Cumulative Effects of Psychologic Distress, Visceral Hypersensitivity, and Abnormal Transit on Patient-reported Outcomes in Irritable Bowel Syndrome

Simrén M1, Törnblom H2, Palsson OS3, Van Oudenhove L4, Whitehead WE3, Tack J4. Gastroenterology. 2019 Apr 22. pii: S0016-5085(19)36712-5. doi: 10.1053/j.gastro.2019.04.019. [Epub ahead of print]


Author information

1 University of Gothenburg, Gothenburg, Sweden; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: magnus.simren@medicine.gu.se.

2 University of Gothenburg, Gothenburg, Sweden.

3 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

4 Katholieke Universiteit Leuven, Leuven, Belgium.


BACKGROUND & AIMS: Little is known about the link between pathophysiologic factors and symptoms of irritable bowel syndrome(IBS), or whether these factors have cumulative effects on patient-reported outcomes (PROs). We investigated whether pathophysiologic alterations associated with IBS have cumulative or independent effects on PROs.

METHODS: We performed a retrospective analysis of data from 3 cohorts of patients with IBS (n=407; 74% female; mean age, 36±12 years), based on Rome II or Rome III criteria, seen at a specialized unit for functional gastrointestinal disorders in Sweden from 2002 through 2014. All patients underwent assessments of colonic transit time (radiopaque markers); compliance, allodynia and hyperalgesia (rectal barostat); anxiety and depression (HAD scale), as pathophysiologic factors. Dysfunction was defined by available normal values. PROs included IBS symptom severity, somatic symptom severity, and disease-specific quality of life (QOL).

RESULTS: Allodynia was observed in 36% of patients, hyperalgesia in 22%, accelerated colonic transit in 18%, delayed transit in 7%, anxiety in 52% and depression in 24% - each of these factors was associated with severity of at least 1 symptom of IBS. Rectal compliance was not associated with more severe symptoms of IBS. At least 3 pathophysiologic factors were present in 20% of patients, 2 in 30%, 1 in 31%, and none in 18%. With increasing number of pathophysiologic abnormalities, there was a gradual increase in IBS symptom severity (P<.0001) and somatic symptom severity (P<.0001), and a gradual reduction in QOL (P<.0001).

CONCLUSION: Visceral hypersensitivity, including allodynia and hyperalgesia, abnormal colonic transit, and psychologic factors are all associated with IBS symptoms. These factors have a cumulative effect on gastrointestinal and non-gastrointestinal symptoms, as well as on QOL, in patients with IBS and are therefore relevant treatment targets.

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