Irritable Bowel Syndrome: Toward an Understanding of Severity

Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Clinical Gastroenterology and Hepatology (Impact Factor: 7.9). 09/2005; 3(8):717-25. DOI: 10.1016/S1542-3565(05)00157-6
Source: PubMed


Irritable bowel syndrome (IBS) is a chronic disorder with symptoms that range in severity from mild and intermittent to severe and continuous. Although severity is a guiding factor in clinical decision making related to diagnosis and treatment, current guidelines related to IBS do not address the issue of severity. Recent data suggest that severity as a multidimensional concept, not fully explained by intensity of symptoms, has important clinical implications including health care utilization and health-related quality of life. Components of IBS severity include symptom intensity, time of assessment, whether the patient or physician makes the severity determination, the type of scale used to measure severity, and the degree of disability or impairment. Currently no consensus definition of IBS severity exists, although 2 validated scales of IBS severity have recently been published. Review of the literature suggests that the prevalence of severe or very severe IBS is higher than previously estimated with a range from 3%-69%. Individual IBS symptoms are important but are not sufficient to explain severity. Rather, severity has multiple components including health-related quality of life, psychosocial factors, health care utilization behaviors, and burden of illness. However, studies have not been adequately designed to determine the relative values of these factors in IBS severity.

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Available from: Douglas Drossman, Apr 10, 2014
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    • "In addition to these formal diagnostic criteria issued by the Rome III workgroup (the arm of the nonprofit Rome Foundation tasked with developing diagnostic criteria for all functional gastrointestinal disorders) (Drossman 2006), other symptoms associated with IBS include bloating, urgency and straining during defecation. These diagnostic criteria, however, do not fully capture the burden of illness experienced by many IBS patients (Lembo et al. 2005). IBS diarrhea is often associated with burning, cramping abdominal pain and feelings of urgency, which can significantly disrupt social, occupational and recreational activities. "
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    ABSTRACT: Patients with irritable bowel syndrome (IBS) have been shown to have catastrophic cognitions regarding the social and occupational consequences of GI symptoms. Moreover, the efficacy of cognitive–behavioral therapy for IBS may be partially mediated by reductions in such cognitions. We aimed to develop and validate a short self-report measure of GI specific catastrophic cognitions. The GI-Cognitions Questionnaire (GI-Cog) was administered to a total of 291 participants, including 65 IBS patients, 114 Crohn’s disease patients, 22 patients with co-morbid Crohn’s and IBS and 90 healthy controls. The GI-Cog showed high internal consistency (α = .92) and good test re-test reliability (r = .87) as well as good factor structure. It discriminated between IBS patients, Crohn’s disease patients and normal controls, and explained unique variance in GI symptom severity. The GI-Cog is a short, easy-to-administer self-report measure of GI specific catastrophic cognitions that appears to be both reliable and valid and can be used in future research on vulnerability, treatment outcome and mediators of treatment efficacy.
    Cognitive Therapy and Research 08/2014; 38(4). DOI:10.1007/s10608-014-9607-y · 1.70 Impact Factor
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    • "These symptoms fall along a severity continuum ranging from mild and intermittent to severe and continuous [19]. "

    01/2012; 1:1-7. DOI:10.4303/ne/235546
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    • "At one time, it was thought that the overwhelming majority of IBS patients experienced symptoms that were mild or moderate, with only a small proportion having severe symptoms (Drossman, 1992). However, data now suggests that the number of patients with severe IBS is substantially higher than once thought, with prevalence rates as high as 69% depending on the population surveyed (eg, primary care, GI clinic) or diagnostic criteria used (range 3%–69%) (Lembo, 2005). "
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    ABSTRACT: Irritable bowel syndrome (IBS) is a common disorder characterized by abdominal pain or discomfort and altered bowel habit (chronic or recurrent diarrhea, constipation, or both) that occurs more frequently in women than in men. Severe IBS may be underrecognized and inadequately managed in clinical practice. Although no consensus definition for "severe IBS" exists, patients may be categorized as having severe illness if they show an insufficient response to conventional treatments or if their functionality or quality of life is impaired as a result of their IBS symptoms. Nurses can be an important resource in optimizing the evaluation and treatment of these patients. Nursing assessments that delineate predominant symptoms and the history and nature of prior interventions (e.g., lifestyle changes, over-the-counter or prescription medication trials, psychotherapy, alternative treatments) and subsequent responses are important when advising patients and participating in the management of their IBS. Likewise, the nurse's assessment should include a history of symptom severity and impact on daily functioning, as these elements are important to choosing therapy. The nurse-patient dialogue should also include a description of available treatment options and the benefits and risks associated with each. By maintaining such a dialogue, nurses can hasten IBS recognition, improve management, limit the negative consequences of this common disorder, and improve overall treatment outcomes in this population.
    Gastroenterology nursing: the official journal of the Society of Gastroenterology Nurses and Associates 01/2012; 35(1):12-21; quiz 22-3. DOI:10.1097/SGA.0b013e31823ff0e8 · 0.69 Impact Factor
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