (p < 0.01), pain (p < 0.01) and bloating (p = 0.02), but not with the frequency of bowel habit (p > 0.1). Abdominal bloating was the most bothersome symptom (27.5 %), which was more likely to occur after a meal (52.2 %), at work/school (29.2 %) and during times of stress (26.8 %). Only 4.5 % of IBS-C subjects reported abdominal pain as the ‘most bothersome’ symptom. Conclusions A large population-based Internet survey suggests that abdominal bloating has a great impact on the daily lives of subjects diagnosed with IBS-C. Not only bowel movement/abdominal pain but also abdominal bloating should be evaluated in patients with IBS-C. Electronic supplementary material The online version of this article (doi:10.1186/s13030-016-0070-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Motoyori Kanazawa
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575 Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ayako Nakagawa
- Japan-Asia Clinical Development 2, Astellas Pharma Inc, Tokyo, Japan
| | - Masanori Kosako
- Japan-Asia Clinical Development 2, Astellas Pharma Inc, Tokyo, Japan
| | - Hiraku Akiho
- Japan-Asia Clinical Development 2, Astellas Pharma Inc, Tokyo, Japan
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575 Japan
| |
Collapse
|
60
|
Van Oudenhove L, Törnblom H, Störsrud S, Tack J, Simrén M. Depression and Somatization Are Associated With Increased Postprandial Symptoms in Patients With Irritable Bowel Syndrome. Gastroenterology 2016; 150:866-74. [PMID: 26602216 DOI: 10.1053/j.gastro.2015.11.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Patients with irritable bowel syndrome (IBS) have increased postprandial symptom responses and more psychosocial morbidities than healthy individuals. However, the relationship between psychosocial status and postprandial symptom responses in patients with IBS is unclear. We investigated this relationship in a prospective study of patients with IBS. METHODS A total of 193 IBS patients, diagnosed according to Rome II (n = 126) or Rome III (n = 67) criteria, consumed a standard breakfast (540 kcal: 36% fat, 15% proteins, 49% carbohydrates, and 8.9 g fiber). They completed visual analogue scales assessing the severity of 5 gastrointestinal symptoms (abdominal pain, bloating, nausea, gas, and fullness) before breakfast and every 30 minutes, up to 240 minutes after eating. All patients completed validated self-report questionnaires for their current levels of anxiety and depression; patients diagnosed based on Rome II criteria also completed a somatization questionnaire. The relationship between these variables and the course of gastrointestinal symptom scores over time was analyzed using linear mixed models, controlling for comorbid functional dyspepsia. RESULTS We observed a main effect of anxiety levels on fullness and bloating (P < .04), and of depression levels on abdominal pain (P = .007), reflecting a general upward shift of the entire symptom curve. Depression-by-time interactions were seen for nausea and gas (P < .03). Somatization levels had a main effect on all 5 symptoms (P < .0001), independent of anxiety and depression. We observed somatization-by-time interaction effects for bloating (P = .005), and nausea (P = .02), and a nonsignificant trend was found for pain (P = .054), reflecting a steeper early postprandial increase in symptoms among subjects with higher levels of somatization. CONCLUSIONS Based on a prospective study of patients with IBS, psychosocial morbidities are associated with increased levels of gastrointestinal symptoms in general. Depression and somatization levels are associated specifically with increased postprandial symptoms.
Collapse
Affiliation(s)
- Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders, Department of Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium; Consultation-Liaison Psychiatry, University Psychiatric Centre KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Hans Törnblom
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centered Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stine Störsrud
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, Department of Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
| | - Magnus Simrén
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centered Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
61
|
Chakiath RJ, Siddall PJ, Kellow JE, Hush JM, Jones MP, Marcuzzi A, Wrigley PJ. Descending pain modulation in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Syst Rev 2015; 4:175. [PMID: 26652749 PMCID: PMC4674951 DOI: 10.1186/s13643-015-0162-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. While abdominal pain is a dominant symptom of IBS, many sufferers also report widespread hypersensitivity and present with other chronic pain conditions. The presence of widespread hypersensitivity and extra-intestinal pain conditions suggests central nervous dysfunction. While central nervous system dysfunction may involve the spinal cord (central sensitisation) and brain, this review will focus on one brain mechanism, descending pain modulation. METHOD/DESIGN We will conduct a comprehensive search for the articles indexed in the databases Ovid MEDLINE, Ovid Embase, Ovid PsycINFO and Cochrane Central Register of Controlled Trial (CENTRAL) from their inception to August 2015, that report on any aspect of descending pain modulation in irritable bowel syndrome. Two independent reviewers will screen studies for eligibility, assess risk of bias and extract relevant data. Results will be tabulated and, if possible, a meta-analysis will be carried out. DISCUSSION The systematic review outlined in this protocol aims to summarise current knowledge regarding descending pain modulation in IBS. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015024284.
Collapse
Affiliation(s)
- Rosemary J Chakiath
- Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia. .,Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia.
| | - Philip J Siddall
- Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia. .,Department of Pain Management, HammondCare, Greenwich Hospital, Sydney, NSW, Australia. .,Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.
| | - John E Kellow
- Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia. .,Department of Gastroenterology, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.
| | - Julia M Hush
- Discipline of Physiotherapy, Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, Sydney, NSW, Australia. .,The Centre for Physical Health, Macquarie University, North Ryde, Australia.
| | - Mike P Jones
- Psychology Department, Macquarie University, North Ryde, Sydney, NSW, Australia.
| | - Anna Marcuzzi
- Discipline of Physiotherapy, Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, Sydney, NSW, Australia. .,The Centre for Physical Health, Macquarie University, North Ryde, Australia.
| | - Paul J Wrigley
- Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia. .,Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia.
| |
Collapse
|
62
|
Grinsvall C, Törnblom H, Tack J, Van Oudenhove L, Simrén M. Psychological factors selectively upregulate rectal pain perception in hypersensitive patients with irritable bowel syndrome. Neurogastroenterol Motil 2015; 27:1772-82. [PMID: 26467837 DOI: 10.1111/nmo.12689] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 08/25/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Visceral hypersensitivity and psychological symptoms are frequent features in irritable bowel syndrome (IBS). Exploring mechanistic pathways leading to visceral hypersensitivity is of importance to direct future studies and treatment options. In this study, we evaluated the contribution of psychological factors to the perception of painful and non-painful rectal sensations in hyper- vs normosensitive IBS patients. METHODS We included 138 IBS patients (Rome II criteria) who underwent an ascending method of limited rectal balloon distension paradigm. At the end of each distension step, subjects rated the perceived intensity of non-painful ('unpleasantness') and painful rectal sensations on visual analog scales. Sensitivity status was determined based on pain thresholds. Anxiety, depression and somatization were assessed by questionnaires. Mixed models were used to test the relationship between sensitivity status, psychological variables, and pain & unpleasantness ratings upon increasing distension. KEY RESULTS Hypersensitive IBS patients had lower sensory thresholds for pain, first perception, urge to defecate, and discomfort (p < 0.0001). Upon increasing distension, they rated both painful and non-painful sensations as more intense than normosensitive patients (p < 0.0001). Psychological factors were associated with higher pain ratings during distension in hypersensitive (p < 0.006-0.0001), but not in normosensitive patients. Anxiety, but not depression or somatization, was associated with increased intensity ratings of non-painful sensations (p < 0.001), independent of sensitivity status. CONCLUSIONS & INFERENCES Hypersensitive IBS patients are characterized by increased perception of pain, but also of non-painful sensations. Psychological factors increase the perception of painful sensations in hypersensitive patients only, whereas non-painful visceral sensations were exaggerated in anxious patients regardless of the sensitivity status.
Collapse
Affiliation(s)
- C Grinsvall
- Dept of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Törnblom
- Dept of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - L Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - M Simrén
- Dept of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
63
|
Abstract
Within the last decade, research regarding the human gut microbiome has exploded. While the gastrointestinal tract was once regarded simply as a digestive organ, new technologies have led the science world to wonder about the impact that the gut microbiota may have on human health and disease. The gut microbiome is now becoming known for its role in metabolism, immune defense, and behavior. From in utero variations to those that rapidly occur post partum, our gut microbiome changes with age, environment, stress, diet, and health status as well as medication exposure. This article reviews what is currently known regarding various influences on the gut microbiome and is meant to encourage the reader to further explore the unknown.
Collapse
Affiliation(s)
- Gail A Cresci
- Department of Gastroenterology/Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Emmy Bawden
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
64
|
Abstract
Despite an extensive body of reported information about peripheral and central mechanisms involved in the pathophysiology of IBS symptoms, no comprehensive disease model has emerged that would guide the development of novel, effective therapies. In this Review, we will first describe novel insights into some key components of brain-gut interactions, starting with the emerging findings of distinct functional and structural brain signatures of IBS. We will then point out emerging correlations between these brain networks and genomic, gastrointestinal, immune and gut-microbiome-related parameters. We will incorporate this new information, as well as the reported extensive literature on various peripheral mechanisms, into a systems-based disease model of IBS, and discuss the implications of such a model for improved understanding of the disorder, and for the development of more-effective treatment approaches in the future.
Collapse
Affiliation(s)
- Emeran A Mayer
- Department of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-7378, USA
| | - Jennifer S Labus
- Department of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-7378, USA
| | - Kirsten Tillisch
- Department of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-7378, USA and West Los Angeles VA Medical Center, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
| | - Steven W Cole
- Department of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-7378, USA
| | - Pierre Baldi
- Institute for Genomics and Bioinformatics, University of California at Irvine, 4038 Bren Hall, Irvine, CA 92697-3435, USA
| |
Collapse
|
65
|
Sood R, Gracie DJ, Law GR, Ford AC. Systematic review with meta-analysis: the accuracy of diagnosing irritable bowel syndrome with symptoms, biomarkers and/or psychological markers. Aliment Pharmacol Ther 2015; 42:491-503. [PMID: 26076071 DOI: 10.1111/apt.13283] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/14/2015] [Accepted: 05/30/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a complex, heterogeneous disease which can be challenging to diagnose. No study has identified and assessed the accuracy of all available methods of diagnosing IBS. AIM To conduct a systematic review of the literature to identify and assess accuracy of symptom-based diagnostic criteria, biomarkers, psychological markers or combinations thereof. METHODS MEDLINE, EMBASE and EMBASE Classic were searched (until April 2015) to identify studies reporting accuracy of available methods to diagnose IBS in adult populations. Eligible studies assessed accuracy of these diagnostic tests against an accepted reference standard. Data were extracted to calculate positive and negative likelihood ratios, with 95% confidence intervals (CIs), of the diagnostic test utilised. Where more than one study used the same test, data were pooled in a meta-analysis. RESULTS Twenty-two studies (7106 patients) were eligible. Positive and negative likelihood ratios of the current gold standard, the Rome III criteria, were 3.35 (95% CI: 2.97-3.79) and 0.39 (95% CI: 0.34-0.46), similar to other symptom-based criteria. Eleven biomarkers performed no better than symptom-based criteria. Psychological markers performed well in one study. Five different combinations were assessed. The best in terms of positive likelihood ratio was faecal calprotectin, intestinal permeability and Rome I criteria (26.4; 95% CI: 11.4-61.9), and in terms of negative likelihood ratio serum-based biomarkers and psychological markers (0.18; 95% CI: 0.12-0.25). CONCLUSIONS Symptom-based diagnostic criteria, biomarkers and psychological markers performed modestly in predicting IBS. Combining symptoms with markers appears more effective, and may represent the way forward in the diagnosis of IBS.
Collapse
Affiliation(s)
- R Sood
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - D J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - G R Law
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - A C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
66
|
Hubbard CS, Hong JY, Jiang Z, Ebrat B, Suyenobu B, Smith S, Heendeniya N, Naliboff BD, Tillisch K, Mayer EA, Labus JS. Increased attentional network functioning related to symptom severity measures in females with irritable bowel syndrome. Neurogastroenterol Motil 2015; 27:1282-94. [PMID: 26087779 PMCID: PMC4550526 DOI: 10.1111/nmo.12622] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/24/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased attention to gastrointestinal (GI) symptoms and disease-specific contexts may play an important role in the enhanced perception of visceral stimuli frequently reported in patients with irritable bowel syndrome (IBS). In this study, we test the hypothesis that altered attentional mechanisms underlie central pain amplification in IBS. METHODS To evaluate brain networks that support alerting, orienting, and executive attention, we employed the attention network test (ANT), a modified flanker task which measures the efficiency of functioning of core attentional networks, during functional magnetic resonance imaging in 15 IBS patients (mean age = 31 [11.96]) and 14 healthy controls (HCs; mean age = 31 [10.91]). KEY RESULTS Patients with IBS, compared to HCs, showed shorter reaction times during the alerting and orienting conditions which were associated with greater activation of anterior midcingulate and insular cortices, and decreased activity in the right inferior frontal junction and supplementary motor cortex. Patients also showed activation in the dorsal medial prefrontal cortex and concurrent thalamic deactivation during the executive control portion of the ANT relative to HCs, but no group difference in reaction times were found. The activity in brain regions showing group differences during the ANT were associated with measures of GI-specific anxiety, pain catastrophizing, and fear of uncertainty. In IBS, activity in the anterior midcingulate during alerting correlated with duration of GI-symptoms and overall symptom severity. CONCLUSIONS & INFERENCES Together, these results suggest that IBS patients have specific abnormalities in attentional network functioning and these deficits may underlie symptom-related anxiety, hypervigilance, and visceral hypersensitivity.
Collapse
Affiliation(s)
- Catherine S. Hubbard
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD,Center for Pain and the Brain, Boston Children’s Hospital
| | - Jui-Yang Hong
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Department of Biomedical Engineering, UCLA, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| | - Zhiguo Jiang
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA
| | - Bahar Ebrat
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA
| | - Brandall Suyenobu
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA
| | - Suzanne Smith
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA
| | - Nuwanthi Heendeniya
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA
| | - Bruce D. Naliboff
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,VA Greater Los Angeles Healthcare System, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| | - Kirsten Tillisch
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| | - Emeran A. Mayer
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Department of Physiology, UCLA, Los Angeles, CA,Department of Psychiatry, UCLA, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| | - Jennifer S. Labus
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Department of Psychiatry, UCLA, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| |
Collapse
|
67
|
Hungin APS, Becher A, Cayley B, Heidelbaugh JJ, Muris JWM, Rubin G, Seifert B, Russell A, De Wit NJ. Irritable bowel syndrome: an integrated explanatory model for clinical practice. Neurogastroenterol Motil 2015; 27:750-63. [PMID: 25703486 DOI: 10.1111/nmo.12524] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 01/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although irritable bowel syndrome (IBS) is a symptom-based diagnosis, clinicians' management of and communication about the disorder is often hampered by an unclear conceptual understanding of the nature of the problem. We aimed to elucidate an integrated explanatory model (EM) for IBS from the existing literature for pragmatic use in the clinical setting. METHODS Systematic and exploratory literature searches were performed in PubMed to identify publications on IBS and EMs. KEY RESULTS The searches did not identify a single, integrated EM for IBS. However, three main hypotheses were elucidated that could provide components with which to develop an IBS EM: (i) altered peripheral regulation of gut function (including sensory and secretory mechanisms); (ii) altered brain-gut signaling (including visceral hypersensitivity); and (iii) psychological distress. Genetic polymorphisms and epigenetic changes may, to some degree, underlie the etiology and pathophysiology of IBS and could increase the susceptibility to developing the disorder. The three model components also fit into one integrated explanation for abdominal symptoms and changes in stool habit. Additionally, IBS may share a common pathophysiological mechanism with other associated functional syndromes. CONCLUSIONS & INFERENCES It was possible to elucidate an integrated, three-component EM as a basis for clinicians to conceptualize the nature of IBS, with the potential to contribute to better diagnosis and management, and dialog with sufferers.
Collapse
Affiliation(s)
- A P S Hungin
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - A Becher
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Research and Evaluation Unit, Oxford PharmaGenesis Ltd, Oxford, UK
| | - B Cayley
- Department of Family Medicine, University of Wisconsin, Madison, WI, USA
| | - J J Heidelbaugh
- Departments of Family Medicine and Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - J W M Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - G Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - B Seifert
- Institute of General Practice, Charles University, Praha, Czech Republic
| | - A Russell
- Department of Anthropology, Durham University, Durham, UK
| | - N J De Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
68
|
van Tilburg MAL, Levy RL, Walker LS, Von Korff M, Feld LD, Garner M, Feld AD, Whitehead WE. Psychosocial mechanisms for the transmission of somatic symptoms from parents to children. World J Gastroenterol 2015; 21:5532-41. [PMID: 25987776 PMCID: PMC4427675 DOI: 10.3748/wjg.v21.i18.5532] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/19/2014] [Accepted: 12/20/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To examine familial aggregation of irritable bowel syndrome (IBS) via parental reinforcement/modeling of symptoms, coping, psychological distress, and exposure to stress. METHODS Mothers of children between the ages of 8 and 15 years with and without IBS were identified through the Group Health Cooperative of Puget Sound. Mothers completed questionnaires, including the Child Behavior Checklist (child psychological distress), the Family Inventory of Life Events (family exposure to stress), SCL-90R (mother psychological distress), and the Pain Response Inventory (beliefs about pain). Children were interviewed separately from their parents and completed the Pain Beliefs Questionnaire (beliefs about pain), Pain Response Inventory (coping) and Child Symptom Checklist [gastrointestinal (GI) symptoms]. In addition, health care utilization data was obtained from the automated database of Group Health Cooperative. Mothers with IBS (n = 207) and their 296 children were compared to 240 control mothers and their 335 children, while controlling for age and education. RESULTS Hypothesis 1: reinforcement of expression of GI problems is only related to GI symptoms, but not others (cold symptoms) in children. There was no significant correlation between parental reinforcement of symptoms and child expression of GI or other symptoms. Hypothesis 2: modeling of GI symptoms is related to GI but not non-GI symptom reporting in children. Children of parents with IBS reported more non-GI (8.97 vs 6.70, P < 0.01) as well as more GI (3.24 vs 2.27, P < 0.01) symptoms. Total health care visits made by the mother correlated with visits made by the child (rho = 0.35, P < 0.001 for cases, rho = 0.26, P < 0.001 for controls). Hypothesis 3: children learn to share the methods of coping with illness that their mothers exhibit. Methods used by children to cope with stomachaches differed from methods used by their mothers. Only 2/16 scales showed weak but significant correlations (stoicism rho = 0.13, P < 0.05; acceptance rho = 0.13, P < 0.05). Hypothesis 4: mothers and children share psychological traits such as anxiety, depression, and somatization. Child psychological distress correlated with mother's psychological distress (rho = 0.41, P < 0.001 for cases, rho= 0.38, P < 0.001 for controls). Hypothesis 5: stress that affects the whole family might explain the similarities between mothers and their children. Family exposure to stress was not a significant predictor of children's symptom reports. Hypothesis 6: the intergenerational transmission of GI illness behavior may be due to multiple mechanisms. Regression analysis identified multiple independent predictors of the child's GI complaints, which were similar to the predictors of the child's non-GI symptoms (mother's IBS status, child psychological symptoms, child catastrophizing, and child age). CONCLUSION Multiple factors influence the reporting of children's gastrointestinal and non-gastrointestinal symptoms. The clustering of illness within families is best understood using a model that incorporates all these factors.
Collapse
|
69
|
The crossroads of gastroenterology and psychiatry - what benefits can psychiatry provide for the treatment of patients suffering from gastrointestinal symptoms. GASTROENTEROLOGY REVIEW 2015; 10:222-8. [PMID: 26759629 PMCID: PMC4697033 DOI: 10.5114/pg.2015.51213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 11/30/2014] [Accepted: 01/08/2015] [Indexed: 12/12/2022]
Abstract
Introduction Gastrointestinal symptoms are very common in the general population. Many of them coincide with mental disorders (especially with neuroses, stress-related disorders, somatisation disorders, autonomic dysfunction, and anxiety) that are associated with psychological trauma, conflicts, and difficulties with interpersonal relationships. Aim Assessment of the association between gastrointestinal complaints and stressful situations in relationships, among patients admitted to day hospital for neurotic and behavioural disorders. Material and methods Analysis of the likelihood of co-occurrence of abdominal symptoms and stressful situations, reported by patients before admission, in a large group of subjects treated with psychotherapy. Results Gastrointestinal symptoms were highly prevalent in the studied group (they were reported by 40–50% of patients). The most common complaints in women were: loss of appetite (52%), nausea (49%), and constipation and flatulence (45%). In men the most prevalent symptoms were: loss of appetite (47%), heartburn (44%), and flatulence (43%). Functional gastrointestinal symptoms (especially vomiting in cases of nervousness in females or heartburn in males) were significantly associated with greater likelihood of current difficulties in interpersonal relationships, such as conflicts with partner/spouse or parent. Conclusions The results suggest that in many cases symptoms of anxiety disorders or somatisation disorders coexisted with irritable bowel syndrome and functional dyspepsia.
Collapse
|
70
|
Gerson CD, Gerson MJ, Chang L, Corazziari ES, Dumitrascu D, Ghoshal UC, Porcelli P, Schmulson M, Wang WA, Zali M. A cross-cultural investigation of attachment style, catastrophizing, negative pain beliefs, and symptom severity in irritable bowel syndrome. Neurogastroenterol Motil 2015; 27:490-500. [PMID: 25817055 DOI: 10.1111/nmo.12518] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 12/29/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little information exists regarding whether psychosocial variables in irritable bowel syndrome (IBS) vary by geographic location. Adult attachment is an important psychological concept rooted in childhood relationship experience that has not been previously studied in IBS. Catastrophizing and negative pain beliefs have been described in IBS and may be affected by attachment. AIMS In this cross-cultural study, we determined: (i) whether attachment differs between IBS patients and controls, (ii) whether geographic location has a significant effect on attachment style, catastrophizing and negative pain beliefs, and (iii) how all three variables correlate with IBS symptom severity. METHODS 463 IBS patients, with moderate to severe symptom scores, and 192 healthy controls completed validated questionnaires about attachment, catastrophizing, negative pain beliefs and IBS-SSS in nine locations, USA (New York, Los Angeles), Mexico, Italy (Rome, Bari), Romania, Iran, India, and China. KEY RESULTS Attachment anxiety and avoidance scores were significantly higher in IBS patients than in controls (p < 0.001). This was particularly true for the fearful-avoidant attachment category, especially in China and Romania. Path analysis showed that attachment anxiety and avoidance had indirect effects on IBS-SSS through catastrophizing (p < 0.0001) and negative pain beliefs (p = 0.005). All three psychosocial measures varied significantly depending on location. CONCLUSIONS & INFERENCES In the IBS population studied, attachment style was significantly different in IBS compared to a control population. Geographic differences in attachment, catastrophizing and negative pain beliefs were documented and their correlation with symptom severity and thus, research of psychosocial variables in IBS should take into account the location of the population studied.
Collapse
Affiliation(s)
- C D Gerson
- Division of Gastroenterology, Mount Sinai School of Medicine, New York, NY, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
71
|
Costanian C, Tamim H, Assaad S. Prevalence and factors associated with irritable bowel syndrome among university students in Lebanon: Findings from a cross-sectional study. World J Gastroenterol 2015; 21:3628-3635. [PMID: 25834330 PMCID: PMC4375587 DOI: 10.3748/wjg.v21.i12.3628] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the bowel habits and the prevalence of irritable bowel syndrome (IBS) and to investigate the influence of health behavior and social factors on IBS prevalence in university students.
METHODS: This cross-sectional study was conducted at five major universities in Greater Beirut and its suburbs, between February and June 2014. Using a convenience sample, a total of 813 students aged 18 years old and above participated in this study. Participants were asked to complete a comprehensive anonymous questionnaire which detailed characteristics on socio-demographic, health-related, and lifestyle factors, as well as IBS. The ROME III criteria were used as a tool to ascertain IBS. A χ2 test was used to determine differences between categorical variables; stepwise logistic regression was used to measure the association between IBS and its risk factors.
RESULTS: An overall prevalence of IBS of 20% was recorded among university students. The bivariate analysis showed that females were significantly more likely to report having IBS than males (29.1% vs 18.2%, P < 0.01). Those living at the school dormitory or in a private residence (39.5%) were more likely to have IBS than those living with their families (16.3%) (P < 0.01). The multivariate analysis showed that those who had a relatively high family income level (US$ > 2000) were almost 6 times more likely to report having IBS than their counterparts.
CONCLUSION: This is the first study to describe the nature of IBS among young adults in Lebanon. The prevalence of IBS among university students in our sample was higher than that reported in the West.
Collapse
|
72
|
Patel P, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P, Ford AC. Irritable bowel syndrome is significantly associated with somatisation in 840 patients, which may drive bloating. Aliment Pharmacol Ther 2015; 41:449-58. [PMID: 25586008 DOI: 10.1111/apt.13074] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/08/2014] [Accepted: 12/19/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Psychological factors may influence persistence and perceived severity of symptoms in irritable bowel syndrome (IBS). Literature suggests that somatisation is associated with IBS. However, the relationship between IBS subtype, symptoms of IBS and somatisation is unclear. AIM To examine this issue in a large cohort of secondary care patients. METHODS Demographic and gastrointestinal (GI) symptom data were collected from 4224 adult patients via the Rome III questionnaire. Somatisation data were collected using the patient health questionnaire-12. Mean somatisation score and number of somatic symptoms were compared between IBS patients and controls with minimal GI symptoms, and between IBS subtypes using analysis of variance. Effect of level of somatisation on symptom frequency was compared according to IBS subtype using a χ(2) test. RESULTS 840 patients met Rome III criteria for IBS, controls were 2137 patients with GI symptoms without IBS. Mean somatisation scores and number of somatic symptoms were higher in IBS vs. controls (P < 0.001), and in mixed stool pattern IBS (IBS-M), vs. IBS with constipation (IBS-C) or diarrhoea (IBS-D) (P < 0.001). High levels of somatisation were more prevalent in IBS-M (31.7%) vs. IBS-C (22.5%) or IBS-D (20.8%) (P = 0.003). For all IBS subtypes, high levels of somatisation were associated with a greater frequency of bloating or abdominal distension prior to logistic regression. CONCLUSIONS IBS is strongly associated with higher levels of somatisation, particularly IBS-M. Bloating may be associated with higher levels of somatisation, perhaps explaining why it can be difficult to treat.
Collapse
Affiliation(s)
- P Patel
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | | | | | | | | | | | | |
Collapse
|
73
|
Lou Z, Gu XH, Zhong HZ. Medical care experiences of the 30th Chinese Antarctic research expedition: a retrospective study. Chin Med J (Engl) 2015; 128:398-400. [PMID: 25635438 PMCID: PMC4837873 DOI: 10.4103/0366-6999.150116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Hai-Zhong Zhong
- Department of Field Medical Station, Changhai Hospital of The Second Military Medical University, Shanghai 200433, China
| |
Collapse
|
74
|
More negative self-esteem and inferior coping strategies among patients diagnosed with IBS compared with patients without IBS--a case-control study in primary care. BMC FAMILY PRACTICE 2015; 16:6. [PMID: 25626450 PMCID: PMC4316793 DOI: 10.1186/s12875-015-0225-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/15/2015] [Indexed: 12/14/2022]
Abstract
Background Irritable Bowel Syndrome (IBS) is a chronic, relapsing gastrointestinal disorder, that affects approximately 10% of the general population and the majority are diagnosed in primary care. IBS has been reported to be associated with altered psychological and cognitive functioning such as mood disturbances, somatization, catastrophizing or altered visceral interoception by negative emotions and stress. The aim was to investigate the psychosocial constructs of self-esteem and sense of coherence among IBS patients compared to non-IBS patients in primary care. Methods A case–control study in primary care setting among IBS patients meeting the ROME III criteria (n = 140) compared to controls i.e. non-IBS patients (n = 213) without any present or previous gastrointestinal complaints. The data were collected through self-reported questionnaires of psychosocial factors. Results IBS-patients reported significantly more negative self-esteem (p < 0.001), lower scores for positive self-esteem (p < 0.001), and lower sense of coherence (p < 0.001) than the controls. The IBS-cases were also less likely to report ‘good’ health status (p < 0.001) and less likely to report a positive belief in the future (p < 0.001). After controlling for relevant confounding factors in multiple regressions, the elevation in negative self-esteem among IBS patients remained statistically significant (p = 0.02), as did the lower scores for sense of coherence among IBS cases (p = 0.04). Conclusions The more frequently reported negative self-esteem and inferior coping strategies among IBS patients found in this study suggest the possibility that psychological therapies might be helpful for these patients. However these data do not indicate the causal direction of the observed associations. More research is therefore warranted to determine whether these psychosocial constructs are more frequent in IBS patients.
Collapse
|
75
|
Markert C, Suarez-Hitz K, Ehlert U, Nater UM. Distress criterion influences prevalence rates of functional gastrointestinal disorders. BMC Gastroenterol 2014; 14:215. [PMID: 25518853 PMCID: PMC4284923 DOI: 10.1186/s12876-014-0215-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/09/2014] [Indexed: 12/15/2022] Open
Abstract
Background Functional gastrointestinal disorders (FGID) are defined by a combination of chronic or recurrent gastrointestinal symptoms. Prevalence rates of FGID are high. Symptoms are associated with distress, and sufferers show high stress levels. However, the current diagnostic criteria do not consider subjective distress elicited by the symptoms, thus potentially leading to overestimated prevalence rates. The aim of this study was to explore the reduction in prevalence rates when distress is considered in the diagnostic criteria. Methods In this web-based study, FGID were diagnosed using the Rome II criteria. Prevalence rates with and without subjective distress elicited by the symptoms were computed. Additionally, stress levels and stress reactivity were assessed. Results Prevalence rates of FGID in our sample were similar to those in other studies. However, when considering the distress criterion, on average, a decrease of 38.51% was found in the prevalence rates of FGID. Sufferers who were subjectively distressed by their symptoms reported significantly higher stress levels than non-distressed subjects (all p < 0.001). Conclusions The consideration of a criterion of subjective distress in the diagnosis of FGID has consequences for actual prevalence rates of FGID. Distressed subjects differ markedly from non-distressed subjects in terms of their stress levels. The inclusion of a distress criterion in the ongoing development of diagnostic criteria for FGID is therefore warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12876-014-0215-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Charlotte Markert
- Department of Psychology, University of Marburg, Gutenbergstrasse 18,35037, Marburg, Germany.
| | - Kerstin Suarez-Hitz
- Department of Psychology, University of Zurich, Binzmühlestrasse 14,8050, Zurich, Switzerland.
| | - Ulrike Ehlert
- Department of Psychology, University of Zurich, Binzmühlestrasse 14,8050, Zurich, Switzerland.
| | - Urs M Nater
- Department of Psychology, University of Marburg, Gutenbergstrasse 18,35037, Marburg, Germany.
| |
Collapse
|
76
|
Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2014; 264:651-60. [PMID: 24705634 DOI: 10.1007/s00406-014-0502-z] [Citation(s) in RCA: 367] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/26/2014] [Indexed: 12/17/2022]
Abstract
Irritable bowel syndrome (IBS) has been associated with high prevalence of psychological disorders. However, it remains unclear whether IBS and each of its subtypes (predominant diarrhea IBS-D, constipation IBS-C, mixed IBS-M) are associated with higher anxiety and depressive symptoms levels. This study aimed to determine the associations of IBS and each of its subtypes with anxiety and/or depression. We conducted a systematic review and meta-analysis using five electronic databases (PubMed, PsychINFO, BIOSIS, Science Direct, and Cochrane CENTRAL). We selected case-control studies comparing anxiety and depression levels of patients with IBS to healthy controls, using standardized rating scales. Outcomes were measured as random pooled standardized mean differences (SMD). Ten studies were included in our analysis (885 patients and 1,384 healthy controls). Patients with IBS had significant higher anxiety and depression levels than controls (respectively, SMD = 0.76, 95 % CI 0.47; 0.69, p < 0.01, I2 = 81.7 % and SMD = 0.80, 95 % CI 0.42; 1.19, p < 0.01, I2 = 90.7 %). This significant difference was confirmed for patients with IBS-C and -D subtypes for anxiety, and only in IBS-D patients for depression. However, other IBS subtypes had a statistical trend to be associated with both anxiety and depressive symptomatology, which suggests a lack of power due to the small number of studies included. Patients with IBS had significantly higher levels of anxiety and depression than healthy controls. Anxiety and depression symptomatology should be systematically checked and treated in IBS patients, as psychological factors are important moderators of symptom severity, symptom persistence, decisions to seek treatment, and response to treatment.
Collapse
|
77
|
Abstract
IBS is estimated to have a prevalence of up to 20% in Western populations and results in substantial costs to health-care services worldwide, estimated to be US$1 billion per year in the USA. IBS remains difficult to diagnose due to its multifactorial aetiology, heterogeneous nature and overlap of symptoms with organic pathologies, such as coeliac disease and IBD. As a result, IBS often continues to be a diagnosis of exclusion, resulting in unnecessary investigations. Available methods for the diagnosis of IBS-including the current gold standard, the Rome III criteria-perform only moderately well. Visceral hypersensitivity and altered pain perception do not discriminate between IBS and other functional gastrointestinal diseases or health with any great accuracy. Attention has now turned to developing novel biomarkers and using psychological markers (so-called psychomarkers) to aid the diagnosis of IBS. This Review describes how useful symptoms, symptom-based criteria, biomarkers and psychomarkers, and indeed combinations of all these approaches, are in the diagnosis of IBS. Future directions in diagnosing IBS could include combining demographic data, gastrointestinal symptoms, biomarkers and psychomarkers using statistical methods. Latent class analysis to distinguish between IBS and non-IBS symptom profiles might also represent a promising avenue for future research.
Collapse
|
78
|
De Palma G, Collins SM, Bercik P, Verdu EF. The microbiota-gut-brain axis in gastrointestinal disorders: stressed bugs, stressed brain or both? J Physiol 2014; 592:2989-97. [PMID: 24756641 PMCID: PMC4214655 DOI: 10.1113/jphysiol.2014.273995] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/17/2014] [Indexed: 12/29/2022] Open
Abstract
The gut-brain axis is the bidirectional communication between the gut and the brain, which occurs through multiple pathways that include hormonal, neural and immune mediators. The signals along this axis can originate in the gut, the brain or both, with the objective of maintaining normal gut function and appropriate behaviour. In recent years, the study of gut microbiota has become one of the most important areas in biomedical research. Attention has focused on the role of gut microbiota in determining normal gut physiology and immunity and, more recently, on its role as modulator of host behaviour ('microbiota-gut-brain axis'). We therefore review the literature on the role of gut microbiota in gut homeostasis and link it with mechanisms that could influence behaviour. We discuss the association of dysbiosis with disease, with particular focus on functional bowel disorders and their relationship to psychological stress. This is of particular interest because exposure to stressors has long been known to increase susceptibility to and severity of gastrointestinal diseases.
Collapse
Affiliation(s)
- Giada De Palma
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stephen M Collins
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Premysl Bercik
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Elena F Verdu
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
79
|
Taft TH, Riehl ME, Dowjotas KL, Keefer L. Moving beyond perceptions: internalized stigma in the irritable bowel syndrome. Neurogastroenterol Motil 2014; 26:1026-35. [PMID: 24832499 PMCID: PMC8569739 DOI: 10.1111/nmo.12357] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/07/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Internalized stigma (IS) is an important construct in the chronic illness literature with implications for several patient reported outcomes. To date, no study exists evaluating IS in patients with the irritable bowel syndrome (IBS). METHODS Two hundred and forty three online and clinical participants completed the following questionnaires: the IS scale for mental illness (ISMI; modified for IBS), perceived stigma scale for IBS, NIH-PROMIS Anxiety and Depression Scales, IBS quality of life scale, and the Perceived Health Competence Scale. Demographical and clinical data were also collected. KEY RESULTS The modified ISMI was reliable and valid in this population. Participants reported both perceived and IS. Alienation was most reported, followed by social withdrawal and discrimination experiences. IS predicted 25-40% of the variance in psychological functioning, quality of life, healthcare utilization, and health competence when controlling for stigma perception and disease variables. IBS patients perceived more stigma from personal relations than healthcare providers. Hispanic participants reported more perceived stigma, indicating there may be cultural differences in IBS-related stigma experience. Symptom severity, disruptiveness, and treatment choices are also implicated in stigma perception and internalization. CONCLUSIONS & INFERENCES Patients with IBS report both perceived and IS with alienation most reported. However, IS significantly predicts several patient outcomes when controlling for PS. Cultural and illness traits may influence how stigma is perceived and internalized. Future research is warranted.
Collapse
Affiliation(s)
- T. H. Taft
- Center for Psychosocial Research in GI; Feinberg School of Medicine Division of Gastroenterology & Hepatology; Northwestern University; Chicago IL USA
| | - M. E. Riehl
- Center for Psychosocial Research in GI; Feinberg School of Medicine Division of Gastroenterology & Hepatology; Northwestern University; Chicago IL USA
| | - K. L. Dowjotas
- Center for Psychosocial Research in GI; Feinberg School of Medicine Division of Gastroenterology & Hepatology; Northwestern University; Chicago IL USA
| | - L. Keefer
- Center for Psychosocial Research in GI; Feinberg School of Medicine Division of Gastroenterology & Hepatology; Northwestern University; Chicago IL USA
| |
Collapse
|
80
|
Hausteiner-Wiehle C, Henningsen P. Irritable bowel syndrome: Relations with functional, mental, and somatoform disorders. World J Gastroenterol 2014; 20:6024-6030. [PMID: 24876725 PMCID: PMC4033442 DOI: 10.3748/wjg.v20.i20.6024] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/19/2014] [Indexed: 02/06/2023] Open
Abstract
This review describes the conceptual and clinical relations between irritable bowel syndrome (IBS), other functional, somatoform, and mental disorders, and points to appropriate future conceptualizations. IBS is considered to be a functional somatic syndrome (FSS) with a considerable symptom overlap with other FSSs like chronic fatigue syndrome or fibromyalgia syndrome. IBS patients show an increased prevalence of psychiatric symptoms and disorders, especially depression and anxiety. IBS is largely congruent with the concepts of somatoform and somatic symptom disorders. Roughly 50% of IBS patients complain of gastrointestinal symptoms only and have no psychiatric comorbidity. IBS concepts, treatment approaches, as well as health care structures should acknowledge its variability and multidimensionality by: (1) awareness of additional extraintestinal and psychobehavioral symptoms in patients with IBS; (2) general and collaborative care rather than specialist and separated care; and (3) implementation of “interface disorders” to abandon the dualistic classification of purely organic or purely mental disorders.
Collapse
|
81
|
Barello S, Leone D, Danese S, Vegni E. Inflammatory bowel diseases and psychological issues: A new approach for a systematic analysis of the academic debate. PSYCHOL HEALTH MED 2013; 19:559-71. [DOI: 10.1080/13548506.2013.855317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Serena Barello
- Faculty of Psychology, Università Cattolica del Sacro Cuore, Milano, Italy
| | - Daniela Leone
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Silvio Danese
- Division of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milano, Italy
| | - Elena Vegni
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|