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. 2020 Apr 26;20(1):127.
doi: 10.1186/s12876-020-01252-9.

Impact of symptom severity in patients with diarrhoea-predominant irritable bowel syndrome (IBS-D): results from two separate surveys of HCPs and patients with IBS-D

Anton Emmanuel  1 , Richard William Goosey  2 , Gwen Wiseman  3 , Stephen Baker  4 , Hans Törnblom  5
Affiliations

Impact of symptom severity in patients with diarrhoea-predominant irritable bowel syndrome (IBS-D): results from two separate surveys of HCPs and patients with IBS-D

Anton Emmanuel et al. BMC Gastroenterol. .

Abstract

Background: Management of diarrhoea-predominant irritable bowel syndrome (IBS-D) is generally based on patient-reported symptoms; however, limited information on symptom severity exists. The objective of the study was to assess the impact of IBS-D severity on patient burden and patient and healthcare professional attitudes towards IBS.

Methods: We conducted two web-based surveys of healthcare professionals and patients from Australia, Canada and Europe. We analysed patient characteristics and attitudes by IBS-D severity, which was assessed retrospectively using a composite of four variables: worst abdominal pain, IBS symptom frequency, Bristol Stool Form Scale and quality of life.

Results: Of 679 healthcare professional respondents, one-third routinely classified patients by severity. The patient survey was completed by 513 patients with mild (26%), moderate (33%) and severe (41%) IBS-D, classified using the composite scale. Age, sex and treatment satisfaction did not change with severity; however, 19% of patients classified with severe IBS-D agreed with the statement: 'When my IBS is bad, I wish I was dead' versus 4 and 7% of patients with mild and moderate IBS-D, respectively (p < 0.05). Significantly more patients classified with severe IBS-D reported medication use versus mild IBS-D.

Conclusion: Compared with milder symptoms, severe IBS-D was associated with increased medication use and a negative perspective of IBS-D. This highlights the need for a validated severity scale to inform treatment decisions.

Keywords: Diarrhoea-predominant irritable bowel syndrome; Gastrointestinal symptom rating scale; IBS; Outcomes research; Patient-reported outcomes.

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Conflict of interest statement

AE is supported by the UCL/UCLH Biomedical Research Centre and has served on advisory boards for Allergan plc, Almirall, Shire and Takeda. RWG is an employee of Kantar Health, which received study funding from Allergan plc. GW is a former employee of Allergan plc. SB is an employee of Allergan plc. HT has served on advisory boards for Almirall, Allergan plc and Shire, and has acted as a speaker for Shire, Allergan plc, Almirall and Tillotts.

Figures

Fig. 1
Fig. 1
Criteria for the determination of IBS-D severity by WAP, frequency of symptoms, BSFS and QoL. Cut-offs for severity levels were arbitrary and based on clinical experience; frequency was based on the number of days with IBS symptoms. BSFS Bristol Stool Form Scale; IBS irritable bowel syndrome; IBS-D diarrhoea-predominant irritable bowel syndrome; QoL quality of life; WAP worst abdominal pain
Fig. 2
Fig. 2
Use of the BSFS and WAP scale in the management of patients with IBS-D. Based on responses to the question: ‘At what point, if at all, do you use the following scales in managing your IBS-D patients?’ (a) p < 0.05 for PCPs vs gastroenterologists unaware of the BSFS, only using the BSFS at initial assessment with patient, and using the BSFS at each consultation with patient before and after diagnosis. (b) p < 0.05 for PCPs vs gastroenterologists unaware of the WAP scale, aware of the WAP scale but not using, and using the WAP scale at each consultation with patient before and after diagnosis. BSFS Bristol Stool Form Scale; Gastro gastroenterologist; HCP healthcare professional; IBS-D diarrhoea-predominant irritable bowel syndrome; PCP primary care physician; WAP worst abdominal pain
Fig. 3
Fig. 3
Symptom patterns and most troublesome symptoms by IBS-D severity. (a) Symptom patterns over the past 3 months by IBS-D severity. p < 0.05 for all comparisons (mild vs severe and moderate vs severe; continual and intermittent). Based on responses to the question: ‘Which best describes the pattern of your IBS symptoms over the past 3 months?’ aDefined as experiencing some IBS symptoms every day. bDefined as having some days without any IBS symptoms. (b) Most troublesome symptoms currently experienced by IBS-D severity. Based on the first selected response to the question: ‘Which of the symptoms you currently experience trouble you the most?’ (bloating was not included as a potential response). *p < 0.05. IBS irritable bowel syndrome; IBS-D diarrhoea-predominant irritable bowel syndrome
Fig. 4
Fig. 4
Patients’ feelings about having IBS by IBS-D severity. Based on responses to the question: ‘How do you currently feel about having IBS?’ (a) Negative emotions associated with IBS. (b) Positive emotions associated with IBS. *p < 0.05. IBS irritable bowel syndrome; IBS-D diarrhoea-predominant irritable bowel syndrome
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