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Multicenter Study
. 2026 Feb;14(1):e70157.
doi: 10.1002/ueg2.70157.

Increased Disease Burden in Irritable Bowel Syndrome With Comorbid Conditions and Psychiatric Diagnoses in a Multinational European Cohort: Results From the DISCOvERIE Project

Irina Midenfjord  1 , Mahrukh Khadija  1 , Elias Sundelin  1 , Inês A Trindade  1 , Hans Törnblom  1 , Javier Santos  2 , Beatriz Lobo  2 , Danique Mulder  3 , Alejandro Arias Vasquez  3 , Georgy Ruesing  4 , Andreas Reif  4   5 , Mareike Aichholzer  4 , Maaike Van Den Houte  6 , Lukas Van Oudenhove  6 , Maria Chiara Matteucci  7 , Giovanni Barbara  7 , Michelle Bosman  8 , Daisy Jonkers  8 , Josep Antoni Ramos-Quiroga  9 , Eva Jekkel  10 , István Bitter  10 , Andrei-Vasile Pop  11 , Dan Lucian Dumitrascu  11 , Carmen Alonso-Cotoner  2 , Amanda Rodríguez-Urrutia  9 , Magnus Simrén  1
Affiliations
Multicenter Study

Increased Disease Burden in Irritable Bowel Syndrome With Comorbid Conditions and Psychiatric Diagnoses in a Multinational European Cohort: Results From the DISCOvERIE Project

Irina Midenfjord et al. United European Gastroenterol J. 2026 Feb.

Abstract

Background: Patients with Irritable bowel syndrome (IBS) frequently suffer from comorbid psychiatric or somatic conditions, but the association with overall GI symptom severity and disease burden in IBS has not yet been established.

Objective: This pan-European project, the DISCOvERIE project, aimed to characterize IBS patients with and without comorbid psychiatric (anxiety, depression) and/or somatic (fibromyalgia, chronic fatigue syndrome) conditions, and to compare them with disease (psychiatric and/or somatic condition without IBS) and healthy controls to further elucidate the effect of comorbid conditions on the disease burden in IBS.

Methods: Participants from nine different European centers were included: IBS patients (Rome IV criteria) with and without comorbid conditions, disease controls, and healthy controls. The presence of comorbidities was assessed through the Mini International Neuropsychiatric Interview (MINI) for anxiety or depression or through diagnostic criteria for fibromyalgia or chronic fatigue syndrome. Validated questionnaires on IBS (IBS-SSS), depressive (PHQ-9), anxiety (GAD-7) and somatic symptom severity (PHQ-12), fibromyalgia symptoms (FIQ) and fatigue (MFI) were completed.

Results: In total, 842 participants were recruited between March 2021 and January 2023, of which 607 had IBS, 161 were disease controls and 74 were healthy controls. IBS, anxiety, depression, somatic symptoms and fatigue were more severe in IBS patients with comorbidities compared with IBS patients without comorbidities. The severity of the abovementioned symptoms all increased gradually with increasing number of comorbidities (all p < 0.001).

Conclusion: This large pan-European study highlights the significant impact of psychiatric and somatic comorbidities in IBS, and their strong link with outcomes and disease burden.

Keywords: IBS; Irritable bowel syndrome; anxiety; chronic fatigue syndrome; depression; fibromyalgia; gastrointestinal symptoms; psychiatric diagnoses; symptom burden; symptom severity.

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Conflict of interest statement

Inês A. Trindade receives consultancy fees from Pfizer and speaker fees from the Portuguese Study Group for IBD (GEDII). Hans Törnblom served as a consultant for Cinclus Pharma, Dr Falk GmbH, Galapagos, Medifactia, Mylan, PRO.MED.CS, Purpose Pharma and Vipun Medical. Javier Santos serves/has served as a medical consultant for Noventure, Devintecpharma, Reckitt, Hipra, Ipsen, Viatris, Ordesa and Sequentia and discloses present or past recent scientific collaborations with Ordesa, Salvat, Norgine, Alfa‐Sigma, Cosmo, Adare, Pileje, Danone, Farmasierra, Italfarmaco, Venter, Takeda, and Menarini. Beatriz Lobo has past/present scientific collaborations with Alfa‐Sigma, Venter, Devintecpharma, GE HealthCare, Schwabe Farma Ibérica and is a consultant/Advisory Board member in Schwabe Farma Ibérica and VenterPharm. Andreas Reif has received honoraria for lectures and/or advisory boards from Janssen/Johnson & Johnson, Boehringer Ingelheim, Compass, GH Research, SAGE/Biogen, LivaNova, Medice, Shire/Takeda, Newron, MSD, AbbVie, cyclerion and received research grants from Medice and Janssen. Mareike Aichholzer received honoraria for scientific advice and travel funds from Janssen and speaker honoraria from UCB Pharma. Lukas Van Oudenhove has served as a consultant and advisory board member and collaborated scientifically with Danone and Nestlé. Giovanni Barbara receives consultancies, business interests or sources of honoraria payments from Aboca, AB Biotics, Agave, Alfa Sigma, AGPharma, Bayer, Biocodex, Boeringer, Bromatech, Cadigroup, Danone, Diadema, Falk Pharma, GE Healthcare, Giuliani, Mayoly, Malesci, Sanofy, Sofar and Yakult. Josep Antoni Ramos‐Quiroga was on the speakers’ bureau and/or acted as consultant for Biogen, Idorsia, Casen‐Recordati, Johnson&Johnson, Novartis, Takeda, Bial, Sincrolab, Neuraxpharm, Novartis, BMS, Medice, Rubió, Uriach, Technofarma and Raffo in the last 3 years; received travel fees from Idorsia, Johnson&Johnson, Rubió, Takeda, Bial and Medice and received unrestricted educational and research support from the following companies in the last 3 years: Exeltis, Idorsia, Casen‐Recordati, Takeda, Neuraxpharm, Oryzon, Roche, Probitas and Rubió. István Bitter received speaker or consultancy fees from Gedeon Richter, Janssen/Janssen Cilag/Johnson@&Johnson, KRKA, Lundbeck, Medichem Pharmaceuticals, Mitsubishi Tanabe Pharma Singapore Inc. by Unilab, Medscape and Newron outside of this work in the past 3 years and received royalties from Oxford University Press. Dan Lucian Dumitrascu is a speaker and advisory board member in, and/or receiving grants from: Abbot, Abvie, Alfasigma, Biocodex, ES Vida, Ewopharma, Gilead, Ipsen, Menarini, Merz, Prisum, Sanofi, Terapia, Vedra and Zentiva. Carmen Alonso‐Cotoner has past/present scientific collaborations with Alfa‐Sigma, Venter, Norgine, Menarini, Noventure, Bioproject, Devintecpharma and is a consultant/Advisory Board member in Alfasigma and VenterPharma. Amanda Rodríguez‐Urrutia has served as a consultant for Danone, and she has collaborated scientifically with Janssen‐Cilag, Danone, Pileje, Farmasierra, Aboca and Organon. Magnus Simrén receives unrestricted research grants from: BioGaia; is a Consultant/Advisory Board member in Biocodex, Tillotts, BioGaia, Renapharma, and AlfaSigma and is in the Speakers’ bureau for Tillotts, Takeda, Biocodex, Sanofi, Abbvie, Janssen Immunology, Pfizer, BioGaia, Renapharma, Mayoly and Bromatech. Irina Midenfjord, Mahrukh Khadija, Elias Sundelin, Danique Mulder, Alejandro Arias Vasquez, Georgy Ruesing, Maaike Van Den Houte, Maria Chiara Matteucci, Michelle Bosman, Daisy Jonkers, Eva Jekkel and Andrei‐Vasile Pop declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Combinations of comorbidities in IBS patients. The number of IBS patients with specific combinations of comorbidities is presented in the figure. In addition to the IBS patients presented in the figure, eight had incomplete data and were excluded from the analysis.
FIGURE 2
FIGURE 2
Combinations of the most common psychiatric (MINI) diagnoses in IBS patients. The number of IBS patients with specific combinations of psychiatric diagnoses according to the MINI interview is presented in the figure. Depression is here specified as fulfilling criteria for either current or recurrent major depressive episodes. MINI: Mini International Neuropsychiatric Interview.
FIGURE 3
FIGURE 3
Linear trends in symptom severity with increasing number of comorbidities in IBS patients. One‐way ANOVA with linear trend analyses between the number of comorbidities in IBS patients and symptom severity. FIQ: Partial η 2 = 0.286, p < 0.001. GAD‐7: Partial η 2 = 0.284, p < 0.001. IBS‐SSS: Partial η 2 = 0.034, p < 0.001. MFI general fatigue: Partial η 2 = 0.206, p < 0.001. PHQ‐9: Partial η 2 = 0.364, p < 0.001. PHQ‐12: Partial η 2 = 0.281, p < 0.001. IBS with 1 comorbidity: IBS with psychiatric (i.e., anxiety and/or depression) or somatic (i.e., fibromyalgia and/or chronic fatigue) comorbidity. IBS with 2 comorbidities: IBS with both psychiatric and somatic comorbidities. FIQ: Fatigue Impact Questionnaire, GAD‐7: Generalized Anxiety Disorder 7‐item scale, IBS: Irritable Bowel Syndrome, IBS‐SSS: IBS Severity Scoring System, MFI: Multidimensional Fatigue Inventory, MINI: Mini International Neuropsychiatric Interview, PHQ‐9: Patient Health Questionnaire 9 item scale, PHQ‐12: Patient Health Questionnaire 12 item scale.
FIGURE 4
FIGURE 4
Linear trends in symptom severity with increasing number of psychiatric (MINI) diagnoses in IBS patients. One‐way ANOVA with linear trend analyses between the number of psychiatric diagnoses in IBS patients and symptom severity. FIQ: Partial η 2 = 0.114, p < 0.001. GAD‐7: Partial η 2 = 0.191, p < 0.001. IBS‐SSS: Partial η 2 = 0.019, p < 0.001. MFI general fatigue: Partial η 2 = 0.094, p < 0.001. PHQ‐9: Partial η 2 = 0.213, p < 0.001. PHQ‐12: Partial η 2 = 0.097, p < 0.001. FIQ: Fatigue Impact Questionnaire, GAD‐7: Generalized Anxiety Disorder 7‐item scale, IBS: Irritable Bowel Syndrome, IBS‐SSS: IBS Severity Scoring System, MFI: Multidimensional Fatigue Inventory, MINI: Mini International Neuropsychiatric Interview, PHQ‐9: Patient Health Questionnaire 9 item scale, PHQ‐12: Patient Health Questionnaire 12 item scale.
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References

    1. Sperber A. D., Bangdiwala S. I., Drossman D. A., et al., “Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study,” Gastroenterology 160, no. 1 (2021): 99–114.e3, 10.1053/j.gastro.2020.04.014. - DOI - PubMed
    1. Lacy B. E., Mearin F., Chang L., et al., “Bowel Disorders,” Gastroenterology 150, no. 6 (2016): 1393–1407.e5, 10.1053/j.gastro.2016.02.031. - DOI
    1. Midenfjord I., Polster A., Sjövall H., Törnblom H., and Simrén M., “Anxiety and Depression in Irritable Bowel Syndrome: Exploring the Interaction With Other Symptoms and Pathophysiology Using Multivariate Analyses,” Neuro‐Gastroenterology and Motility 31, no. 8 (2019): e13619, 10.1111/nmo.13619. - DOI
    1. Trindade I. A., Hreinsson J. P., Melchior C., et al., “Global Prevalence of Psychological Distress and Comorbidity With Disorders of gut‐brain Interactions,” American Journal of Gastroenterology 119, no. 1 (2024): 165–175, 10.14309/ajg.0000000000002500. - DOI - PubMed
    1. Zamani M., Alizadeh‐Tabari S., and Zamani V., “Systematic Review With Meta‐Analysis: The Prevalence of Anxiety and Depression in Patients With Irritable Bowel Syndrome,” Alimentary Pharmacology and Therapeutics 50, no. 2 (2019): 132–143, 10.1111/apt.15325. - DOI - PubMed

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