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 told this newspaper. “Even more important than that, it gives you the whole package of what's going on, both physically and psychologically. That can affect your diagnostic and treatment approach,” he added.
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 versus 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 versus 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 versus 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.
The precise relationship between functional bowel disorders and psychosocial disorders is unclear, he said.
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 cingulated cortex, the brain's pain modulation center.