MONTREAL — Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Douglas A. Drossman, M.D., said at the 13th World Congress of Gastroenterology.
Such factors “should be looked at in the first visit because in some cases it might prevent you from doing unnecessary tests” in patients with IBS, he said in an interview. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically.”
In a study of 211 patients with moderate and severe functional bowel syndrome, Dr. Drossman found that major depression was more pronounced in patients with severe symptoms than in those with moderate symptoms (12.5 vs. 9.3 on the Beck Depression Inventory). Poor coping responses like “catastrophizing” were more common in patients with severe symptoms, compared with patients with moderate symptoms (12.9 vs. 8.2 on the Coping Strategies Questionnaire) (Am. J. Gastroenterol. 2000;95:974–80).
The study also showed that compared with patients with milder symptoms, those with more severe symptoms felt that they had less control of their symptoms (2.2 vs. 2.6 on the Coping Strategies Questionnaire) and reported having a significantly poorer quality of life (58.5 versus 69.3 overall score on the IBS Quality of Life questionnaire). “There is also a higher frequency of sexual, physical, or emotional abuse in those with more severe symptoms,” said Dr. Drossman, codirector of the University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill.
Studies suggest that 5%–40% of IBS patients have severe symptoms, and 25%–50% have moderate symptoms. “If you are in a primary care setting, your severe group will be much smaller—maybe 5%—but if you're in a major referral center, you are going to see 50%–60% severe patients,” he said.
The precise relationship between functional bowel disorders and psychosocial disorders is unclear, Dr. Drossman said. Some theories are that comorbid psychosocial factors may affect perception of physical experiences; stress can lower the pain threshold and produce other GI symptoms; and psychosocial disturbances may increase pain perception via functional changes in the brain's pain modulation center.