What level of IBS symptoms drives impairment in health-related quality of life in community subjects with irritable bowel syndrome? : Are current IBS symptom thresholds clinically meaningful? (original) (raw)
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Clinical Determinants of Health-Related Quality of Life in Patients With Irritable Bowel Syndrome
Archives of Internal Medicine, 2004
Background: Current guidelines recommend routine assessment of health-related quality of life (HRQOL) in patients with irritable bowel syndrome (IBS). However, physicians rarely have the time to measure HRQOL with the appropriate methodological rigor, and data suggest that HRQOL in patients with IBS is often estimated using inaccurate clinical gestalt. The identification of predictive factors could allow physicians to better assess HRQOL without using misleading clinical clues. We, therefore, sought to identify determinants of HRQOL in patients with IBS.
Symptom Differences in Moderate to Severe Ibs Patients Based on Predominant Bowel Habit
American Journal of Gastroenterology, 1999
OBJECTIVE: We sought to determine if irritable bowel syndrome (IBS) patients with different bowel habit predominance differ in self-reported viscerosensory symptoms related to the upper and lower gastrointestinal (GI) tract, somatosensory symptoms, and constitutional functions. METHODS: Six hundred and twenty-five Rome criteria-positive IBS patients completed a bowel symptom questionnaire (BSQ), psychological symptom checklist (SCL-90), and health status (SF-36). Bowel habit predominance for IBS patients was determined using the Rome criteria for functional constipation (IBS-C; n ϭ 140) and functional diarrhea (IBS-D; n ϭ 216). The BSQ included questions about viscerosensory symptoms of the upper (chest pressure, bloating, fullness, early satiety, nausea) and lower GI tract (bloating, pain, incomplete evacuation), somatosensory symptoms related to the musculoskeletal system (pain in neck/shoulders, lower back/hip, muscles/joints), and constitutional functions (sleep, appetite, libido). Analysis was further conducted between the IBS-C and IBS-D patients, controlling for gender and quality of sleep, and using the Bonferroni correction to control for multiple comparisons. RESULTS: Female gender was more prevalent among IBS-C than IBS-D (77% vs 56.1%, p Ͻ 0.01), whereas age did not differ (40.2 Ϯ 1.2 yr vs 39.5 Ϯ 1.0 yr). Symptoms referred to the upper GI were more prevalent in IBS-C than IBS-D: early satiety (56.7% vs 33.9%, p Ͻ 0.004), fullness (63.2% vs 38.5%, p Ͻ 0.05), and a trend for upper bloating (80.3 vs 62.6%). IBS-C patients reported higher severity ratings for lower GI bloating (p Ͻ 0.001). IBS-C more commonly reported musculoskeletal symptoms (92.2% vs 75.4%, p Ͻ 0.001), as well as impairment in sleep (31.3 vs 17.5%, p Ͻ 0.009), appetite (35.0% vs 18.4%, p Ͻ 0.015) and sexual function (45.2% vs 33.1%, p Ͻ 0.0021). There were no differences in SCL-90 and SF-36 scores. CONCLUSIONS: Compared with the IBS-D group, the IBS-C patients show greater prevalence of a wide range of symptoms referred to the upper and lower abdomen, musculoskeletal, and constitutional functions. These findings may be related to differences in autonomic or perceptual responses to visceral and somatic stimuli, and are likely to have implications for treatment responses in the two subgroups.
The IBS-36: a new quality of life measure for irritable bowel syndrome
2002
OBJECTIVE: We aimed to develop and validate a quality of life instrument for patients with irritable bowel syndrome (IBS). METHODS: Using focus groups, existing questionnaires, and literature reviews, five IBS patients and nine gastroenterologists compiled and pilot tested for content validity a 70item questionnaire. The questionnaire was then administered to 107 IBS patients, and using these data, the 70-item questionnaire was reduced to 36 questions through statistical and consensus methodology. The IBS-36 questionnaire was tested for construct validity, reliability, reproducibility, and responsiveness using a gold standard of structured interviews by three gastroenterologists, the Medical Outcomes Study Short Form Quality of Life Questionnaire, and the Coping Resource Inventory. RESULTS: The IBS-36 consists of 36 questions scored on a 7-point Likert scale. It has a very high internal consistency (Cronbach's ␣ ϭ 0.95) and a high test-retest reliability (Spearman's r ϭ 0.92) and correlates as hypothesized with the Medical Outcomes Study Short Form Quality of Life Questionnaire (p Ͻ 0.001), McGill pain scores (p Ͻ 0.001), and IBS patient-reported sleep, symptom, and pain scores (ps ϭ 0.030, Ͻ0.001, and Ͻ0.001, respectively). CONCLUSIONS: The IBS-36 addresses all areas of quality of life affected by IBS and is easy to administer and score. The IBS-36 is a well-validated, condition-specific quality of life measure for IBS patients that is sensitive to clinical intervention and highly correlated with established quality of life measures and patient-reported symptom scores.
Pain, 2008
Irritable bowel syndrome (IBS) affects up to 22% of the general population. Its aetiology remains unclear. Previously reported cross-sectional associations with psychological distress and depression are not fully understood. We hypothesised that psychosocial factors, particularly those associated with somatisation, would act as risk markers for the onset of IBS. We conducted a community-based prospective study of subjects, aged 25-65 years, randomly selected from the registers of three primary care practices. Responses to a detailed questionnaire allowed subjects' IBS status to be classified using a modified version of the Rome II criteria. The questionnaire also included validated psychosocial instruments. Subjects free of IBS at baseline and eligible for follow-up 15 months later formed the cohort for this analysis (n = 3732). An adjusted participation rate of 71% (n = 2456) was achieved at follow-up. 3.5% (n = 86) of subjects developed IBS. After adjustment for age, gender and baseline abdominal pain status, high levels of illness behaviour (odds ratio (OR) = 5.2; 95% confidence interval (95% CI) 2.5-11.0), anxiety (OR = 2.0; 95% CI 0.98-4.1), sleep problems (OR = 1.6; 95% CI 0.8-3.2), and somatic symptoms (OR = 1.6; 95% CI 0.8-2.9) were found to be independent predictors of IBS onset. This study has demonstrated that psychosocial factors indicative of the process of somatisation are independent risk markers for the development of IBS in a group of subjects previously free of IBS. Similar relationships are observed in other "functional" disorders, further supporting the hypothesis that they have similar aetiologies.
Quality of Life in Patients With Irritable Bowel Syndrome
Journal of Clinical Gastroenterology, 2011
Background: Quality of life (QOL) is reduced in patients with irritable bowel syndrome (IBS) and little is known about differences in QOL in relation to referral status, gender and predominant bowel pattern in IBS patients. This study aimed to explore these relationships. Methods: 343 patients with IBS according to the Rome I criteria (251 females, 92 males) completed ve different self-administered questionnaires to evaluate QOL. There were 119 patients with diarrhea-predominant IBS (IBS-D), 93 with constipationpredominant IBS (IBS-C) and 131 with alternating constipation and diarrhea (IBS-A). The study group comprised 209 hospital outpatients and 134 primary care patients. The questionnaires were mailed to the patients with an overall response rate of 88%. Results: QOL was reduced in hospital outpatients compared to primary care patients, but only in females. IBS subgroup (IBS-D), physical fatigue and general health independently predicted referral to a gastroenterologist. Females had lower QOL than males. No differences, except in severity of diarrhea and constipation, were observed between IBS subgroups. Perceived fatigue was related to well-being, psychological and gastrointestinal symptoms. Independent predictors for fatigue were depression, trait anxiety, general health and vitality, along with eating dysfunction and female sex. Conclusion: IBS female patients seen in referral centers versus primary care is a highly selected group with reduced QOL. QOL in IBS is affected by gender, but not by subgroup. Our ndings have implications for the generalizability of results in IBS trials. Fatigue is a common symptom in IBS that correlates to general well-being and psychological and subjective gastrointestinal symptoms.
Gastroentérologie Clinique et Biologique, 2004
Aims-Heath-related quality of life (QoL) is decreased in patients with irritable bowel syndrome (IBS) but the relationship between symptom intensity of IBS and QoL remains largely unknown. The aim of this prospective survey was to investigate the relationship between intensity of IBS and changes in QoL. Methods-Eight hundred and fifty-eight patients with IBS, according to Rome II criteria, completed a symptom questionnaire to measure intensity of IBS, and the gastrointestinal quality of life (GIQLI) questionnaire, which is a general QoL measure in patients with gastrointestinal disorders. Results-37.2% of the patients had constipation-predominant type IBS, 37.3% had diarrhea-predominant IBS and 25.4% had alternating diarrhea and constipation type symptoms. IBS was considered to be in remission or mild in 8.3% of patients; 41.3% had moderate IBS and 50.4% had severe IBS. The mean GIQLI score was 88 ± 20. There was a significant correlation between symptom intensity and changes in QoL. Other significantly related factors were the type of bowel abnormality and gender. Conclusion-In IBS patients, symptom intensity and type of IBS have a negative impact on health-related QoL. RÉSUMÉ Relations entre la sévérité et la qualité de vie chez 858 malades ayant un syndrome de l'intestin irritable
The American journal of gastroenterology, 2013
Despite the fact that food and diet are central issues, that concern patients with irritable bowel syndrome (IBS), the current understanding about the association between the intake of certain foods/food groups and the gastrointestinal (GI) symptom pattern, psychological symptoms, and quality of life is poor. The aim of this study was to determine which food groups and specific food items IBS patients report causing GI symptoms, and to investigate the association with GI and psychological symptoms and quality of life. We included 197 IBS patients (mean age 35 (18-72) years; 142 female subjects) who completed a food questionnaire in which they specified symptoms from 56 different food items or food groups relevant to food intolerance/allergy. The patients also completed questionnaires to assess depression and general anxiety (Hospital Anxiety and Depression), GI-specific anxiety (Visceral Sensitivity Index), IBS symptoms (IBS-Severity Scoring System), somatic symptoms (Patient Health...