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Are there gender specific predictors of health related quality of life (HRQOL) impairment in patients with irritable bowel syndrome?
AJG – September, Suppl., 2002
We did a cross–sectional study to determine the role of smoking, alcohol, aspirin, acetaminophen, education level and marital status on the prevalence of functional bowel disorders in a community sample of employed adults. Methods: 1069 employees of the Veterans Affairs (VA) Health Care System were mailed validated questionnaires inquiring about their bowel habits (Bowel Disease Questionnaire). Rome I criteria were used to define irritable bowel syndrome (IBS), constipation and diarrhea. Results: 723 subjects (response rate 72%) returned the survey (age range 24 –77). One hundred and forty (19.4%) subjects reported symptoms of constipation, 10.9% chronic diarrhea and 9.1% IBS. Adjusting for age, constipation (OR 1.9, CI 1.29 – 2.94, p .01) and IBS (OR 1.4, CI 0.78 – 2.38, p .24) were more prevalent in females but chronic diarrhea was no different by gender. Adjusting for gender, none of these disorders were related to age. Controlling for age and gender, IBS was not associated with education level, smoking, aspirin use or alcohol consumption. Unmarried subjects (OR 1.3, CI 1.04 – 1.55, p .02), and subjects taking acetaminophen (OR 1.6, CI 1.28 –2.09, P .01) were at higher risk for IBS. Adjusting for age and gender, none of the above factors were associated with chronic diarrhea or constipation. Conclusions: Functional bowel disorders are common in employed adults. Constipation and IBS are more common in females. Education level, smoking, alcohol, or aspirin use are not risk factor for IBS, constipation or chronic diarrhea.
861 ARE THERE GENDER SPECIFIC PREDICTORS OF HEALTH RELATED QUALITY OF LIFE (HRQOL) IMPAIRMENT IN PATIENTS WITH IRRITABLE BOWEL SYNDROME? Joel A. Sach, M.D., Lin Chang, M.D., Bruce Naliboff, Ph.D. and Emeran A. Mayer, M.D.*. Dept. of Medicine, GLA VA HC and UCLA, UCLA/CURE Digestive Research Center/Neuroenteric Disease Program, Los Angeles, CA. Purpose: Irritable bowel syndrome (IBS) is a common condition characterized by abdominal pain/discomfort and altered bowel habits and has a female predominance. Many IBS patients, particularly women, also report extra–intestinal symptoms such as fatigue (Whorwell et al., Gut 1986). Fatigue and lack of energy can be assessed using a validated questionnaire (Maastricht) which measures vital exhaustion (Appels et al. 1987). While vital exhaustion has been shown to independently predict health related quality of life (HRQOL) in IBS patients (Sach et al., Gastro 2002), potential gender related differences influencing these observations remain unexplored. We aimed to 1) compare vital exhaustion, psychological symptoms and HRQOL in male and female IBS patients and healthy controls, and 2) to determine if there are gender differences in the predictive factors of HRQOL in IBS. Methods: 35 healthy controls (age⫽ 38⫾1.4, 60%F) and 80 Rome positive IBS patients (age ⫽ 42⫾ 1.2, 75%F) recruited through advertisement and UCLA IBS clinic who completed the UCLA bowel symptom questionnaire, Hospital Anxiety & Depression (HAD) questionnaire, SF–12 (HRQOL), and the Maastricht Questionnaire. Results: The IBS patients had a mean overall GI severity score of 11 (0 –20 scale) which did not differ in males and females with IBS. Compared to controls, HRQOL measures were significantly impaired in IBS in both the mental (MCS: 46 vs. 53; P⬍0.001) and physical (PCS: 46 vs. 56; P⬍0.001) domains. Vital exhaustion scores were overall significantly higher in the IBS vs. controls (p⫽0.01) but this difference was only significant between the female IBS and controls (p⫽0.005) and not between the male groups. Elevated HAD scores were not significantly different between IBS and controls or between IBS males and females. Overall, elevated vital exhaustion scores significantly predicted impairments in both MCS and PSC measures of QOL even after adjusting for depression, anxiety, overall GI symptom severity and age. While vital exhaustion was the main predictor of QOL in female IBS patients, depression and anxiety were more predictive of QOL in male IBS patients.
Abstracts
S283
Conclusions: Predictors of HRQOL impairment in moderate to severe IBS appear to differ in male and female patients. In males cognitive factors are the strongest predictors of impaired HRQOL while in females physical factors predominate.
862 THE PREVALENCE OF GASTROINTESTINAL SYMPTOMS IN PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS David A. Hirschl, M.S., Jin H. Park, M.D., Terry D. Heiman–Patterson, M.D., Mark Ovsiowitz, M.D., Brahmesh Siva, M.D., Therea A. Paylor, R.N. and James C. Reynolds, M.D.*. Division of Gastroenterology and Hepatology, MCP Hahnemann University, Philadelphia, Pennsylvania and ALS Hope Foundation, MCP Hahnemann University, Philadelphia, PA. Purpose: Amyotrophic Lateral Sclerosis (ALS), is a progressive debilitating disease that affects somatic upper and lower motor neurons. Malnutrition and reduced respiratory function are the two best predictors of a poorer prognosis. While dysphagia is a major cause of malnutrition, recent evidence suggests that this degenerative disease may also affect the entire digestive tract. No studies have yet defined the prevalene of GI symptoms in patients with ALS. Identification of specific symptoms may aid in the management of these patients, and may lead to an improved quality of life. The purpose of this study was to assess the prevalence of GI symptoms in patients with ALS and the degree to which their quality of life was affected. Methods: The McGill Quality of Life Questionnaire, and the Digestive Health Status Index were administered to patients who had been diagnosed with ALS (n⫽50) and an age–matched control population (n⫽68). Subjects completed questionnaires with assistance as needed to assure data quality. Scores were calculated using established guidelines, and analyzed using the Student’s t–Test. Results: ALS patients had a significantly worse overall quality of life score (6.5 vs. 7.3(p⬍0.02)). This decreased quality of life was related to impaired physical well being (6.3 vs. 7.3 (p⬍0.04)) while psychological well– being was similar between the two groups (6.5 vs. 7.0(p⬎0.19)). Several GI symptoms contributed to this impaired physical well– being. While dysphagia is an important cause of malnutrition in these patients, we also found that early satiety was a problem for these patients (p⬍0.002). Of ALS patients, 28% commonly experienced early satiety compared to 10% of controls. Early satiety occurred only in patients with advancing ALS, suggesting a disease–mediated mechanism. Constipation (17.3 vs. 14.9(p⫽0.38)), dysmotility symptoms (13.8 vs 11.9 (p⫽0.29)) and pain– experience symptoms (14.0 vs. 12.7 (p⫽0.67)) were greater in ALS patients than controls, but these data were not statistically significant. GERD symptoms and diarrhea symptoms were similar in patients and controls. Conclusions: Early satiety can be an important factor in malnutrition of patients with ALS and affects their overall physical well– being. A better understanding of the mechanism of this symptom and its treatment may provide an important means of improving the overall well– being of these patients.
863 BUPROPION FOR SMOKING CESSATION IMPROVES SYMPTOMS OF IRRITABLE BOWEL SYNDROME (IBS) Christine L. Frissora, M.D.*. Division of Gastroenterology and Hepatology, The Weill Medical College of Cornell University, New York, NY. Purpose: IBS is a common disease. Women in their 3rd decade are among the most commonly affected. Smoking in the US continues to increase in young women. Lifestyle modifications, especially encouraging smoking cessation, are an essential part of the treatment of IBS. Bupropion (WELLBUTRIN/ZYBAN) is an antidepressant effective for smoking cessation. IBS symptoms improve when patients are treated with bupropion for smoking cessation.
We did a cross–sectional study to determine the role of smoking, alcohol, aspirin, acetaminophen, education level and marital status on the prevalence of functional bowel disorders in a community sample of employed adults. Methods: 1069 employees of the Veterans Affairs (VA) Health Care System were mailed validated questionnaires inquiring about their bowel habits (Bowel Disease Questionnaire). Rome I criteria were used to define irritable bowel syndrome (IBS), constipation and diarrhea. Results: 723 subjects (response rate 72%) returned the survey (age range 24 –77). One hundred and forty (19.4%) subjects reported symptoms of constipation, 10.9% chronic diarrhea and 9.1% IBS. Adjusting for age, constipation (OR 1.9, CI 1.29 – 2.94, p .01) and IBS (OR 1.4, CI 0.78 – 2.38, p .24) were more prevalent in females but chronic diarrhea was no different by gender. Adjusting for gender, none of these disorders were related to age. Controlling for age and gender, IBS was not associated with education level, smoking, aspirin use or alcohol consumption. Unmarried subjects (OR 1.3, CI 1.04 – 1.55, p .02), and subjects taking acetaminophen (OR 1.6, CI 1.28 –2.09, P .01) were at higher risk for IBS. Adjusting for age and gender, none of the above factors were associated with chronic diarrhea or constipation. Conclusions: Functional bowel disorders are common in employed adults. Constipation and IBS are more common in females. Education level, smoking, alcohol, or aspirin use are not risk factor for IBS, constipation or chronic diarrhea.
861 ARE THERE GENDER SPECIFIC PREDICTORS OF HEALTH RELATED QUALITY OF LIFE (HRQOL) IMPAIRMENT IN PATIENTS WITH IRRITABLE BOWEL SYNDROME? Joel A. Sach, M.D., Lin Chang, M.D., Bruce Naliboff, Ph.D. and Emeran A. Mayer, M.D.*. Dept. of Medicine, GLA VA HC and UCLA, UCLA/CURE Digestive Research Center/Neuroenteric Disease Program, Los Angeles, CA. Purpose: Irritable bowel syndrome (IBS) is a common condition characterized by abdominal pain/discomfort and altered bowel habits and has a female predominance. Many IBS patients, particularly women, also report extra–intestinal symptoms such as fatigue (Whorwell et al., Gut 1986). Fatigue and lack of energy can be assessed using a validated questionnaire (Maastricht) which measures vital exhaustion (Appels et al. 1987). While vital exhaustion has been shown to independently predict health related quality of life (HRQOL) in IBS patients (Sach et al., Gastro 2002), potential gender related differences influencing these observations remain unexplored. We aimed to 1) compare vital exhaustion, psychological symptoms and HRQOL in male and female IBS patients and healthy controls, and 2) to determine if there are gender differences in the predictive factors of HRQOL in IBS. Methods: 35 healthy controls (age⫽ 38⫾1.4, 60%F) and 80 Rome positive IBS patients (age ⫽ 42⫾ 1.2, 75%F) recruited through advertisement and UCLA IBS clinic who completed the UCLA bowel symptom questionnaire, Hospital Anxiety & Depression (HAD) questionnaire, SF–12 (HRQOL), and the Maastricht Questionnaire. Results: The IBS patients had a mean overall GI severity score of 11 (0 –20 scale) which did not differ in males and females with IBS. Compared to controls, HRQOL measures were significantly impaired in IBS in both the mental (MCS: 46 vs. 53; P⬍0.001) and physical (PCS: 46 vs. 56; P⬍0.001) domains. Vital exhaustion scores were overall significantly higher in the IBS vs. controls (p⫽0.01) but this difference was only significant between the female IBS and controls (p⫽0.005) and not between the male groups. Elevated HAD scores were not significantly different between IBS and controls or between IBS males and females. Overall, elevated vital exhaustion scores significantly predicted impairments in both MCS and PSC measures of QOL even after adjusting for depression, anxiety, overall GI symptom severity and age. While vital exhaustion was the main predictor of QOL in female IBS patients, depression and anxiety were more predictive of QOL in male IBS patients.
Abstracts
S283
Conclusions: Predictors of HRQOL impairment in moderate to severe IBS appear to differ in male and female patients. In males cognitive factors are the strongest predictors of impaired HRQOL while in females physical factors predominate.
862 THE PREVALENCE OF GASTROINTESTINAL SYMPTOMS IN PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS David A. Hirschl, M.S., Jin H. Park, M.D., Terry D. Heiman–Patterson, M.D., Mark Ovsiowitz, M.D., Brahmesh Siva, M.D., Therea A. Paylor, R.N. and James C. Reynolds, M.D.*. Division of Gastroenterology and Hepatology, MCP Hahnemann University, Philadelphia, Pennsylvania and ALS Hope Foundation, MCP Hahnemann University, Philadelphia, PA. Purpose: Amyotrophic Lateral Sclerosis (ALS), is a progressive debilitating disease that affects somatic upper and lower motor neurons. Malnutrition and reduced respiratory function are the two best predictors of a poorer prognosis. While dysphagia is a major cause of malnutrition, recent evidence suggests that this degenerative disease may also affect the entire digestive tract. No studies have yet defined the prevalene of GI symptoms in patients with ALS. Identification of specific symptoms may aid in the management of these patients, and may lead to an improved quality of life. The purpose of this study was to assess the prevalence of GI symptoms in patients with ALS and the degree to which their quality of life was affected. Methods: The McGill Quality of Life Questionnaire, and the Digestive Health Status Index were administered to patients who had been diagnosed with ALS (n⫽50) and an age–matched control population (n⫽68). Subjects completed questionnaires with assistance as needed to assure data quality. Scores were calculated using established guidelines, and analyzed using the Student’s t–Test. Results: ALS patients had a significantly worse overall quality of life score (6.5 vs. 7.3(p⬍0.02)). This decreased quality of life was related to impaired physical well being (6.3 vs. 7.3 (p⬍0.04)) while psychological well– being was similar between the two groups (6.5 vs. 7.0(p⬎0.19)). Several GI symptoms contributed to this impaired physical well– being. While dysphagia is an important cause of malnutrition in these patients, we also found that early satiety was a problem for these patients (p⬍0.002). Of ALS patients, 28% commonly experienced early satiety compared to 10% of controls. Early satiety occurred only in patients with advancing ALS, suggesting a disease–mediated mechanism. Constipation (17.3 vs. 14.9(p⫽0.38)), dysmotility symptoms (13.8 vs 11.9 (p⫽0.29)) and pain– experience symptoms (14.0 vs. 12.7 (p⫽0.67)) were greater in ALS patients than controls, but these data were not statistically significant. GERD symptoms and diarrhea symptoms were similar in patients and controls. Conclusions: Early satiety can be an important factor in malnutrition of patients with ALS and affects their overall physical well– being. A better understanding of the mechanism of this symptom and its treatment may provide an important means of improving the overall well– being of these patients.
863 BUPROPION FOR SMOKING CESSATION IMPROVES SYMPTOMS OF IRRITABLE BOWEL SYNDROME (IBS) Christine L. Frissora, M.D.*. Division of Gastroenterology and Hepatology, The Weill Medical College of Cornell University, New York, NY. Purpose: IBS is a common disease. Women in their 3rd decade are among the most commonly affected. Smoking in the US continues to increase in young women. Lifestyle modifications, especially encouraging smoking cessation, are an essential part of the treatment of IBS. Bupropion (WELLBUTRIN/ZYBAN) is an antidepressant effective for smoking cessation. IBS symptoms improve when patients are treated with bupropion for smoking cessation.