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. 2014 Jan;26(1):36-45.
doi: 10.1111/nmo.12220. Epub 2013 Aug 29.

Characterization of symptoms in irritable bowel syndrome with mixed bowel habit pattern

A M Su  1 , W Shih, A P Presson, L Chang
Affiliations

Characterization of symptoms in irritable bowel syndrome with mixed bowel habit pattern

A M Su et al. Neurogastroenterol Motil. 2014 Jan.

Abstract

Background: Irritable bowel syndrome (IBS) with mixed bowel habits (IBS-M) is a heterogeneous subtype with varying symptoms of constipation and diarrhea, and has not been well characterized. We aimed to characterize gastrointestinal (GI) and non-GI symptoms in IBS-M patients from a US patient population, and to compare them with IBS with constipation (IBS-C) and diarrhea (IBS-D).

Methods: Subjects answering community advertisements and meeting Rome III criteria for IBS completed symptom questionnaires.

Key results: Of the initial 289 IBS patients identified, one third (n = 51, 32.5%) who met Rome III criteria for IBS-M endorsed having either loose stools or hard stools due to medication. These patients had more severe symptoms and longer duration of flares compared to the rest of the IBS-M group (p = 0.014, p = 0.005). Excluding IBS-M patients with medication-related extremes in stool form who could not be reclassified by medical history, 247 IBS patients were assessed. IBS-M was the most common (44.1%), followed by IBS-C (27.9%), IBS-D (26.3%), and IBS-U (unsubtyped, 1.6%). While IBS-M shared symptoms with both IBS-C and IBS-D, there were significant differences in the prevalence of bowel habit symptoms (p-value range: <0.001-0.002). IBS-M patients reported most bothersome symptoms that were more similar to IBS-D, with the most common being irregular bowel habits (27.5%), bloating (26.6%), and abdominal pain (20.2%). There were no differences in non-GI symptoms between subtypes.

Conclusions & inferences: IBS-M is a heterogeneous symptom group and thus requires that subclassification criteria be better defined. Use of laxative/antidiarrheal medications adds to the diagnostic complexity in a potentially more severe subset of IBS-M and should be assessed for accurate subclassification.

Keywords: abdominal pain; constipation; diarrhea; irritable bowel syndrome; mixed bowel habits.

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Conflict of interest statement

Potential Competing Interests: None

Conflict of Interest/Study Support: Guarantor of the article: Lin Chang

Figures

Figure 1
Figure 1
Flowchart depicting subjects selection and sample sizes for each analysis. Dashed boxes indicate groups included in each of the separate analyses: IBS-M medication group assessment and final IBS subtype characterizations.
Figure 2
Figure 2
Frequency of associated bowel habit symptoms compared across subtypes (IBS-C, IBS-D, and IBS-M). All symptoms included were found to be significantly different among subtypes (p-value range =<0.001 to 0.002). Bowel movements less than three times a week, bowel movements more than three times a day, straining with defecation, incomplete evacuation, need for manual evacuation after defecation, and difficulty relaxing to let stool come out.
Figure 3
Figure 3
Frequency of typical symptoms IBS subjects reported to experiencing on a usual basis. There was a significant difference among subtypes for reporting urgency (p<0.001) and a trend for a difference in nausea (p = 0.014).
Figure 4
Figure 4
Frequency of the single most bothersome symptom identified by each subject and compared across subtypes (IBS-C, IBS-D, IBS-M). There were differences among IBS subtypes across all symptoms (p<0.001).
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