Irritable bowel syndrome (IBS) is a chronic disorder of the gastrointestinal tract characterized by frequent abdominal pain and abnormal bowel habits. IBS affects 15 percent of the general adult population, results in 3.6 million physician visits annually, and costs more than $8 billion per year. Patients with IBS have worse health-related quality of life (HRQOL) than patients with diabetes or severe kidney disease, the article states. However, data suggest that many physicians do not adequately assess the impact of IBS symptoms and non-disease-related symptoms on their patients' lives and health status.
Brennan M. R. Spiegel, M.D., M.S.H.S., of The David Geffen School of Medicine at the University of California, Los Angeles, and colleagues identified several factors that play a role in the HRQOL in patients with IBS.
The researchers examined 770 patients, 18 years and older (69.1 percent female), with IBS at a university-based referral center. Participants completed a 90-item questionnaire on their symptoms, and a 36-item health survey.
The researchers found seven factors were related to patients' HRQOL: making more than five physician visits per year, tiring easily, low energy, severe symptoms, predominantly painful symptoms, feeling that there is "something seriously wrong with my body," and symptom flares lasting longer than 24 hours. The researchers found that eight factors were related to mental HRQOL: feeling tense, feeling nervous, feeling hopeless, difficulty sleeping, tiring easily, low sexual interest, IBS symptoms interfering with sexual function, and low energy.
"... we have identified specific clinical predictors of mental and physical HRQOL that may facilitate efficient assessment and targeted treatment in patients with IBS," the researchers write. "Whereas physical HRQOL is associated with symptom severity, symptom periodicity, and pain, mental HRQOL is associated with abnormalities in sexuality, mood, and anxiety."
"These findings suggest that rather than focusing on physiological epiphenomena (stool characteristics and subtype of IBS) and potentially misleading clinical factors (age and disease duration), physicians might be better served to gauge global symptom severity, address anxiety, and eliminate factors contributing to chronic stress in patients with IBS."
(Arch Intern Med. 2004;164:1773-1780. Available post-embargo at archinternmed.com) Editor's Note: This study was supported by a training grant (Dr. Spiegel), a Career Development Award (Drs. Dulai and Mayer), and a grant from the National Institutes of Health, Bethesda, Md., and by an Advanced Career Development Award from the VA HSR&D, Washington, DC (Dr. Gralnek).
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Journal
Archives of Internal Medicine