- Email: [email protected]
Overlap of functional dyspepsia and irritable bowel syndrome in a community sample
S272
Abstracts
are commonly observed in the IBS and pose diagnostic and treatment challenges. The predisposition to express a large number of non-specific bodily symptoms for psychological reasons is labelled somatization (SOM). It is unknown whether the GI and extra-intestinal comorbidities seen in patients with the IBS are due to SOM or whether they reflect shared pathophysiology. Methods: The Hopkins Bowel Symptom Questionnaire (BSQ) and the SCL 90-R were administered to 133 consecutive patients that met the Rome I criteria for IBS. The BSQ assesses GI symptoms, Non-GI symptoms, and Quality of Life (QoL). IBS subgroups were identified based on the SOM subscale of the SCL 90-R as Normal (⬍ 1 SD above mean; n⫽59, 16M/43F), Moderate (1-2 SD above mean; n⫽54, 16M/38F) or High SOM (⬎ 2 SD above mean; n⫽20, 7M/13F). Data were analyzed via ANOVA or Chi-square. Results: Patients with increased SOM reported more frequent abdominal pain (p⬍0.001), more pain sites (p⬍0.001), and significantly more GI symptoms from both the lower (p⬍0.001) and upper GI tract (p⬍0.001). Level of SOM was associated with reports of Non-GI comorbidities including chronic fatigue, TMJ, low back pain, anxiety attacks, and panic attacks. High SOM patients showed significant elevations on all SCL 90-R subscales (p⬍0.01). Functional abilities and QoL ratings were significantly reduced in IBS patients with elevated SOM. Conclusions: These findings suggest that IBS is a heterogeneous condition that may be impacted by elevated levels of somatization. The presence of multiple GI and non-GI comorbidities may constitute a marker for psychological influences on etiology and these factors may dramatically influence healthcare utilization and treatment outcomes. The relationship between somatization and symptom generation requires further exploration. 817 OVERLAP OF FUNCTIONAL DYSPEPSIA AND IRRITABLE BOWEL SYNDROME IN A COMMUNITY SAMPLE Ashok K. Tuteja, M.D., Nicholas J. Talley, M.D., Sandra K. Joos, Ph.D., David H. Hickam, M.D.* VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT; Mayo Clinic, Rochester, MN and V.A. Medical Center, Portland, OR. Purpose: It has been suggested that functional dyspepsia and Irritable bowel syndrome (IBS) represent the same disease entity, the irritable gut. The purpose of this study was to determine the prevalence of functional dyspepsia and IBS in a community sample to determine how frequently the two disorders occur concurrently. We conducted a cross-sectional study to examine the prevalence of gastrointestinal symptoms and their association with personal and environmental features. Methods: One thousand and sixty-nine employees (age range 24 to 77) of an integrated healthcare system were mailed validated questionnaires (response rate 72%) inquiring about their upper and lower gastrointestinal symptoms (Bowel disease questionnaire), Definitions of dyspepsia (including reflux, dysmotility, and ulcer-like sub-types) and IBS were based on the Rome criteria. Reflux dyspepsia was defined as having dyspepsia according to the Rome criteria with heartburn and/ or reflux once a week or more. Subjects who had symptoms of both functional dyspepsia and IBS were judged to have an overlap syndrome. Results: Seven hundred and twenty-three subjects (response rate 72%) returned the survey (age range 24 –77). One hundred and six (14.7%) subjects reported symptoms of dyspepsia (6.2% ulcer-like dyspepsia, 6.1% dysmotility-like, and 9.4% reflux dyspepsia), and symptoms of IBS were reported by 8.9%. Simultaneous symptoms of both IBS and dyspepsia were reported by 6.2%. Seventy percent of subjects with IBS had functional dyspepsia and 43% of subjects with dyspepsia had IBS. The association between the two syndromes was much greater than expected by chance (kappa ⫽ 0.48). Controlling for age, both IBS and the overlap syndrome were more common in females, but these differences were not significant (p⬎ 0.27). Controlling for age and gender, dyspepsia, IBS and the overlap syndrome were not associated with alcohol or aspirin use (p⬎ 0.19). Four percent of subjects with only dyspepsia, 25% with only IBS and 33% with the overlap syndrome reported consulting a physician in the previous year.
AJG – Vol. 98, No. 9, Suppl., 2003
Conclusions: Among employed individuals, symptoms of either functional dyspepsia or IBS were very common and they frequently occurred simultaneously. Subjects with only dyspepsia rarely consulted a physician, whereas one-third of those with both IBS and functional dyspepsia had consulted a physician. Patients seeking clinical services for gastrointestinal symptoms are likely to have more than one clinical disorder. 818 IBS SEVERITY AND HEALTH-RELATED QUALITY OF LIFE IMPROVE WITH AGE IN WOMEN BUT NOT IN MEN Olafur S. Palsson, Psy.D., William E. Whitehead, Ph.D.*, Victoria Barghout, M.S.P.H., Rona Levy, Ph.D., Andrew Feld, M.D., Michael Von Korff, Ph.D., Michelle Garner, M.S.W., Douglas A. Drossman, M.D., Marsha J. Turner, M.S. University of North Carolina at Chapel Hill, Chapel Hill, NC; Novartis Pharmaceuticals Corp., East Hanover, NJ; University of Washington, Seattle, WA and Group Health Cooperative of Puget Sound, Seattle, WA. Purpose: Two studies (Dig Dis Sci 1993;38:1569 – 80, Alim Pharm Ther 1997;11:1019 –30) have suggested that IBS may become less common in women in post-menopausal years, but it is unknown whether severity of IBS decreases after menopause in women. This study compared IBS severity and IBS-specific quality of life impairment in women and men across the age spectrum. Methods: One thousand six hundred and sixty-five patients diagnosed with functional bowel disorders in primary care and gastroenterology clinics of a northwestern U.S. health maintenance organization completed mailed questionnaires within two weeks of a clinic visit that included the validated IBS Severity Index (Aliment Pharmacol Ther 1997;11:395– 402) and IBSQOL (Dig Dis Sci. 1998;43:400 –11). Data from the 826 patients who met Rome II IBS criteria (638 females, 188 males; age range 18-76, mean ⫽ 51.9 years) were compared. Results: Separate Analysis of Variance comparisons of IBS symptoms and health-related quality of life by decade age groups were conducted for women and men, and showed significant age main effects in women only. Female subjects in post-menopausal age groups (50⫹ years) had significanly less overall IBS severity (p⬍.0001), abdominal pain severity (p⬍.0001) and bloating severity (p⬍.001), and higher quality of life scores on the QOL (p⬍.05), compared to younger women. Women under age 50 had higher IBS severity scores compared to same-age men, but these differences disappeared in older age groups. Overall IBS-QOL scores were not significantly different between the genders in any age group. However, analysis of the 8 content subscales of the IBS-QOL, controlling for IBS severity differences, showed that female patients differed from males on two scales, with more impaired scores on Body Image (p⬍.05) and Food Avoidance (p⬍.01). Conclusions: IBS symptom severity and impairment in health-related quality of life decrease at middle age in female IBS patients. Such systematic age changes are not seen in male IBS patients in the the same clinical settings. This suggests a beneficial impact of cessation of the menstrual cycle in women with the disorder. IBS affects body image and eating behavior in women more than in men. 819 WHAT CONSTITUTES STANDARD MEDICAL CARE FOR IRRITABLE BOWEL SYNDROME (IBS) IN U.S. PRIMARY CARE AND GASTROENTEROLOGY CLINICS? William E. Whitehead, Ph.D.*, Olafur S. Palsson, Psy.D., Rona L. Levy, Ph.D., Michael D. Von Korff, Ph.D., Andrew D. Feld, M.D., Michelle Garner, M.S.W. University of NC at Chapel Hill, Chapel Hill, NC; University of Washington, Seattle, WA and Group Health Cooperative of Puget Sound, Seattle, WA. Purpose: It is unknown how primary care (PC) and gastroenterology (GI) treatment of IBS differs in the U.S. This study compared GI and PC clinics in regard to (a) treatments for IBS, (b) explanations and recommendations given to patients, and (c) patient satisfaction with care.
Abstracts
are commonly observed in the IBS and pose diagnostic and treatment challenges. The predisposition to express a large number of non-specific bodily symptoms for psychological reasons is labelled somatization (SOM). It is unknown whether the GI and extra-intestinal comorbidities seen in patients with the IBS are due to SOM or whether they reflect shared pathophysiology. Methods: The Hopkins Bowel Symptom Questionnaire (BSQ) and the SCL 90-R were administered to 133 consecutive patients that met the Rome I criteria for IBS. The BSQ assesses GI symptoms, Non-GI symptoms, and Quality of Life (QoL). IBS subgroups were identified based on the SOM subscale of the SCL 90-R as Normal (⬍ 1 SD above mean; n⫽59, 16M/43F), Moderate (1-2 SD above mean; n⫽54, 16M/38F) or High SOM (⬎ 2 SD above mean; n⫽20, 7M/13F). Data were analyzed via ANOVA or Chi-square. Results: Patients with increased SOM reported more frequent abdominal pain (p⬍0.001), more pain sites (p⬍0.001), and significantly more GI symptoms from both the lower (p⬍0.001) and upper GI tract (p⬍0.001). Level of SOM was associated with reports of Non-GI comorbidities including chronic fatigue, TMJ, low back pain, anxiety attacks, and panic attacks. High SOM patients showed significant elevations on all SCL 90-R subscales (p⬍0.01). Functional abilities and QoL ratings were significantly reduced in IBS patients with elevated SOM. Conclusions: These findings suggest that IBS is a heterogeneous condition that may be impacted by elevated levels of somatization. The presence of multiple GI and non-GI comorbidities may constitute a marker for psychological influences on etiology and these factors may dramatically influence healthcare utilization and treatment outcomes. The relationship between somatization and symptom generation requires further exploration. 817 OVERLAP OF FUNCTIONAL DYSPEPSIA AND IRRITABLE BOWEL SYNDROME IN A COMMUNITY SAMPLE Ashok K. Tuteja, M.D., Nicholas J. Talley, M.D., Sandra K. Joos, Ph.D., David H. Hickam, M.D.* VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT; Mayo Clinic, Rochester, MN and V.A. Medical Center, Portland, OR. Purpose: It has been suggested that functional dyspepsia and Irritable bowel syndrome (IBS) represent the same disease entity, the irritable gut. The purpose of this study was to determine the prevalence of functional dyspepsia and IBS in a community sample to determine how frequently the two disorders occur concurrently. We conducted a cross-sectional study to examine the prevalence of gastrointestinal symptoms and their association with personal and environmental features. Methods: One thousand and sixty-nine employees (age range 24 to 77) of an integrated healthcare system were mailed validated questionnaires (response rate 72%) inquiring about their upper and lower gastrointestinal symptoms (Bowel disease questionnaire), Definitions of dyspepsia (including reflux, dysmotility, and ulcer-like sub-types) and IBS were based on the Rome criteria. Reflux dyspepsia was defined as having dyspepsia according to the Rome criteria with heartburn and/ or reflux once a week or more. Subjects who had symptoms of both functional dyspepsia and IBS were judged to have an overlap syndrome. Results: Seven hundred and twenty-three subjects (response rate 72%) returned the survey (age range 24 –77). One hundred and six (14.7%) subjects reported symptoms of dyspepsia (6.2% ulcer-like dyspepsia, 6.1% dysmotility-like, and 9.4% reflux dyspepsia), and symptoms of IBS were reported by 8.9%. Simultaneous symptoms of both IBS and dyspepsia were reported by 6.2%. Seventy percent of subjects with IBS had functional dyspepsia and 43% of subjects with dyspepsia had IBS. The association between the two syndromes was much greater than expected by chance (kappa ⫽ 0.48). Controlling for age, both IBS and the overlap syndrome were more common in females, but these differences were not significant (p⬎ 0.27). Controlling for age and gender, dyspepsia, IBS and the overlap syndrome were not associated with alcohol or aspirin use (p⬎ 0.19). Four percent of subjects with only dyspepsia, 25% with only IBS and 33% with the overlap syndrome reported consulting a physician in the previous year.
AJG – Vol. 98, No. 9, Suppl., 2003
Conclusions: Among employed individuals, symptoms of either functional dyspepsia or IBS were very common and they frequently occurred simultaneously. Subjects with only dyspepsia rarely consulted a physician, whereas one-third of those with both IBS and functional dyspepsia had consulted a physician. Patients seeking clinical services for gastrointestinal symptoms are likely to have more than one clinical disorder. 818 IBS SEVERITY AND HEALTH-RELATED QUALITY OF LIFE IMPROVE WITH AGE IN WOMEN BUT NOT IN MEN Olafur S. Palsson, Psy.D., William E. Whitehead, Ph.D.*, Victoria Barghout, M.S.P.H., Rona Levy, Ph.D., Andrew Feld, M.D., Michael Von Korff, Ph.D., Michelle Garner, M.S.W., Douglas A. Drossman, M.D., Marsha J. Turner, M.S. University of North Carolina at Chapel Hill, Chapel Hill, NC; Novartis Pharmaceuticals Corp., East Hanover, NJ; University of Washington, Seattle, WA and Group Health Cooperative of Puget Sound, Seattle, WA. Purpose: Two studies (Dig Dis Sci 1993;38:1569 – 80, Alim Pharm Ther 1997;11:1019 –30) have suggested that IBS may become less common in women in post-menopausal years, but it is unknown whether severity of IBS decreases after menopause in women. This study compared IBS severity and IBS-specific quality of life impairment in women and men across the age spectrum. Methods: One thousand six hundred and sixty-five patients diagnosed with functional bowel disorders in primary care and gastroenterology clinics of a northwestern U.S. health maintenance organization completed mailed questionnaires within two weeks of a clinic visit that included the validated IBS Severity Index (Aliment Pharmacol Ther 1997;11:395– 402) and IBSQOL (Dig Dis Sci. 1998;43:400 –11). Data from the 826 patients who met Rome II IBS criteria (638 females, 188 males; age range 18-76, mean ⫽ 51.9 years) were compared. Results: Separate Analysis of Variance comparisons of IBS symptoms and health-related quality of life by decade age groups were conducted for women and men, and showed significant age main effects in women only. Female subjects in post-menopausal age groups (50⫹ years) had significanly less overall IBS severity (p⬍.0001), abdominal pain severity (p⬍.0001) and bloating severity (p⬍.001), and higher quality of life scores on the QOL (p⬍.05), compared to younger women. Women under age 50 had higher IBS severity scores compared to same-age men, but these differences disappeared in older age groups. Overall IBS-QOL scores were not significantly different between the genders in any age group. However, analysis of the 8 content subscales of the IBS-QOL, controlling for IBS severity differences, showed that female patients differed from males on two scales, with more impaired scores on Body Image (p⬍.05) and Food Avoidance (p⬍.01). Conclusions: IBS symptom severity and impairment in health-related quality of life decrease at middle age in female IBS patients. Such systematic age changes are not seen in male IBS patients in the the same clinical settings. This suggests a beneficial impact of cessation of the menstrual cycle in women with the disorder. IBS affects body image and eating behavior in women more than in men. 819 WHAT CONSTITUTES STANDARD MEDICAL CARE FOR IRRITABLE BOWEL SYNDROME (IBS) IN U.S. PRIMARY CARE AND GASTROENTEROLOGY CLINICS? William E. Whitehead, Ph.D.*, Olafur S. Palsson, Psy.D., Rona L. Levy, Ph.D., Michael D. Von Korff, Ph.D., Andrew D. Feld, M.D., Michelle Garner, M.S.W. University of NC at Chapel Hill, Chapel Hill, NC; University of Washington, Seattle, WA and Group Health Cooperative of Puget Sound, Seattle, WA. Purpose: It is unknown how primary care (PC) and gastroenterology (GI) treatment of IBS differs in the U.S. This study compared GI and PC clinics in regard to (a) treatments for IBS, (b) explanations and recommendations given to patients, and (c) patient satisfaction with care.