PharmacoEconomics

, Volume 19, Issue 6, pp 643–653 | Cite as

Quality of Life in Irritable Bowel Syndrome

Review Article

Abstract

Quality-of-life (QOL) assessment is becoming increasingly important in the evaluation of the impact of disease and the effect of therapy. This is particularly so for irritable bowel syndrome (IBS) where there is often a tendency for a chronic clinical course, but with no associated mortality. Instruments used to study quality of life may be generic or disease specific, and care needs to be taken to ensure that the instrument used has been adequately validated for the purpose intended. Several disease-specific instruments [Irritable Bowel Syndrome Quality of Life (IBS-QOL, IBSQOL) and Functional Digestive Disorders Quality of Life (FDDQL)], in addition to generic measures, are now available for use in IBS.

Quality of life in patients with IBS is surprisingly poor, particularly in the population seeking healthcare, where it can be compared with conditions which carry a high mortality, such as ischaemic heart disease, heart failure and diabetes mellitus. Pain severity appears to be an important factor in determining quality of life in IBS, although bowel disturbance and psychological difficulties are also likely to be important.

There is limited data on the effect of treatment of IBS on quality of life. Improvement has been reported with dietry modification, drug treatments and hypnotherapy. It is likely that, in the future, QOL measures will become increasingly used as secondary end-points in therapeutic trials in IBS.

References

  1. 1.
    Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut 1999; 45 Suppl. 2: 43–7Google Scholar
  2. 2.
    Talley NJ, Zinsmeister AR, Schleck CD, et al. Dyspepsia and dyspepsia subgroups: a population based study. Gastroenterology 1992; 102: 1259–68PubMedGoogle Scholar
  3. 3.
    Talley NJ, Weaver AL, Zinsmeister AR, et al. Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol 1992; 136: 165–77PubMedGoogle Scholar
  4. 4.
    Constitution of the World Health Organisation. Handbook of basic documents. 5th ed. Geneva: Palais des Nations, 1952Google Scholar
  5. 5.
    Testa MA, Simonson DC. Current concepts: assessment of quality of life outcomes. N Engl J Med 1996; 334 (13): 835–40PubMedCrossRefGoogle Scholar
  6. 6.
    Irvine EJ. Quality of life: rationale and methods for developing a disease-specific instrument for inflammatory bowel disease. Scand J Gastroenterol 1993; 28 Suppl. 199: 22–7CrossRefGoogle Scholar
  7. 7.
    Bech P. Quality of life measurements for patients taking which drugs? The clinical PCASEE perspective. Pharmacoeconomics 1995 Feb; 7 (2): 141–51PubMedCrossRefGoogle Scholar
  8. 8.
    Lee OY, Fitzgerald LZ, Naliboff B, et al. Impact of advertisement and clinic populations in symptoms and perception of irritable bowel syndrome. Aliment Pharmacol Ther 1999; 13: 1631–8PubMedCrossRefGoogle Scholar
  9. 9.
    Guthrie EA, Creed FH, Whorwell PJ, et al. Outpatients with irritable bowel syndrome: a comparison of first time and chronic attenders. Gut 1992; 33 (3): 361–3PubMedCrossRefGoogle Scholar
  10. 10.
    Xuan J, Kirchdoerfer LJ, Boyer JG, et al. Effects of comorbidity on health related quality of life scores: an analysis of clinical trial data. Clin Ther 1999; 21 (2): 383–403PubMedCrossRefGoogle Scholar
  11. 11.
    Patrick DL, Drossman DA, Frederick IO, et al. Quality of life in persons with irritable bowel syndrome: development and validation of a new measure. Dig Dis Sci 1998 Feb; 43 (2): 400–11PubMedCrossRefGoogle Scholar
  12. 12.
    Steward AL, Greenfield S, Hays RD, et al. Functional status and well being of patients with chronic conditions: results from the medical outcomes study. JAMA 1989; 262: 907–13CrossRefGoogle Scholar
  13. 13.
    Bergner M, Bobbitt RA, Pollard WE, et al. The sickness impact profile: validation of a health status measure. Med Care 1976; 14 (1): 57–67PubMedCrossRefGoogle Scholar
  14. 14.
    Borgaonkar MR, Irvine EJ. Quality of life measurement in gastrointestinal and liver disorders. Gut 2000; 47: 444–54PubMedCrossRefGoogle Scholar
  15. 15.
    Hahn BA, Kirchdoerfer LJ, Fullerton S, et al. Evaluation of a new quality of life questionnaire for patients with irritable bowel syndrome. Aliment Pharmacol Ther 1997 Jun; 11 (3): 547–52PubMedCrossRefGoogle Scholar
  16. 16.
    Whitehead WE, Burnett CK, Edwin WC, et al. Impact of irritable bowel syndrome on quality of life. Dig Dis Sci 1996; 41 (11): 2248–53PubMedCrossRefGoogle Scholar
  17. 17.
    Chassany O, Marquis P, Scherrer B, et al. Validation of a specific quality of life questionnaire for functional digestive disorders. Gut 1999; 44: 527–33PubMedCrossRefGoogle Scholar
  18. 18.
    Irvine EJ. The quality of quality of life. Gut 1999; 44: 450–1PubMedCrossRefGoogle Scholar
  19. 19.
    Wong E, Guyatt GH, Cook DJ, et al. Development of a questionnaire to measure quality of life in irritable bowel syndrome. Eur J Surg Suppl 1998; (583): 50–6PubMedCrossRefGoogle Scholar
  20. 20.
    Eypasch E, Williams JI, Wood-Dauphinee S, et al. Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 1995 Feb; 82 (2): 216–22PubMedCrossRefGoogle Scholar
  21. 21.
    Shaw M, Talley NJ, Adlis S, et al. Development of a digestive health status instrument: tests of scaling assumptions, structure and reliability in a primary care population. Aliment Pharmacol Ther 1998 Nov; 12 (11): 1067–78PubMedCrossRefGoogle Scholar
  22. 22.
    Wiklund IK, Glise H. Quality of life in different gastrointestinal conditions. Eur J Surg Suppl. 1998; 582: 56–61PubMedGoogle Scholar
  23. 23.
    Drossman DA, Li Z, Leserman J. Health status by gastrointestinal diagnosis and abuse history. Gastroenterology 1996; 110 (4): 999–1007PubMedCrossRefGoogle Scholar
  24. 24.
    Dancey CP, Backhouse S. Towards a better understanding of patients with irritable bowel syndrome. J Adv Nursing 1993; 18: 1443–50CrossRefGoogle Scholar
  25. 25.
    Hahn BA, Kirchdoerfer LJ, Fullerton S, et al. Patient perceived severity of irritable bowel syndrome in relation to symptoms, health care utilization and quality of life. Aliment Pharmacol Ther 1997; 11: 553–9PubMedCrossRefGoogle Scholar
  26. 26.
    Stassels SA, Hahn BA. Short Form 36 (SF-36) scores in patients with IBS compared with US norms. Gastroenterology 1997; 112 Suppl.: A44Google Scholar
  27. 27.
    Chassany O, Marquis P, Fraitag B, et al. European psychometric validation of a specific quality of life questionnaire in functional digestive disorders [abstract]. Gut 1996; 99 (Suppl. 3): A33Google Scholar
  28. 28.
    Chassany O, Bergmann JF. Quality of life in irritable bowel syndrome, effect of therapy. Eur J Surg Suppl 1998; 583: 81–6PubMedGoogle Scholar
  29. 29.
    Gralnek IM, Hays RD, Kilbourne A, et al. The impact of irritable bowel syndrome on health related quality of life. Gastroenterology 2000; 119: 654–60PubMedCrossRefGoogle Scholar
  30. 30.
    Koloski NA, Talley NJ, Boyce PM. The impact of functional gastrointestinal disorders on quality of life. Am J Gastroenterol 2000 Jan; 95 (1): 67–71PubMedCrossRefGoogle Scholar
  31. 31.
    Drossman DA, Li Z, Toner BB, et al. Functional bowel disorders: a multicentre comparison of health status and development of illness severity index. Dig Dis Sci 1995; 40: 986–95PubMedCrossRefGoogle Scholar
  32. 32.
    Talley NJ, Zinsmeister AR, Melton LJ. Irritable bowel syndrome in a community: subgroups risk factors and health care utilization. Am J Epidemiol 1995; 142: 76–83PubMedGoogle Scholar
  33. 33.
    Glia A, Lindberg G. quality of life in patients with different types of functional constipation. Scand J Gastroenterol 1997; 32: 1083–9PubMedCrossRefGoogle Scholar
  34. 34.
    Drossman DA, Creed FH, Fava GA. Psychosocial aspects of functional gastrointestinal disorders. Gastroenterol Int 1995; 8: 47–90Google Scholar
  35. 35.
    Walker EA, Gelfand AN, Gelfand MD. Psychiatric diagnoses, sexual and physical victimisation and disability in patients with irritable bowel syndrome or inflammatory bowel disease. Psychol Med 1995; 25 (6): 1259–67PubMedCrossRefGoogle Scholar
  36. 36.
    Drossman DA, McKee DC, Sandler RS. Psychological factors in the irritable bowel syndrome. Gastroenterology 1988; 95: 701–8PubMedGoogle Scholar
  37. 37.
    Lydiard RB, Fossey MD, March W. Prevalence of psychiatric disorders in patients with IBS. Psychosomatics 1993; 34: 229–34PubMedCrossRefGoogle Scholar
  38. 38.
    Drossman DA, Leserman J, Nachman G. Sexual and physical abuse in women with functional than organic gastrointestinal disorders. Ann Intern Med 1990; 113: 828–33PubMedGoogle Scholar
  39. 39.
    Talley NJ, Fett SL, Zinsmeister AR, et al. Gastrointestinal tract symptoms and self-reported abuse: a population-based study. Gastroenterology 1994; 107 (4): 1040–9PubMedGoogle Scholar
  40. 40.
    Longstreth GF, Wolde-Tsadik G. Irritable bowel type symptoms in HMO examinees. Dig Dis Sci 1993; 38: 1581–9PubMedCrossRefGoogle Scholar
  41. 41.
    Creed F, Craig T, Farmer R. Functional abdominal pain, psychiatric illness and life events. Gut 1988; 29 (2): 235–42PubMedCrossRefGoogle Scholar
  42. 42.
    Craig TKJ, Brown GW. Goal frustration and life events in the aetiology of painful gastrointestinal disorder. J Psychosom Res 1984; 28: 411–21PubMedCrossRefGoogle Scholar
  43. 43.
    Whitehead WE, Crowell MD, Robinson JC. Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut 1992; 33: 825–30PubMedCrossRefGoogle Scholar
  44. 44.
    Barton A, Pal B, Whorwell PJ, et al. Increased prevalence of sicca complex and fibromyalgia in patients with irritable bowel syndrome. Am J Gastroenterol 1999; 94 (7): 1898–901PubMedCrossRefGoogle Scholar
  45. 45.
    Whorwell PJ, McCallum M, Creed FH, et al. Non-colonic features of irritable bowel syndrome. Gut 1986; 27: 37–40PubMedCrossRefGoogle Scholar
  46. 46.
    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 (12): 3541–6PubMedCrossRefGoogle Scholar
  47. 47.
    Hahn BA, Yan S, Stassels S. Impact of irritable bowel syndrome on quality of life and resource use in the United States & United Kingdom. Digestion 1999; 60: 77–81PubMedCrossRefGoogle Scholar
  48. 48.
    O’Keefe EA, Talley NJ, Zinsmeister AR, et al. Bowel disorders impair functional status and quality of life in the elderly: a population based study. J Gerontol A Biol Sci Med Sci 1995 Jul; 50 (4): M184–9CrossRefGoogle Scholar
  49. 49.
    Drossman DA, Whitehead WE, Camilleri M. Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology 1997; 112 (6): 2120–37PubMedCrossRefGoogle Scholar
  50. 50.
    Switz DM. What a gastroenterologist does all day: a survey of a state society’s practice. Gastroenterology 1976; 70: 1048PubMedGoogle Scholar
  51. 51.
    Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther 1997; 11 (6): 1019–30PubMedCrossRefGoogle Scholar
  52. 52.
    Everhart JE, Renault PF. Irritable bowel syndrome in office based practice in the United States. Gastroenterology 1991; 100: 998–1005PubMedGoogle Scholar
  53. 53.
    Maxton DG, Whorwell PJ. Use of medical resources and attitudes to health care in patients with chronic abdominal pain. Br J Med Econ 1992; 2: 75–9Google Scholar
  54. 54.
    Whitehead WE, Cheskin LJ, Heller BR. Evidence for exacerbation of irritable bowel syndrome during menses. Gastroenterology 1990; 98: 1485PubMedGoogle Scholar
  55. 55.
    Talley NJ, Gabriel SE, Harmsen WS, et al. Medical costs in community subjects with irritable bowel syndrome. Gastroenterology 1995; 109: 1736–41PubMedCrossRefGoogle Scholar
  56. 56.
    KMPG Peat Marwick Inc. The economic burden of irritable bowel syndrome in Canada. Symposium on functional digestive disease 1997; 34: 10Google Scholar
  57. 57.
    Drossman DA, Li Z, Andruzzi E. US householder survey of functional gastrointestinal disorders. Prevalence, sociodemography and health impact. Dig Dis Sci 1993; 38 (9): 1569–80PubMedCrossRefGoogle Scholar
  58. 58.
    Schuster MM. Diagnostic evaluation of the irritable bowel syndrome. Gastroenterol Clin North Am 1991; 20: 269PubMedGoogle Scholar
  59. 59.
    Klein KB. Controlled treatment trials in the irritable bowel syndrome: a critique. Gastroenterology 1988; 95: 232–41PubMedGoogle Scholar
  60. 60.
    King TS, Hunter JO. quality of life in irritable bowel syndrome: does it improve with resolution of symptoms? Gastroenterology 1997; 112 Suppl.: A761Google Scholar
  61. 61.
    Mathias JR, Clench MH, Abell TE, et al. Effects of leuprolide acetate on functional bowel disease: a multicentre, double blind, placebo-controlled study. Gastroenterology 1997; 112 Suppl.: A784Google Scholar
  62. 62.
    Dapoigny M, Abitbol JL, Meric G, et al. Fedotozine in IBS: results of a six week placebo controlled multicentre therapeutic trial. Gastroenterology 1995; 108 Suppl.: A588CrossRefGoogle Scholar
  63. 63.
    Chassany O, Geneve J, Abitbol JL, et al. Specific quality of life questionnaire in IBS: effect of fedotozine. Gastroenterology 1995; 108 Suppl.: A581CrossRefGoogle Scholar
  64. 64.
    Drossman DA, Creed FH, Olden KW, et al. Psychosocial aspects of the functional gastrointestinal disorders. In: Drossman DA, Talley NJ, Thompson WG, et al., editors. The functional gastrointestinal disorders: diagnosis pathophysiology & treatment: a multinational consensus. Vol 2. Mclean (VA): Degnon and associates. In pressGoogle Scholar
  65. 65.
    Guthrie E, Creed F, Dawson D, et al. A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 1991; 100: 450–7PubMedGoogle Scholar
  66. 66.
    Talley NJ, Owen BK, Boyce P, et al. Psychological treatments for irritable bowel syndrome: a critique of controlled treatment trials. Am J Gastroenterol 1996; 91: 277–83PubMedGoogle Scholar
  67. 67.
    Galovski TE, Blanchard EB. The treatment of irritable bowel syndrome with hypnotherapy. Appl Psychophysiol Biofeedback 1998; 23: 219–32PubMedCrossRefGoogle Scholar
  68. 68.
    Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable bowel syndrome. Lancet 1984; 2 (8414): 1232–4PubMedCrossRefGoogle Scholar
  69. 69.
    Whorwell PJ, Prior A, Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut 1987; 28: 423–5PubMedCrossRefGoogle Scholar
  70. 70.
    Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome — the effect of hypnotherapy. Aliment Pharmacol Ther 1996; 10: 91–5PubMedCrossRefGoogle Scholar
  71. 71.
    Harvey RF, Hinton RA, Gunery RM, et al. Individual and group hypnotherapy in the treatment of refractory IBS. Lancet 1989; 1: 424–5PubMedCrossRefGoogle Scholar
  72. 72.
    Chiotakakau-Faliakau E, Kamm MA, Ray AJ, et al. Biofeedback provides long term benefit for patients with intractable, slow and normal transit constipation. Gut 1998; 42: 517–21CrossRefGoogle Scholar
  73. 73.
    Wiklund I. Quality of life and regulatory issues. Scand J Gastroenterol 1996; 31 Suppl. 221: 37–8CrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Department of MedicineUniversity Hospital of South ManchesterManchesterEngland

Personalised recommendations