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Subtypes of Irritable Bowel Syndrome Based on Abdominal Pain/Discomfort Severity and Bowel Pattern

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Abstract

Introduction

Irritable bowel syndrome (IBS) has traditionally been classified by stooling pattern (e.g., diarrhea-predominant). However, other patterns of symptoms have long been recognized, e.g., pain severity. Our objective was to examine the utility of subtyping women with IBS based on pain/discomfort severity as well as predominant bowel pattern.

Methods

Women (n = 166) with IBS completed interviews, questionnaires, and kept a diary for 28 days. Rome II questionnaire items eliciting the past year recall of hard and loose stools, and frequency and severity of abdominal pain or discomfort were used to classify participants into six subtypes—three bowel pattern categories by two pain/discomfort severity categories. Concordance of these subtypes with corresponding diary items was examined. Analysis of variance (ANOVA) tested the relationship of bowel pattern and pain categories to measures of quality of life and symptoms.

Results

There is moderate congruence of the retrospective classification of bowel pattern and pain/discomfort severity subtypes with prospectively reported stool frequency and consistency and pain severity. Quality of life, impact of IBS on work and daily activities, and cognitive beliefs about IBS differed significantly based on abdominal pain/discomfort category but not on predominant bowel pattern. There is evidence of an interaction, with the effect of pain severity being strong in the IBS-diarrhea and IBS-mixed groups, but this was absent in the IBS-constipation group. Similar results hold for most diary symptoms, except for those directly related to bowel pattern.

Conclusions

Overall, the distress of IBS is more strongly related to the severity of abdominal pain/discomfort than is the predominant stool pattern in patients with IBS. Categorizing IBS patients by abdominal pain/discomfort severity in conjunction with predominant bowel pattern may be useful to clinicians and researchers in developing more effective management.

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References

  1. US Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). Opportunities and Challenges in Digestive Diseases Research: Recommendations of the National Commission on Digestive Diseases. Bethesda, MD: US Department of Health and Human Services; 2009.

  2. Adeyemo MA, Spiegel BM, Chang L. Meta-analysis: do irritable bowel syndrome symptoms vary between men and women? Aliment Pharmacol Ther. 2010;32:738–755.

    Article  PubMed  CAS  Google Scholar 

  3. Whitehead WE, Drossman DA. Validation of symptom-based diagnostic criteria for irritable bowel syndrome: a critical review. Am J Gastroenterol. 2010;105:814–820.

    Article  PubMed  Google Scholar 

  4. Cain KC, Headstrom P, Jarrett ME, Motzer SA, Park H, Burr RL, et al. Abdominal pain impacts quality of life in women with irritable bowel syndrome. Am J Gastroenterol. 2006;101:124–132.

    Article  PubMed  Google Scholar 

  5. Bond B, Quinlan J, Dukes GE, Mearin F, Clouse RE, Alpers DH. Irritable bowel syndrome: more than abdominal pain and bowel habit abnormalities. Clin Gastroenterol Hepatol. 2009;7:73–79.

    Article  PubMed  Google Scholar 

  6. Spiegel BM, Bolus R, Agarwal N, Sayuk G, Harris LA, Lucak S, et al. Measuring symptoms in the irritable bowel syndrome: development of a framework for clinical trials. Aliment Pharmacol Ther. 2010;32:1275–1291.

    Article  PubMed  CAS  Google Scholar 

  7. Dorn SD, Morris CB, Hu Y, Toner BB, Diamant N, Whitehead WE, et al. Irritable bowel syndrome subtypes defined by Rome II and Rome III criteria are similar. J Clin Gastroenterol. 2009;43:214–220.

    Article  PubMed  Google Scholar 

  8. Cain KC, Jarrett ME, Burr RL, Rosen S, Hertig VL, Heitkemper MM. Gender differences in gastrointestinal, psychological, and somatic symptoms in irritable bowel syndrome. Dig Dis Sci. 2009;54:1542–1549.

    Article  PubMed  Google Scholar 

  9. Digesu GA, Panayi D, Kundi N, Tekkis P, Fernando R, Khullar V. Validity of the Rome III Criteria in assessing constipation in women. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:1185–1193.

    Article  PubMed  Google Scholar 

  10. Jarrett ME, Cain KC, Burr RL, Hertig VL, Rosen SN, Heitkemper MM. Comprehensive self-management for irritable bowel syndrome: randomized trial of in-person vs. combined in-person and telephone sessions. Am J Gastroenterol. 2009;104:3004–3014.

    Article  PubMed  Google Scholar 

  11. Drossman D, Corazziari E, Talley N, Thompson WG, Whitehead WE. Rome II: The Functional Gastrointestinal Disorders. McLean, VA: Degnon Associates, Inc.; 2000.

    Google Scholar 

  12. Hahn BA, Kirchdoerfer LJ, Fullerton S, Mayer E. Evaluation of a new quality of life questionnaire for patients with irritable bowel syndrome. Aliment Pharmacol Ther. 1997;11:547–552.

    Article  PubMed  CAS  Google Scholar 

  13. Toner BB, Stuckless N, Ali A, Downie F, Emmott S, Akman D. The development of a cognitive scale for functional bowel disorders. Psychosom Med. 1998;60:492–497.

    PubMed  CAS  Google Scholar 

  14. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993;4:353–365.

    Google Scholar 

  15. Derogatis LR. BSI: Brief Symptom Inventory; Administration, Scoring, and Procedures Manual. 4th ed. Minneapolis, MN: National Computer Systems; 1993.

    Google Scholar 

  16. Drossman DA, Corazziari E, Delvaux M, Spiller RC, Talley NJ, Thompson WG, et al. Rome III: The Functional Gastrointestinal Disorders. McLean, VA: Degnon Associates, Inc.; 2006.

    Google Scholar 

  17. McCrea GL, Miaskowski C, Stotts NA, Macera L, Paul SM, Varma MG. Gender differences in self-reported constipation characteristics, symptoms, and bowel and dietary habits among patients attending a specialty clinic for constipation. Gend Med. 2009;6:259–271.

    Article  PubMed  Google Scholar 

  18. Varma MG, Wang JY, Berian JR, Patterson TR, McCrea GL, Hart SL. The constipation severity instrument: a validated measure. Dis Colon Rectum. 2008;51:162–172.

    Article  PubMed  Google Scholar 

  19. Bharucha AE, Seide BM, Zinsmeister AR, Melton LJ 3rd. Relation of bowel habits to fecal incontinence in women. Am J Gastroenterol. 2008;103:1470–1475.

    Article  PubMed  Google Scholar 

  20. Pamuk ON, Pamuk GE, Celik AF. Revalidation of description of constipation in terms of recall bias and visual scale analog questionnaire. J Gastroenterol Hepatol. 2003;18:1417–1422.

    Article  PubMed  Google Scholar 

  21. Halder SL, Locke GR 3rd, Schleck CD, Zinsmeister AR, Melton LJ 3rd, Talley NJ. Natural history of functional gastrointestinal disorders: a 12-year longitudinal population-based study. Gastroenterology. 2007;133:799–807.

    Article  PubMed  Google Scholar 

  22. Degen LP, Phillips SF. How well does stool form reflect colonic transit? Gut. 1996;39:109–113.

    Article  PubMed  CAS  Google Scholar 

  23. Kanazawa M, Palsson OS, Thiwan SI, Turner MJ, van Tilburg MA, Gangarosa LM, et al. Contributions of pain sensitivity and colonic motility to IBS symptom severity and predominant bowel habits. Am J Gastroenterol. 2008;103:2550–2561.

    Article  PubMed  Google Scholar 

  24. Posserud I, Syrous A, Lindström L, Tack J, Abrahamsson H, Simrén M. Altered rectal perception in irritable bowel syndrome is associated with symptom severity. Gastroenterology. 2007;133:1113–1123.

    Article  PubMed  Google Scholar 

  25. Kuiken SD, Lindeboom R, Tytgat GN, Boeckxstaens GE. Relationship between symptoms and hypersensitivity to rectal distension in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22:157–164.

    Article  PubMed  CAS  Google Scholar 

  26. Dorn SD, Palsson OS, Thiwan SI, Kanazawa M, Clark WC, van Tilburg MA, et al. Increased colonic pain sensitivity in irritable bowel syndrome is the result of an increased tendency to report pain rather than increased neurosensory sensitivity. Gut. 2007;56:1202–1209.

    Article  PubMed  Google Scholar 

  27. Zar S, Benson MJ, Kumar D. Rectal afferent hypersensitivity and compliance in irritable bowel syndrome: differences between diarrhoea-predominant and constipation-predominant subgroups. Eur J Gastroenterol Hepatol. 2006;18:151–158.

    Article  PubMed  Google Scholar 

  28. Poitras P, Riberdy Poitras M, Plourde V, Boivin M, Verrier P. Evolution of visceral sensitivity in patients with irritable bowel syndrome. Dig Dis Sci. 2002;47:914–920.

    Article  PubMed  Google Scholar 

  29. Piché M, Arsenault M, Poitras P, Rainville P, Bouin M. Widespread hypersensitivity is related to altered pain inhibition processes in irritable bowel syndrome. Pain. 2010;148:49–58.

    Article  PubMed  Google Scholar 

  30. Talley NJ, Boyce P, Jones M. Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population. Gut. 1998;42:690–695.

    Article  PubMed  CAS  Google Scholar 

  31. Wong RK, Palsson OS, Turner MJ, Levy RL, Feld AD, von Korff M, et al. Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome. Am J Gastroenterol. 2010;105:2228–2234.

    Article  PubMed  Google Scholar 

  32. Chang L, Mayer EA, Labus JS, Schmulson M, Lee OY, Olivas TI, et al. Effect of sex on perception of rectosigmoid stimuli in irritable bowel syndrome. Am J Physiol Regul Integr Comp Physiol. 2006;291:R277–R284.

    Article  PubMed  CAS  Google Scholar 

  33. Lee KJ, Kim JH, Cho SW. Relationship of underlying abnormalities in rectal sensitivity and compliance to distension with symptoms in irritable bowel syndrome. Digestion. 2006;73:133–141.

    Article  PubMed  Google Scholar 

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Acknowledgment

This paper was supported by the following grants: 1RC2NR011959, NR04142, P30 NR04001. It is very important that this be included.

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Authors and Affiliations

  1. Department of Biobehavioral Nursing and Health Systems, University of Washington, Box 357266, Seattle, WA, 98195, USA

    Margaret Heitkemper, Robert Burr, Anne Poppe & Monica Jarrett

  2. Department of Biostatistics and Office of Nursing Research, University of Washington, Seattle, WA, USA

    Kevin C. Cain

  3. Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Robert Shulman

Authors
  1. Margaret Heitkemper
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  2. Kevin C. Cain
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  3. Robert Shulman
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  4. Robert Burr
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Correspondence to Margaret Heitkemper.

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Heitkemper, M., Cain, K.C., Shulman, R. et al. Subtypes of Irritable Bowel Syndrome Based on Abdominal Pain/Discomfort Severity and Bowel Pattern. Dig Dis Sci 56, 2050–2058 (2011). https://doi.org/10.1007/s10620-011-1567-4

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  • DOI: https://doi.org/10.1007/s10620-011-1567-4

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