Current Gastroenterology Reports

, Volume 7, Issue 4, pp 264–271 | Cite as

Symptom overlap and comorbidity of irritable bowel syndrome with other conditions

  • Christine L. Frissora
  • Kenneth L. Koch


Irritable bowel syndrome (IBS) is one of several highly prevalent, multi-symptom gastrointestinal motility disorders that have a wide clinical spectrum and are associated with symptoms of gastrointestinal dysmotility and visceral hypersensitivity. Symptom overlap and comorbidity between IBS and other gastrointestinal motility disorders (eg, chronic constipation, functional dyspepsia, gastroesophageal reflux disease), with gastrointestinal disorders that are not related to motility (eg, celiac disease, lactose intolerance), and with somatic conditions (eg, fibromyalgia, chronic fatigue syndrome), are frequent. The clinical associations and pathophysiologic links between IBS and these disorders continue to be explored. This review discusses overlapping symptoms and comorbidity of IBS with select gastrointestinal and non-gastrointestinal disorders and attempts to identify commonalities among these conditions.


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References and Recommended Reading

  1. 1.
    Brandt LJ, Bjorkman D, Fennerty MB, et al.: Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol 2002, 97(Suppl):S7-S26.PubMedGoogle Scholar
  2. 2.
    Camilleri M: Gastrointestinal motility disorders. http:// Accessed 11/8/04.Google Scholar
  3. 3.
    Bassotti G, Stanghellini V, Chiarioni G, et al.: Upper gastrointestinal motor activity in patients with slow-transit constipation. Further evidence for an enteric neuropathy. Dig Dis Sci 1996, 41:1999–2005.PubMedCrossRefGoogle Scholar
  4. 4.
    Portincasa P, Moschetta A, Baldassarre G, et al.: Pan-enteric dysmotility, impaired quality of life and alexithymia in a large group of patients meeting ROME II criteria for irritable bowel syndrome. World J Gastroenterol 2003, 9:2293–2299.PubMedGoogle Scholar
  5. 5.
    Zelnorm (tegaserod maleate) tablets. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2004.Google Scholar
  6. 6.
    Crowell MD: The role of serotonin in the pathophysiology of irritable bowel syndrome. Am J Manag Care 2001, 7(Suppl):S252-S260.PubMedGoogle Scholar
  7. 7.
    Corsetti M, Caenepeel P, Fischler B, et al.: Impact of coexisting irritable bowel syndrome on symptoms and pathophysiological mechanisms in functional dyspepsia. Am J Gastroenterol 2004, 99:1152–1159.PubMedCrossRefGoogle Scholar
  8. 8.
    Cremonini F, Talley NJ: Review article: The overlap between functional dyspepsia and irritable bowel syndrome: a tale of one or two disorders? Aliment Pharmacol Ther 2004, 20:40–49.PubMedCrossRefGoogle Scholar
  9. 9.
    Coates MD, Mahoney CR, Linden DR, et al.: Molecular defects in mucosal serotonin content and decreased serotonin reuptake transporter in ulcerative colitis and irritable bowel syndrome. Gastroenterology 2004, 126:1657–1664.PubMedCrossRefGoogle Scholar
  10. 10.
    Crowell MD, Shetzline MA, Moses PL, et al.: Enterochromaffin cells and 5-HT signaling in the pathophysiology of disorders of gastrointestinal function. Curr Opin Investig Drugs 2004, 5:55–60.PubMedGoogle Scholar
  11. 11.
    Drossman DA, Camilleri M, Mayer EA, Whitehead WE: AGA technical review on irritable bowel syndrome. Gastroenterology 2002, 123:2108–2131.PubMedCrossRefGoogle Scholar
  12. 12.
    Drossman DA, Whitehead WE, Camilleri M: Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology 1997, 112:2120–2137.PubMedCrossRefGoogle Scholar
  13. 13.
    Hungin APS, Tack J, Mearin F, et al.: Irritable bowel syndrome (IBS): prevalence and impact in the USA: the truth in IBS (TIBS) survey. Am J Gastroenterol 2002, 97:S280-S281.CrossRefGoogle Scholar
  14. 14.
    International Foundation for Functional Gastrointestinal Disorders (IFFGD): Travel tips help IBS sufferers enjoy their summer vacations. 04.html.May 25, 2004.Google Scholar
  15. 15.
    Martin R, Barron JJ, Zacker C: Irritable bowel syndrome: toward a cost-effective management approach. Am J Manag Care 2001, 7:S268-S275.PubMedGoogle Scholar
  16. 16.
    American Gastroenterological Association: The Burden of Gastrointestinal Diseases. Bethesda, MD: American Gastroenterological Association; 2001.Google Scholar
  17. 17.
    Longstreth GF, Wilson A, Knight K, et al.: Irritable bowel syndrome, health care use, and costs: a U.S. managed care perspective. Am J Gastroenterol 2003, 98:600–607.PubMedCrossRefGoogle Scholar
  18. 18.
    Kozma CM, Barghout V, Slaton T, et al.: Office-based physician visits: a comparison of irritable bowel syndrome with other gastrointestinal disorders using national ambulatory medical care survey data. Pract Gastroenterol 2002, 15:58–68.Google Scholar
  19. 19.
    Kozma CM, Barghout V, Slaton T, et al.: A comparison of office-based physician visits for irritable bowel syndrome and for migraine and asthma. Manag Care Interface 2002, 15:40–43, 49.PubMedGoogle Scholar
  20. 20.
    Martin BC, Ganguly R, Pannicker S, et al.: Utilization patterns and net direct medical cost to Medicaid of irritable bowel syndrome. Curr Med Res Opin 2003, 19:771–780.PubMedCrossRefGoogle Scholar
  21. 21.
    Thompson WG, Longstreth GF, Drossman DA, et al.: Functional bowel disorders and functional abdominal pain. Gut 1999, 45:II43-II47.PubMedGoogle Scholar
  22. 22.
    Talley NJ, Dennis EH, Schettler-Duncan VA, et al.: Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea. Am J Gastroenterol 2003, 98:2454–2459.PubMedCrossRefGoogle Scholar
  23. 23.
    Whitehead WE, Palsson O, Jones KR: Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology 2002, 122:1140–1156. This systematic literature review summarizes data published between 1966 and 2002 regarding the overlap between IBS and other disorders. Potential pathophysiologic similarities between overlapping disorders are discussed.PubMedCrossRefGoogle Scholar
  24. 24.
    Gershon MD: Review article: serotonin receptors and transporters —roles in normal and abnormal gastrointestinal motility. Aliment Pharmacol Ther 2004, 20:3–14.PubMedCrossRefGoogle Scholar
  25. 25.
    Camilleri M: Management of the irritable bowel syndrome. Gastroenterology 2001, 120:652–668.PubMedCrossRefGoogle Scholar
  26. 26.
    Gershon MD: Serotonin and its implication for the management of irritable bowel syndrome. Rev Gastroenterol Dis 2003, 3(Suppl 2):S25-S34.Google Scholar
  27. 27.
    Corsetti M, Caenepeel P, Fischler B, et al.: Impact of coexisting irritable bowel syndrome on symptoms and pathophysiological mechanisms in functional dyspepsia. Am J Gastroenterol 2004, 99:1152–1159.PubMedCrossRefGoogle Scholar
  28. 28.
    Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ III: Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 1991, 101:927–934.PubMedGoogle Scholar
  29. 29.
    Drossman DA, Li Z, Andruzzi E, et al.: U.S. householder survey of functional gastrointestinal disorders: prevalence, sociodemography, and health impact. Dig Dis Sci 1993, 38:1569–1580.PubMedCrossRefGoogle Scholar
  30. 30.
    Agreus L, Svardsudd K, Nyren O, Tibblin G: Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology 1995, 109:671–680.PubMedCrossRefGoogle Scholar
  31. 31.
    Corazziari E: Definition and epidemiology of functional gastrointestinal disorders. Best Pract Res Clin Gastroenterol 2004, 18:613–631.PubMedCrossRefGoogle Scholar
  32. 32.
    Agreus L, Svardsudd K, Talley NJ, et al.: Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study. Am J Gastroenterol 2001, 96:2905–2914.PubMedGoogle Scholar
  33. 33.
    Locke GR: Specific somatic symptoms associated with irritable bowel syndrome: Somatization may not be the explanation. Gastroenterology 2004, 126:A88.Google Scholar
  34. 34.
    Holtmann G: IBS: a syndrome or many diseases? Best Pract Res Clin Gastroenterol 2004, 18:91–97.PubMedCrossRefGoogle Scholar
  35. 35.
    Fischler B, Tack J, De GV, et al.: Heterogeneity of symptom pattern, psychosocial factors, and pathophysiological mechanisms in severe functional dyspepsia. Gastroenterology 2003, 124:903–910.PubMedCrossRefGoogle Scholar
  36. 36.
    van der Voort IR, Osmanoglou E, Seybold M, et al.: Electrogastrography as a diagnostic tool for delayed gastric emptying in functional dyspepsia and irritable bowel syndrome. Neurogastroenterol Motil 2003, 15:467–473.PubMedCrossRefGoogle Scholar
  37. 37.
    Haag S, Talley NJ, Holtmann G: Symptom patterns in functional dyspepsia and irritable bowel syndrome: relationship to disturbances in gastric emptying and response to a nutrient challenge in consulters and non-consulters. Gut 2004, 53:1445–1451.PubMedCrossRefGoogle Scholar
  38. 38.
    Bouin M, Lupein F, Riberdy M, et al.: Intolerance to visceral distension in functional dyspepsia or irritable bowel syndrome: an organ specific defect or a pan intestinal dysregulation? Neurogastroenterol Motil 2004, 16:311–314.PubMedCrossRefGoogle Scholar
  39. 39.
    Tack J, Demedts I, Dehondt G, et al.: Clinical and pathophysiological characteristics of acute-onset functional dyspepsia. Gastroenterology 2002, 122:1738–1747.PubMedCrossRefGoogle Scholar
  40. 40.
    Spiller RC: Postinfectious irritable bowel syndrome. Gastroenterology 2003, 124:1662–1671.PubMedCrossRefGoogle Scholar
  41. 41.
    Holtmann G, Goebell H, Talley NJ: Functional dyspepsia and irritable bowel syndrome: is there a common pathophysiological basis? Am J Gastroenterol 1997, 92:9514–9519.Google Scholar
  42. 42.
    Talley NJ, Van Zanten SV, Saez LR, et al.: A dose-ranging, placebo-controlled, randomized trial of alosetron in patients with functional dyspepsia. Aliment Pharmacol Ther 2001, 15:525–537.PubMedCrossRefGoogle Scholar
  43. 43.
    Carvalhinhos A, Fidalgo P, Freire A, Matos L: Cisapride compared with ranitidine in the treatment of functional dyspepsia. Eur J Gastroenterol Hepatol 1995, 7:411–417.PubMedGoogle Scholar
  44. 44.
    Van Outryve M, De Nutte N, Van Eeghem P, Gooris JP: Efficacy of cisapride in functional dyspepsia resistant to domperidone or metoclopramide: a double-blind, placebo-controlled study. Scand J Gastroenterol Suppl 1993, 195:47–52.PubMedGoogle Scholar
  45. 45.
    Cremonini F, Delgado-Aros S, Talley NJ: Functional dyspepsia: drugs for new (and old) therapeutic targets. Best Pract Res Clin Gastroenterol 2004, 18:717–733.PubMedCrossRefGoogle Scholar
  46. 46.
    Tougas G, Chen Y, Luo D, et al.: Tegaserod improves gastric emptying in patients with gastroparesis and dyspeptic symptoms. Gastroenterology 2003, 124:A54.CrossRefGoogle Scholar
  47. 47.
    Kalantar JS, Locke GR, Zinsmeister AR, et al.: Familial aggregation of irritable bowel syndrome: a prospective study. Gut 2003, 52:1703–1707.PubMedCrossRefGoogle Scholar
  48. 48.
    Locke GR III, Zinsmeister AR, Talley NJ, et al.: Familial association in adults with functional gastrointestinal disorders. Mayo Clin Proc 2000, 75:907–912.PubMedGoogle Scholar
  49. 49.
    Talley NJ: Irritable bowel syndrome and health care seeking: do we pass our bad habits onto our children? Am J Gastroenterol 2000, 95:340–341.PubMedGoogle Scholar
  50. 50.
    Higgins PD, Johanson JF: Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 2004, 99:750–759.PubMedCrossRefGoogle Scholar
  51. 51.
    Lembo A, Camilleri M: Chronic constipation. N Engl J Med 2003, 349:1360–1368.PubMedCrossRefGoogle Scholar
  52. 55.
    Cash B, Chey WD: Update on the management of chronic constipation: what differentiates chronic constipation from IBS with constipation. Medscape Web site 2004 August 26. Accessed November 17, 2004.Google Scholar
  53. 53.
    Pare P, Ferrazzi S, Thompson WG, et al.: An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol 2001, 96:3130–3137.PubMedCrossRefGoogle Scholar
  54. 54.
    Talley NJ: Differentiating functional constipation from constipation-predominant irritable bowel syndrome: management implications. Rev Gastroenterol Dis 2005, 5:1–9.Google Scholar
  55. 55.
    Locke GR III, Zinsmeister AR, Fett SL, et al.: Overlap of gastrointestinal symptom complexes in a US community. Neurogastroenterol Motil 2005, 17:29–34. This population-based study demonstrates the high prevalence of gastrointestinal symptom overlap in the community.PubMedCrossRefGoogle Scholar
  56. 56.
    Rao SS: Constipation: evaluation and treatment. Gastroenterol Clin North Am 2003, 32:659–683.PubMedCrossRefGoogle Scholar
  57. 57.
    Bassotti G, Chistolini F, Marinozzi G, Morelli A: Abnormal colonic propagated activity in patients with slow transit constipation and constipation-predominant irritable bowel syndrome. Digestion 2003, 68:178–183.PubMedCrossRefGoogle Scholar
  58. 58.
    El Salhy M, Norrgard O, Spinnell S: Abnormal colonic endocrine cells in patients with chronic idiopathic slow-transit constipation. Scand J Gastroenterol 1999, 34:1007–1011.CrossRefGoogle Scholar
  59. 59.
    Rossi S, Choudhary C: Medical treatment and clinical course of gastroesophageal reflux disease. Resid Staff Physician 2003, 49:24–28.Google Scholar
  60. 60.
    Raghunath A, Hungin AP, Wooff D, Childs S: Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review. BMJ 2003, 326:737.PubMedCrossRefGoogle Scholar
  61. 61.
    Pimentel M, Rossi F, Chow EJ, et al.: Increased prevalence of irritable bowel syndrome in patients with gastroesophageal reflux. J Clin Gastroenterol 2002, 34:221–224.PubMedCrossRefGoogle Scholar
  62. 62.
    Berger A, Dukes EM, Oster G: Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain 2004, 5:143–149.PubMedCrossRefGoogle Scholar
  63. 63.
    Heidelbaugh JJ, Nostrant TT, Kim C, Van Harrison R: Management of gastroesophageal reflux disease. Am Fam Physician 2003, 68:1311–1318.PubMedGoogle Scholar
  64. 64.
    Kennedy TM, Jones RH, Hungin AP, et al.: Irritable bowel syndrome, gastro-oesophageal reflux, and bronchial hyper-responsiveness in the general population. Gut 1998, 43:770–774.PubMedGoogle Scholar
  65. 65.
    Lin S, Ke M, Xu J, Kahrilas PJ: Impaired esophageal emptying in reflux disease. Am J Gastroenterol 1994, 89:1003–6.PubMedGoogle Scholar
  66. 66.
    Kahrilas PJ, Quigley EM, Castell DO, Spechler SJ: The effects of tegaserod (HTF 919) on esophageal acid exposure in gastroesophageal reflux disease. Aliment Pharmacol Ther 2000, 14:1503–1509.PubMedCrossRefGoogle Scholar
  67. 67.
    Rodriguez-Stanley S, Zubaidi S, Wolff M, et al.: Tegaserod significantly improves esophageal mechanical pain threshold, regurgitation and global preference vs placebo in patients with functional heartburn. Gastroenterology 2004, 127:331–333.CrossRefGoogle Scholar
  68. 68.
    Talley NJ, Dennis EH, Schettler-Duncan VA, et al.: Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea. Am J Gastroenterology 2003, 98:2454–2459.CrossRefGoogle Scholar
  69. 69.
    Corazziari E: Definition and epidemiology of functional gastrointestinal disorders. Best Pract Res Clin Gastroenterol 2004, 18:613–631.PubMedCrossRefGoogle Scholar
  70. 70.
    Farrell RJ, Kelly CP: Celiac sprue. N Engl J Med 2002, 346:180–188.PubMedCrossRefGoogle Scholar
  71. 71.
    Nelsen DA Jr: Gluten-sensitive enteropathy (celiac disease): more common than you think. Am Fam Physician 2002, 66:2259–2266.PubMedGoogle Scholar
  72. 72.
    Jones J, Boorman J, Cann P, et al.: British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome. Gut 2000, 47(Suppl 2):ii1-ii19.PubMedGoogle Scholar
  73. 73.
    Shahbazkhani B, Forootan M, Merat S, et al.: Coeliac disease presenting with symptoms of irritable bowel syndrome. Aliment Pharmacol Ther 2003, 18:231–235.PubMedCrossRefGoogle Scholar
  74. 74.
    O’Leary C, Wieneke P, Buckley S, et al.: Celiac disease and irritable bowel-type symptoms. Am J Gastroenterol 2002, 97:1463–1467.PubMedCrossRefGoogle Scholar
  75. 75.
    Sanders DS, Carter MJ, Hurlstone DP, et al.: Association of adult coeliac disease with irritable bowel syndrome: a casecontrol study in patients fulfilling ROME II criteria referred to secondary care. Lancet 2001, 358:1504–1508.PubMedCrossRefGoogle Scholar
  76. 76.
    Wahnschaffe U, Ullrich R, Riecken EO, Schulzke JD: Celiac disease-like abnormalities in a subgroup of patients with irritable bowel syndrome. Gastroenterology 2001, 121:1329–1338.PubMedCrossRefGoogle Scholar
  77. 77.
    Locke GR III, Murray JA, Zinsmeister AR, et al.: Celiac disease serology in irritable bowel syndrome and dyspepsia: a population-based case-control study. Mayo Clin Proc 2004, 79:476–482.PubMedCrossRefGoogle Scholar
  78. 78.
    Niec AM, Frankum B, Talley NJ: Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998, 93:2184–2190.PubMedCrossRefGoogle Scholar
  79. 79.
    Pimentel M, Kong Y, Park S: Breath testing to evaluate lactose intolerance in irritable bowel syndrome correlates with lactulose testing and may not reflect true lactose malabsorption. Am J Gastroenterol 2003, 98:2700–2704.PubMedCrossRefGoogle Scholar
  80. 80.
    Shaw AD, Davies GJ: Lactose intolerance: problems in diagnosis and treatment. J Clin Gastroenterol 1999, 28:208–216.PubMedCrossRefGoogle Scholar
  81. 81.
    Montes R, Monge E: Lactose malabsorption and IBS [letter]. Scand J Gastroenterol 2004, 39:1033.PubMedCrossRefGoogle Scholar
  82. 82.
    Farup PG, Monsbakken KW, Vandvik PO: Lactose malabsorption in a population with irritable bowel syndrome: prevalence and symptoms. A case-control study. Scand J Gastroenterol 2004, 39:645–649.PubMedCrossRefGoogle Scholar
  83. 83.
    Aaron LA, Buchwald D: A review of the evidence for overlap among unexplained clinical conditions. Ann Intern Med 2001, 134:868–881.PubMedGoogle Scholar
  84. 84.
    Akkus S, Senol A, Ayvacioglu NB, et al.: Is female predominance in irritable bowel syndrome related to fibromyalgia? Rheumatol Int 2004, 24:106–109.PubMedCrossRefGoogle Scholar
  85. 85.
    Wallace DJ, Hallegua DS: Fibromyalgia: the gastrointestinal link. Curr Pain Headache Rep 2004, 8:364–368.PubMedGoogle Scholar
  86. 86.
    Sperber AD, Atzmon Y, Neumann L, et al.: Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications. Am J Gastroenterol 1999, 94:3541–3546.PubMedCrossRefGoogle Scholar
  87. 87.
    Vandvik PO, Wilhelmsen I, Ihlebaek C, Farup PG: Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications. Aliment Pharmacol Ther 2004, 20:1195–1203.PubMedCrossRefGoogle Scholar
  88. 88.
    Chang L, Berman S, Mayer EA, et al.: Brain responses to visceral and somatic stimuli in patients with irritable bowel syndrome with and without fibromyalgia. Am J Gastroenterol 2003, 98:1354–1361.PubMedCrossRefGoogle Scholar
  89. 89.
    Chang L, Mayer EA, Johnson T, et al.: Differences in somatic perception in female patients with irritable bowel syndrome with and without fibromyalgia. Pain 2000, 84:297–307.PubMedCrossRefGoogle Scholar
  90. 90.
    Pimentel M, Wallace D, Hallegua D, et al.: A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Ann Rheum Dis 2004, 63:450–452.PubMedCrossRefGoogle Scholar
  91. 91.
    Dominguez JM, Serri K: Image in clinical medicine. Disseminated histoplasmosis in a patient with human immunodeficiency virus infection. N Engl J Med 2002, 346:2061.PubMedCrossRefGoogle Scholar
  92. 92.
    Williams RE, Hartmann KE, Sandler RS, et al.: Prevalence and characteristics of irritable bowel syndrome among women with chronic pelvic pain. Obstet Gynecol 2004, 104:452–458.PubMedGoogle Scholar

Copyright information

© Current Science Inc. 2005

Authors and Affiliations

  • Christine L. Frissora
    • 1
  • Kenneth L. Koch
  1. 1.Department of MedicineThe Weill Medical College of Cornell UniversityNew YorkUSA

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