Document Detail


Predictors of patient-assessed illness severity in irritable bowel syndrome.
MedLine Citation:
PMID:  18637089     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Conceptual models suggest that "irritable bowel syndrome (IBS) severity" is a multidimensional outcome that is related to, yet distinct from, health-related quality of life (HRQOL). Existing severity questionnaires are largely based on physician rather than patient-based ratings. Since severity is a patient-centered outcome, it is essential that future instruments are based on patients' self-perceptions of severity. We measured patient-derived predictors of severity in a large cohort of IBS patients.
METHODS: We performed a cross-sectional analysis in 755 IBS patients recruited at a university-based center. Subjects completed a bowel symptom questionnaire, SCL-90, and SF-36. The main outcome was patient-assessed "overall severity of gastrointestinal symptoms," as measured on a 0-20 scale (20 = most severe). We first developed a conceptual model of IBS, and then performed bivariate analyses to identify biopsychosocial predictors of severity. We then entered significant predictors into a multivariable model to measure the independent association of each predictor with severity.
RESULTS: Six factors predicted severity: (a) abdominal pain rating (P < 0.001); (b) belief that "something serious is wrong with body" (P < 0.001); (c) straining with defecation (P= 0.001); (d) myalgias (P= 0.02); (e) urgency with defecation (P= 0.03); and (f) bloating (P= 0.05). Severity correlated highly with HRQOL in bivariate, but not multivariate, analysis.
CONCLUSION: Patient-derived severity in IBS is related to, yet distinct from, generic HRQOL. IBS severity is predicted by abdominal pain, bloating, straining, urgency, myalgias, and disease-related concern. These symptoms fall along both poles of the "brain-gut axis," indicating that a full assessment of patient severity must include a balanced biopsychosocial history.
Authors:
Brennan Spiegel; Amy Strickland; Bruce D Naliboff; Emeran A Mayer; Lin Chang
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-06-12
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  103     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-15     Completed Date:  2008-10-28     Revised Date:  2014-09-21    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2536-43     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Abdominal Pain / diagnosis,  epidemiology,  etiology*
Cross-Sectional Studies
Female
Humans
Incidence
Irritable Bowel Syndrome / complications*,  diagnosis
Male
Middle Aged
Pain Measurement
Prognosis
Quality of Life*
Questionnaires
Retrospective Studies
Severity of Illness Index*
Grant Support
ID/Acronym/Agency:
1 R24AT002681-NCCAM/AT/NCCAM NIH HHS; 2P30DK041301-17/DK/NIDDK NIH HHS; P50 DK064539-019001/DK/NIDDK NIH HHS; P50 DK64539/DK/NIDDK NIH HHS; R24 AT002681/AT/NCCAM NIH HHS; R24 AT002681-01/AT/NCCAM NIH HHS
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