Patients With Irritable Bowel Syndrome Are Willing to Take Substantial Medication Risks for Symptom Relief

Clin Gastroenterol Hepatol. 2021 Jan;19(1):80-86. doi: 10.1016/j.cgh.2020.04.003.Epub 2020 Apr 11.

Shawn L Shah 1Nigeen H Janisch 2Michael Crowell 3Brian E Lacy 4


Author information

  • 1Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York. Electronic address: shawnlshah@gmail.com.
  • 2Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
  • 3Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona.
  • 4Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.


Background & aims: Irritable bowel syndrome (IBS) is a common chronic functional bowel disorder for which patients take significant risks to ameliorate symptoms. Unfortunately, there is no cure for IBS. We assessed the willingness of patients with IBS to take medication risks and the costs they would pay to improve symptoms.

Methods: We mailed a survey on medication risk to patients with IBS who met the Rome IV criteria. The survey collected data on patient demographics, symptoms, medication use, prior medication-averse events, and pain catastrophization. A standard gamble evaluated respondents' willingness to take medication risks, and a willingness-to-pay set of questions quantified maximal spending on a hypothetical medication to treat IBS.

Results: Among respondents (n = 215; 81.8% female; mean age, 57 y) the average duration of IBS symptoms was 17.7 years. Patients whose predominant symptom was severe diarrhea (diarrhea-predominant IBS) reported accepting a mean 10.2% ± 15.7% risk of sudden death for a 99% chance of cure. Pain catastrophizing scale scores were not associated with an increased likelihood of taking medication risks. Patients with IBS would be willing to pay an average amount of $73 per month (if annual income was <$75,000) and $197 per month (if annual income was >$75,000) for a medication that would resolve their pain.

Conclusions: In a survey of 215 patients with IBS, we found that patients with diarrhea-predominant IBS are willing to take extraordinary risks to improve their symptoms, whereas patients with IBS and pain catastrophization are not. Clinician understanding of patients' willingness to take medication risks might help them guide their patients through complex therapeutic options.

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