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. 2017 May;29(5):10.1111/nmo.13003.
doi: 10.1111/nmo.13003. Epub 2016 Dec 16.

Gastrointestinal symptom severity in irritable bowel syndrome, inflammatory bowel disease and the general population

A D Lee  1   2   3   4   5 , B M Spiegel  1   2   4   6   7 , R D Hays  3   7   8 , G Y Melmed  1 , R Bolus  4   6 , D Khanna  9 , P P Khanna  9 , L Chang  6   10
Affiliations

Gastrointestinal symptom severity in irritable bowel syndrome, inflammatory bowel disease and the general population

A D Lee et al. Neurogastroenterol Motil. 2017 May.

Abstract

Background: Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) patients report similar gastrointestinal (GI) symptoms, yet comparisons of symptom severity between groups and with the general population (GP) are lacking.

Methods: We compared Patient-Reported Outcomes Measurement Information System (PROMIS® ) GI symptom scales measuring gastro-esophageal reflux (GER), disrupted swallowing, diarrhea, bowel incontinence, nausea/vomiting, constipation, belly pain, and gas/bloating in: (i) USA GP sample, (ii) IBS patients, and (iii) IBD patients from tertiary care and community populations. Symptom severity scores were based on T-score metric with mean 50±10 (standard deviation) relative to the GP.

Key results: Of 1643 patients enrolled, there were 253 IBS patients (68% F, mean age 45±15 years), 213 IBD patients (46% F, mean age 41±14 years), and 1177 GP subjects (57% F, mean age 46±16 years). IBS patients reported greater severity of GER, disrupted swallowing, nausea/vomiting, belly pain, gas/bloating, and constipation symptoms than their IBD counterparts (all P<.05). Compared to the GP, IBD patients had worse belly pain, gas/bloating, diarrhea, and bowel incontinence, but less severe GER and disrupted swallowing (all P<.05), and IBS patients had more severe nausea/vomiting, belly pain, gas/bloating, and constipation (all P<.05). Women had more severe belly pain and gas/bloating than men, whereas men had more severe bowel incontinence (all P<.05).

Conclusion & inferences: IBS and IBD are associated with more severe GI symptoms compared to the GP excluding esophageal symptoms. Unlike IBD, IBS is not characterized by observable GI inflammation but patients report more severe upper and lower GI symptoms.

Keywords: gender; inflammatory bowel disease; irritable bowel syndrome; symptom severity.

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Figures

Figure 1
Figure 1. Gastrointestinal Subdomains Measured by the PROMIS® GI Symptom Scale
The eight symptom domains and the number of items in the GI PROMIS® questionnaire are shown.
Figure 2
Figure 2. Gastrointestinal Symptom Severity in Irritable Bowel Syndrome versus the General Population
The symptom domain scores for the general population (GP, gray box) and the Irritable Bowel Syndrome (IBS) patients (black box) are shown. The IBS patients had significantly higher scores (greater severity) for belly pain, gas/bloating, diarrhea, constipation, nausea and vomiting compared to the GP (all P<.05).
Figure 3
Figure 3. Gastrointestinal Symptom Severity in Inflammatory Bowel Disease versus the General Population
The symptom domain scores for the general population (GP, gray box) and the Inflammatory Bowel Disease (IBD) patients (white box) are shown. The IBD patients had significantly higher scores (greater severity) for belly pain, gas/bloating, diarrhea, bowel incontinence but lower severity scores for gastroesophageal reflux (GER) and difficulty swallowing compared to the GP (all P<.05).
Figure 4
Figure 4. Gastrointestinal Symptom Severity in Irritable Bowel Syndrome versus Inflammatory Bowel Disease
The symptom domain scores for the Irritable Bowel Syndrome (IBS) patients (black box) and the Inflammatory Bowel Disease (IBD) patients (white box) are shown. The IBS patients had significantly higher scores (greater severity) for belly pain, gas/bloating, constipation, gastroesophageal reflux (GER), difficulty swallowing and nausea and vomiting than the IBD patients (all P<.05).
See this image and copyright information in PMC

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