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. 2022 Sep 7;28(33):4861-4874.
doi: 10.3748/wjg.v28.i33.4861.

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

Xiu-Cai Fang  1 , Wen-Juan Fan  2   3 , Douglas D Drossman  4   5   6 , Shao-Mei Han  7 , Mei-Yun Ke  2
Affiliations

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

Xiu-Cai Fang et al. World J Gastroenterol. .

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.

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Conflict of interest statement

Conflict-of-interest statement: There are no conflicts of interest to report.

Figures

Figure 1
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
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
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.
See this image and copyright information in PMC

References

    1. Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, Whitehead WE, Dumitrascu DL, Fang X, Fukudo S, Kellow J, Okeke E, Quigley EMM, Schmulson M, Whorwell P, Archampong T, Adibi P, Andresen V, Benninga MA, Bonaz B, Bor S, Fernandez LB, Choi SC, Corazziari ES, Francisconi C, Hani A, Lazebnik L, Lee YY, Mulak A, Rahman MM, Santos J, Setshedi M, Syam AF, Vanner S, Wong RK, Lopez-Colombo A, Costa V, Dickman R, Kanazawa M, Keshteli AH, Khatun R, Maleki I, Poitras P, Pratap N, Stefanyuk O, Thomson S, Zeevenhooven J, Palsson OS. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160:99–114.e3. - PubMed
    1. Drossman DA, Corazziari E, Delvaux M. Rome III-functional gastrointestinal disorders. 3th ed. BW & A Books, inc: Durham, 2006.
    1. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel Disorders. Gastroenterology. 2016 - PubMed
    1. Fang X, Francisconi CF, Fukudo S, Gerson MJ, Kang JY, Schmulson W MJ, Sperber AD. Multicultural Aspects in Functional Gastrointestinal Disorders (FGIDs) Gastroenterology. 2016 - PubMed
    1. Spiegel BM, Bolus R, Agarwal N, Sayuk G, Harris LA, Lucak S, Esrailian E, Chey WD, Lembo A, Karsan H, Tillisch K, Talley J, Chang L. Measuring symptoms in the irritable bowel syndrome: development of a framework for clinical trials. Aliment Pharmacol Ther. 2010;32:1275–1291. - PubMed

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