Irritable bowel syndrome: toward an understanding of severity.

Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Clinical Gastroenterology and Hepatology (Impact Factor: 6.53). 09/2005; 3(8):717-25. DOI: 10.1016/S1542-3565(05)00157-6
Source: PubMed

ABSTRACT 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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    ABSTRACT: AIM: To investigate the latent structure of an irritable bowel syndrome (IBS) symptom severity scale in a population of healthy adults. METHODS: The Birmingham IBS symptom questionnaire which consists of three symptom specific scales (diarrhea, constipation, pain) was evaluated by means of structural equation modeling. We compared the original 3-factor solution to a general factor model and a bifactor solution in a large internet sample of college students (n = 875). Statistical comparisons of competing models were conducted by means of χ 2 difference tests. Regarding the evaluation of model fit, we examined the comparative fit index (CFI) and the Root Mean Square Error of Approximation (RMSEA). RESULTS: Results clearly favored a bifactor model of IBS symptom severity (CFI = 0.99, RMSEA = 0.05) which consisted of a strong general IBS somatization factor and three symptom specific factors (diarrhea, constipation, pain) based on the subscales of the Birmingham IBS symptom questionnaire. The fit indices of the competing one factor model (CFI = 0.85, RMSEA = 0.17) and three factor model (CFI = 0.97, RMSEA = 0.08) were clearly inferior. χ 2 difference tests showed that the differences between the models were indeed significant in favor of the bifactor model (P< 0.001). Correlations of the four latent factors with measures of pain sensitivity, somatoform dissociation, fatigue severity, and demographic variables support the validity of our bifactor model of IBS specific symptom severity. CONCLUSION: The findings suggest that IBS symptom severity might best be understood as a continuous and multidimensional construct which can be reliably and validly assessed with the B-IBS.
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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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    ABSTRACT: Objectives To assess prospectively the agreement of orocaecal transit time (OCTT) measurements by lactulose hydrogen breath test (LHBT) and magnetic resonance imaging (MRI) in healthy subjects. Methods Volunteers underwent abdominal 1.5-T MRI using axial and coronal single-shot fast-spin-echo T2-weighted sequences, having fasted and after lactulose ingestion (10 g/125 mL). Imaging and H2 excretion gas-chromatography were performed concurrently every 15 min up to 180 min. MR images were analyzed using semiautomatic segmentation to calculate small bowel gas volume (SBGV) and visually to detect bolus arrival in the caecum. Agreement between MRI- and LHBT-OCTT was assessed. Results Twenty-eight subjects (17 men/11 women; mean age ± standard deviation 30 ± 8 years) were evaluated. Two H2 non-producers on LHBT were excluded. OCTT measured by MRI and LHBT was concordant in 18/26 (69 %) subjects (excellent agreement, k = 0.924). Median SBGV was 49.0 mL (interquartile interval 44.1 – 51.6 mL). In 8/26 (31 %) subjects, MRI showed that the lactulose bolus was in the terminal ileum and not the caecum when H2E increased on LHBT. Median OCTT measured by MRI was significantly longer than OCTT measured by LHBT [135 min (120 – 150 min) vs. 127.5 min (105 – 150 min); p = 0.008]. Above baseline levels, correlation between [H2] and SBGV was significant (r = 0.964; p Conclusions MRI provides valid measurements of OCTT and gas production in the small bowel. Key Points • MRI is a valid technique to measure OCTT. • Excellent agreement between MRI and LHBT was found. • Measuring gas production using MRI may provide evidence of small bowel fermentation.
    European Radiology 01/2015; DOI:10.1007/s00330-014-3575-1 · 4.34 Impact Factor


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May 22, 2014