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Fibromyalgia: The gastrointestinal link

Current Pain and Headache Reports volume 8, pages 364–368 (2004)Cite this article

Abstract

Patients with fibromyalgia (FM) frequently have gastrointestinal symptoms and signs. This article critically reviews the available literature and concludes the following: evidence that inflammatory bowel disease is associated with FM is contradictory, but should be looked for in patients taking concomitant steroids; patients diagnosed with celiac disease often have a history of FM or irritable bowel syndrome (IBS) that may or may not be present; reflux, nonulcer dyspepsia, and noncardiac chest pain are common in FM patients; medications used to manage pain, inflammation, and gastrointestinal complaints confound the management of FM; and IBS affects smooth muscles and the parasympathetic nervous system, while FM patients have complaints of striated muscles and dysfunction of the sympathetic nervous system. Of those patients with FM, 30% to 70% have concurrent IBS. Small intestinal bacterial overgrowth is associated with hyperalgesia and IBS-like complaints, is common in FM, and responds transiently to antimicrobial therapy.

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References and Recommended Reading

  1. Yunus M, Masi AT, Calabro JJ, et al.: Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched controls. Semin Arthritis Rheum 1981, 11:151–171.

    PubMed  Article  CAS  Google Scholar 

  2. Manning AP, Thompson C, Weinzierl M, et al.: Towards positive diagnosis of the irritable bowel. Br Med J 1978, 2:653–654.

    PubMed  CAS  Article  Google Scholar 

  3. Palm O, Moum B, Jahnsen J, Gran JT: Fibromyalgia and chronic widespread pain in patients with inflammatory bowel disease: a cross-sectional population survey. J Rheumatol 2001, 28:590–594.

    PubMed  CAS  Google Scholar 

  4. Buskila D, Odes LR, Neumann L, Odes HS: Fibromyalgia in inflammatory bowel disease. J Rheumatol 1999, 26:1167–1171.

    PubMed  CAS  Google Scholar 

  5. Zipser RD, Patel D, Yahya KZ, et al.: Presentations of adult celiac disease in a nationwide patient support group. Dig Dis Sci 2003, 48:761–764.

    PubMed  Article  Google Scholar 

  6. Triadafilopoulos G, Simms RW, Goldenberg DL: Bowel dysfunction in fibromyalgia syndrome. Dig Dis Sci 1991, 36:59–64.

    PubMed  Article  CAS  Google Scholar 

  7. Chang L: The association of functional gastrointestinal disorders and fibromyalgia. Eur J Surg 1998, 583:32–36. One of the best reviews of the subject.

    Article  Google Scholar 

  8. Malt EA, Ursin H: Mutilation anxiety differs among females with fibromyalgia and functional dyspepsia and population controls. J Psychosom Res 2003, 54:523–531.

    PubMed  Article  Google Scholar 

  9. Malt EA, Berle JE, Olafsson S, et al.: Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders: a study of women with random sample population controls. J Psychosom Res 2000, 49:285–289.

    PubMed  Article  CAS  Google Scholar 

  10. Klerman EB, Goldenberg DL, Brown EN, et al.: Circadian rhythms of women with fibromyalgia. J Clin Endocrinol Metab 2001, 86:1034–1039.

    PubMed  Article  CAS  Google Scholar 

  11. Silver DS, Wallace DJ: The management of fibromyalgia-associated syndromes. Rheum Dis Clin North Am 2002, 28:405–417.

    PubMed  Article  Google Scholar 

  12. Wallace DJ, Wallace JB: All About Fibromyalgia. London, New York: Oxford University Press; 2002.

    Google Scholar 

  13. Huang CS, Farraye FA: Irritable bowel syndrome: managing this complex disorder. Womens Health Prim Care 2003, 6:247–256.

    Google Scholar 

  14. Thompson WG, Longstreth GF, Drossman DA, et al.: Functional bowel disorders and functional abdominal pain. Gut 1999, 45:43–47.

    Google Scholar 

  15. Cook IJ, Van Elden A, Collins SM: Patients with irritable bowel syndrome have greater pain tolerance than normal subjects. Gastroenterology 1987, 93:727–733.

    PubMed  CAS  Google Scholar 

  16. Serra J, Azpiroz F, Malagelada JR: Impaired transit and tolerance of intestinal gas in the irritable bowel syndrome. Gut 2001, 48:14–19.

    PubMed  Article  CAS  Google Scholar 

  17. Veale D, Kavanaugh G, Fielding JF, Fitzgerald O: Primary fibromyalgia and the irritable bowel syndrome: different expressions of a common pathogenetic process. Br J Rheumatol 1991, 30:220–222.

    PubMed  Article  CAS  Google Scholar 

  18. Sivri A, Cindas A, Dincer F, Sivri B: Bowel dysfunction and irritable bowel function in fibromyalgia patients. Clin Rheumatol 1996, 15:283–286.

    Article  Google Scholar 

  19. Lubrano E, Iovino P, Tremolaterra F, et al.: Fibromyalgia in patients with irritable bowel syndrome: an association with the severity of the intestinal disorder. Int J Colorectal Dis 2001, 16:211–215.

    PubMed  Article  CAS  Google Scholar 

  20. 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. Outstanding for its thoughtfulness and thoroughness.

    PubMed  Article  CAS  Google Scholar 

  21. Sperber AD, Carmel S, Atzmon Y, et al.: The sense of coherence index and the irritable bowel syndrome: a cross-sectional comparison among irritable bowel syndrome patients with and without coexisting fibromyalgia, irritable bowel syndrome non-patients, and controls. Scand J Gastroenterol 1999, 34:259–263.

    PubMed  Article  CAS  Google Scholar 

  22. Sperber AD, Carmel S, Atzmon Y, et al.: Use of Functional Bowel Disorder Severity Index (FBDSI) in a study of patients with the irritable syndrome and fibromyalgia. Am J Gastrointestinal 2000, 95:995–998.

    CAS  Article  Google Scholar 

  23. Scarinci IC, McDonald-Haile J, Bradley LA, Richter JE: Altered pain perception and psychosocial features among women with gastrointestinal disorders and history of abuse: a preliminary model. Am J Med 1994, 97:108–118.

    PubMed  Article  CAS  Google Scholar 

  24. 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. Outstanding methodologies were used in this study.

    PubMed  Article  CAS  Google Scholar 

  25. Chun A, Desaultes S, Slivka A, et al.: Visceral algesia in irritable bowel syndrome, fibromyalgia, and sphincter of Oddi dysfunction: type III. Dig Dis Sci 1999, 44:631–636.

    PubMed  Article  CAS  Google Scholar 

  26. Toskes PP, Kumar A: Enteric bacterial flora and bacterial overgrowth syndrome. In Sleisenger and Fortran’s Gastrointestinal and Liver Disease, edn 6. Edited by Feldman M, Scharschmidt BF, Sleisenger MH: Philadelphia: WB Saunders; 1998:1523.

    Google Scholar 

  27. King CE, Toskes PP: Comparison of the 1-gram [14C] xylose, 10-gram lactulose-H2, and 80-gram glucose H2 breath tests in patients with small intestinal bacterial overgrowth. Gastroenterology 1986, 91:1447.

    PubMed  CAS  Google Scholar 

  28. Pimentel M, Chow EJ, Hallegua DJ, et al.: Small intestinal bacterial overgrowth: a possible association with fibromyalgia. J Musculoskel Pain 2001, 9:107–113.

    Article  Google Scholar 

  29. Pimentel M, Hallegua DS, Wallace DJ, et al.: Improvement of symptoms by eradication of small intestinal overgrowth in FMS: a double-blind study. Arthritis Rheum 1999, 42:S343.

    Google Scholar 

  30. Pimentel M, Wallace DJ, 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. Outstanding for its thoroughness.

    PubMed  Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Cedars-Sinai/UCLA School of Medicine, 8737 Beverly Blvd., Suite 203, 90048, Los Angeles, CA, USA

    Daniel J. Wallace MD & David S. Hallegua MD

Authors
  1. Daniel J. Wallace MD
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  2. David S. Hallegua MD
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Wallace, D.J., Hallegua, D.S. Fibromyalgia: The gastrointestinal link. Current Science Inc 8, 364–368 (2004). https://doi.org/10.1007/s11916-996-0009-z

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  • DOI: https://doi.org/10.1007/s11916-996-0009-z

Keywords

  • Irritable Bowel Syndrome
  • Fibromyalgia
  • Functional Dyspepsia
  • Fibromyalgia Impact Questionnaire
  • Small Intestinal Bacterial Overgrowth