Digestive Diseases and Sciences

, Volume 40, Issue 5, pp 986–995

Functional bowel disorders

A multicenter comparison of health status and development of illness severity index
  • Douglas A. Drossman
  • Zhiming Li
  • Brenda B. Toner
  • Nicholas E. Diamant
  • Francis H. Creed
  • David Thompson
  • Nicholas W. Read
  • Chris Babbs
  • Marcelo Barreiro
  • Leslie Bank
  • William E. Whitehead
  • Marvin M. Schuster
  • Elspeth A. Guthrie
Intestinal Disorders, Inflammatory Bowel Disease, Immunology, And Microbiology

Abstract

In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0–100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months × 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.

Key words

functional bowel disorders irritable bowel syndrome chronic abdominal pain functional constipation illness severity index functional colonic diseases 

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References

  1. 1.
    Thompson WG, Creed F, Drossman DA, Heaton KW, Mazzacca G: Functional bowel disorders and chronic functional abdominal pain. Gastroenterol Int 5:75–91, 1992Google Scholar
  2. 2.
    Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE: Identification of subgroups of functional bowel disorders. Gastroenterol Int 3:159–172, 1990Google Scholar
  3. 3.
    Drossman DA, Richter JE, Talley NJ, Thompson WG, Corazziari E, Whitehead WE (eds): Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology and Treatment. Boston, Little, Brown and Company, 1994Google Scholar
  4. 4.
    Harvey RF, Salih SY, Read AE: Organic and functional disorders in 2000 gastroenterology outpatients. Lancet 1:632–634, 1983PubMedGoogle Scholar
  5. 5.
    Mitchell CM, Drossman DA: Survey of the AGA membership relating to patients with functional gastrointestinal disorders. Gastroenterology 92:1282–1284, 1987Google Scholar
  6. 6.
    Drossman DA, Li Z, Andruzzi E, Temple R, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E, Richter JE, Koch GG: US householder survey of functional gastrointestinal disorders: Prevalence, sociodemography and health impact. Dig Dis Sci 38:1569–1580, 1993PubMedGoogle Scholar
  7. 7.
    Drossman DA: The functional gastrointestinal disorders and their diagnosis: A coming of age.In The Functional Gastrointestinal Disorders: Diagnosis: Pathophysiology and Treatment. DA Drossman, JE Richter, NJ Talley, WG Thompson, E Corazziari, WE Whitehead (eds). Boston, Little, Brown and Company, 1994, p 1Google Scholar
  8. 8.
    Drossman DA, Thompson WG: The irritable bowel syndrome: Review and a graduated, multicomponent treatment approach. Ann Intern Med 116:1009–1016, 1992PubMedGoogle Scholar
  9. 9.
    Sandler RS, Drossman DA, Nathan HP, McKee DC: Symptom complaints and health care seeking behavior in subjects with bowel dysfunction. Gastroenterology 87:314–318, 1984PubMedGoogle Scholar
  10. 10.
    Drossman DA, McKee DC, Sandler RS, Mitchell CM, Cramer EM, Lowman BC, Burger AL: Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology 95:701–708, 1988PubMedGoogle Scholar
  11. 11.
    Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ III: Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 101:927–934, 1991PubMedGoogle Scholar
  12. 12.
    Heaton KW, O'Donnell LJD, Braddon FEM, Mountford RA, Hughes AO, Cripps PJ: Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology 102:1962–1967, 1992PubMedGoogle Scholar
  13. 13.
    Talley NJ: Optimal design of treatment trials.In Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology and Treatment. DA Drossman, JE Richter, NJ Talley, WG Thompson, E Corazziari, WE Whitehead (eds). Boston, Little, Brown and Company, 1994, p 265Google Scholar
  14. 14.
    Talley NJ, Nyren O, Drossman DA, Heaton KW, Veldhuyzen van Zanten SJO, Koch MM, Ransohoff DF: The irritable bowel syndrome: Toward optimal design of controlled treatment trials. Gastroenterol Int 4:189–211, 1993Google Scholar
  15. 15.
    Melzack R: The McGill pain questionnaire: Major properties and scoring methods. Pain 1:277–299, 1975PubMedGoogle Scholar
  16. 16.
    Koch GG, Edwards S: Clinical efficacy trials with categorical data.In Biopharmaceutical Statistics for Drug Development. KE Peace (ed). New York, Marcel Dekker, 1988Google Scholar
  17. 17.
    Irvine EJ, Feagan B, Rochon J, Archambault A, Fedorak RN, Groll A, Kinnear D, Saibil F, McDonald JWD: Quality of life: A valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Gastroenterology 106:287–296, 1994PubMedGoogle Scholar
  18. 18.
    Talley NJ, Nyren O, Drossman DA, Heaton KW, Veldhuyzen van Zanten SJO, Koch MM, Ransohoff DF: The irritable bowel syndrome: Toward optimal design of controlled treatment trials. Gastroenterol Int 4:189–211, 1993Google Scholar
  19. 19.
    Best WR, Becktel JM, Singleton JW, Kern FJ: Development of a Crohn's disease activity index. National Cooperative Crohn's disease study. Gastroenterology 70:439–444, 1976PubMedGoogle Scholar
  20. 20.
    Mayer EA, Gebhart GF: Basic and clinical aspects of visceral hyperalgesia. Gastroenterol 107:271–293, 1994Google Scholar
  21. 21.
    Corney RH, Stanton R: Physical symptom severity, psychological and social dysfunction in a series of outpatients with irritable bowel syndrome. J Psychosom Res 34:483–491, 1990PubMedGoogle Scholar
  22. 22.
    Drossman DA: Psychosocial factors in chronic functional abdominal pain.In Basic and Clinical Aspects of Chronic Abdominal Pain, Vol 9. EA Mayer, H Raybould (eds). Amsterdam, Elsevier Science Publishers, 1993, p 271Google Scholar
  23. 23.
    Guthrie E, Creed F, Dawson D, Tomenson B: A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 100:450–457, 1991PubMedGoogle Scholar
  24. 24.
    Whorwell PJ, Prior A, Colgan SM: Hypnotherapy in severe irritable bowel syndrome: Further experience. Gut 28:423–425, 1987PubMedGoogle Scholar
  25. 25.
    Whitehead WE, Bosmajian L, Zonderman AB, Costa PTJ, Schuster MM: Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. Gastroenterology 95:709–714, 1988PubMedGoogle Scholar
  26. 26.
    Drossman DA, Leserman J, Nachman G, Li Z, Gluck H, Toomey TC, Mitchell CM: Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 113:828–833, 1990PubMedGoogle Scholar
  27. 27.
    Thompson WG: C. Functional Bowel Disorders and D. Functional Abdominal Pain.In Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology and Treatment. DA Drossman, JE Richter, NJ Talley, WG Thompson, E Corazziari (eds). Boston, Little, Brown and Company, 1994, p 115Google Scholar
  28. 28.
    Duncan GH, Bushnell MC, Lavigne GJ: Comparison of verbal and visual analogue scales for measuring the intensity and unpleasantness of experimental pain. Pain 37:295–303, 1989PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Douglas A. Drossman
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Zhiming Li
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Brenda B. Toner
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Nicholas E. Diamant
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Francis H. Creed
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • David Thompson
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Nicholas W. Read
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Chris Babbs
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Marcelo Barreiro
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Leslie Bank
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • William E. Whitehead
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Marvin M. Schuster
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  • Elspeth A. Guthrie
    • 8
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
  1. 1.University of TorontoTorontoCanada
  2. 2.Manchester Royal InfirmaryManchesterEngland
  3. 3.University of ManchesterManchesterEngland
  4. 4.University of SheffieldSheffieldEngland
  5. 5.Birch Hall HospitalRochdaleEngland
  6. 6.Valley Health CareBinghamton
  7. 7.Francis Scott Key Medical CenterBaltimoreMaryland
  8. 8.Division of Digestive DiseasesUniversity of North CarolinaChapel Hill

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