Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain?

Abstract

Background: The Rome IV criteria eliminated abdominal discomfort for irritable bowel syndrome (IBS), which was previously included in Rome III. There are questions as to whether IBS patients with abdominal discomfort (seen in Rome III but not Rome IV) are different from those with abdominal pain (Rome IV).

Aim: To compare bowel symptoms and psychosocial features in IBS patients diagnosed with Rome III criteria with abdominal discomfort, abdominal pain, and pain & discomfort.

Methods: We studied IBS patients meeting Rome III criteria. We administered the IBS symptom questionnaire, psychological status, and IBS quality of life. Patients were classified according to the predominant abdominal symptom associated with defecation into an only pain group, only discomfort group, and pain & discomfort group. We compared bowel symptoms, extraintestinal symptoms, IBS quality of life, psychological status and healthcare-seeking behaviors, and efficacy among the three groups. Finally, we tested risk factors for symptom reporting in IBS patients.

Results: Of the 367 Rome III IBS patients enrolled, 33.8% (124 cases) failed to meet Rome IV criteria for an IBS diagnosis. There were no meaningful differences between the pain group (n = 233) and the discomfort group (n = 83) for the following: (1) Frequency of defecatory abdominal pain or discomfort; (2) Bowel habits; (3) Coexisting extragastrointestinal pain; (4) Comorbid anxiety and depression; and (5) IBS quality of life scores except more patients in the discomfort group reported mild symptom than the pain group (22.9% vs 9.0%). There is a significant tendency for patients to report their defecatory and non-defecatory abdominal symptom as pain alone, or discomfort alone, or pain & discomfort (all P < 0.001).

Conclusion: IBS patients with abdominal discomfort have similar bowel symptoms and psychosocial features to those with abdominal pain. IBS symptoms manifesting abdominal pain or discomfort may primarily be due to different sensation and reporting experience.

Keywords: Abdominal discomfort; Abdominal pain; Diagnosis; Irritable bowel syndrome; Psychosocial distress; Quality of life.

Figure 1

Constitution diagram of irritable bowel syndrome patients diagnosed with Rome III and Rome IV criteria. About one-third of irritable bowel syndrome patients (parts dragged out of ring) diagnosed with Rome III criteria failed in irritable bowel syndrome diagnosis with Rome IV criteria because of only having abdominal discomfort before defecation (in green, 22.6%) or frequency of abdominal pain less than 1 d/wk (in light colors, 14.2%), which 3% of patients among them have discomfort alone with less frequency (in light green). IBS: Irritable bowel syndrome.

Figure 2

Comparison of bowel movements and stool forms in irritable bowel syndrome with diarrhea patients and improvement of abdominal pain or discomfort after defecation in irritable bowel syndrome patients among the abdominal pain alone, abdominal discomfort alone, and abdominal pain & discomfort groups. A: Bowel movements during irritable bowel syndrome with diarrhea non-onset and onset status; B: Stool forms based on Bristol Stool Form Scale during irritable bowel syndrome with diarrhea non-onset and onset status; C: Degree of improvement of abdominal pain and discomfort with defecation; D: Waiting time for improvement of abdominal pain and discomfort with defecation in irritable bowel syndrome patients. Numbers in the column are percentages. ^bP < 0.01. BM: Bowel movement.

Figure 3

Comparison of irritable bowel syndrome-quality of life. There were no significant differences in the total score and eight domain scores among the three groups. Numbers in the column are percentages. IBS-QOL: Irritable bowel syndrome-quality of life.