Irritable Bowel Syndrome Symptoms in Nonalcoholic Fatty Liver Disease Patients Are an Indicator of Depression and Anxiety

ClinGastroenterol. 2023NovDec;57(10):10161023. doi:10.1097/MCG.0000000000001770.Epub 2022 Oct 10.


Lissa Franco 1Michelle Jones-Pauley 2Omar Tamimi 2Leila Neshatian 3Duc Nguyen 4Edward Graviss 4Eamonn Mm Quigley 5 2David Victor 3rd 5 6 2


Author information

1Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.

2Department of Medicine, Houston Methodist Hospital.

3Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.

4Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Research Institute, Houston, TX.

5Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology.

6Sherrie and Alan Conover Center for Liver Disease and Transplantation.


Goals: Determine factors associated with Irritable bowel syndrome (IBS) in nonalcoholic fatty liver disease (NAFLD) patients.

Background: IBS affects 10% to 15% of the adult population worldwide and is linked to anxiety and depression. The impact of IBS-type symptoms in NAFLD patients is not well described.

Study: A cross-sectional study of patients in the hepatology clinic at Houston Methodist Hospital was performed based on a respondent postal survey. IBS was defined by the Rome IV questionnaire, anxiety and depression were assessed with the Hospital Anxiety Depression scale. Patients with inflammatory bowel disease, colorectal carcinoma, or small bowel tumors were excluded. Patients were divided based on Rome IV diagnostic criteria for IBS and Hospital Anxiety Depression scale.

Results: 130 patients were included in the analysis, 38 satisfied Rome IV criteria for IBS (IBS group) versus 92 who did not (non-IBS group). Depression was more prevalent in the IBS group (18.4% vs 5.4%, P =0.01). Anxiety was also greater in the IBS group (31.6% vs 9.8%, P =0.002). Female sex, depression, and body mass index (BMI)>30 were independent predictors of IBS in NAFLD in 4 multiple logistic regression models. In newly diagnosed IBS patients, gamma-glutamyl transferase levels were lower (67.5 vs 28, P =0.04). Current abdominal pain was higher than 100% versus 81.3% ( P =0.045), as was pain associated with the change in stool frequency (96.3% vs 50%; P <0.001).

Conclusion: Our study highlights the increased rate of IBS symptoms, depression, and anxiety in patients with NAFLD. Clinicians should be alert when IBS symptoms are reported by a NAFLD patient and be aware of the impact of these comorbidities on quality of life and response to therapy.

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