Clinical Determinants of Health-Related Quality of Life in Patients With Irritable Bowel Syndrome

Division of Gastroenterology, the VA Greater Los Angeles Healthcare System, CA 90073, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 10/2004; 164(16):1773-80. DOI: 10.1001/archinte.164.16.1773
Source: PubMed


Current guidelines recommend routine assessment of health-related quality of life (HRQOL) in patients with irritable bowel syndrome (IBS). However, physicians rarely have the time to measure HRQOL with the appropriate methodological rigor, and data suggest that HRQOL in patients with IBS is often estimated using inaccurate clinical gestalt. The identification of predictive factors could allow physicians to better assess HRQOL without using misleading clinical clues. We, therefore, sought to identify determinants of HRQOL in patients with IBS.
We examined 770 patients, 18 years or older, with IBS at a university-based referral center. Subjects completed a symptom questionnaire, the Symptoms Checklist-90 items psychometric checklist, and the 36-Item Short-Form Health Survey. The main outcome was HRQOL as measured by the mental and physical component scores of the 36-Item Short-Form Health Survey. We first developed a list of hypothesis-driven HRQOL predictors, and then performed multivariate regression analysis to measure the independent association of each predictor with HRQOL.
Seven factors (r(2) = 0.39) independently predicted physical HRQOL: (1) more than 5 physician visits per year, (2) tiring easily, (3) low in energy, (4) severe symptoms, (5) predominantly painful symptoms, (6) the feeling that there is "something seriously wrong with body," and (7) symptom flares for longer than 24 hours. Eight factors (r(2) = 0.36) independently predicted mental HRQOL: (1) feeling tense, (2) feeling nervous, (3) feeling hopeless, (4) difficulty sleeping, (5) tiring easily, (6) low sexual interest, (7) IBS symptom interference with sexual function, and (8) low energy.
Health-related quality of life in patients with IBS is primarily related to extraintestinal symptoms rather than traditionally elicited gastrointestinal symptoms. These findings suggest that rather than focusing on physiological epiphenomena (stool characteristics and subtype of IBS) and potentially misleading clinical factors (age and disease duration), physicians might be better served to gauge global symptom severity, address anxiety, and eliminate factors contributing to chronic stress in patients with IBS.

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    • "Our findings are consistent with the findings in many international studies that found many physicians have significant misconceptions regarding the etiology, diagnosis, pathogenesis, and prognosis of IBS.[6171521] Moreover, in spite of the fact that a majority of the physicians surveyed knew the clinical features of IBS, we found that only 36.9% of them knew its alarming features.[1020] As such, misconceptions about IBS may interfere with its care, especially during education and reassurance about the benign nature of the condition. "
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    ABSTRACT: Primary health care (PHC) physicians manage most patients with irritable bowel syndrome (IBS). In Saudi Arabia, there are limited data on their knowledge, attitudes, and practices about this disorder. This study aimed to assess knowledge, attitudes, and practices of primary care physicians about IBS. A cross-sectional survey of 70 practitioners aged 36 ± 10.25 years was carried out in primary care centers in AlJouf Province of Saudi Arabia. The physicians were asked to fill a valid questionnaire containing their sociodemographic data, and well-modified questions regarding their knowledge, attitudes, and practices about IBS. Data was processed and analyzed using SPSS (version 15) program, and the level of significance was set at P<0.05. A response rate of 92.9% yielded 65 questionnaires for analysis. Majority of physicians surveyed (83.1%) considered IBS as a common health problem in Saudi Arabia, and (55.4%) believed it is underestimated. There was a significant association between physicians' qualifications and using diagnostic tools to facilitate IBS diagnosis (14.3% vs 35.5%; P<0.05), while utilization of "Rome or Manning criteria" was more frequent by physicians with master's degree (35.5%) compared to residents (14.3%). Also, 35.4% of physicians (15 males and 8 females) were not sure how to diagnose IBS. This study suggested that PHC physicians had a suitable attitude toward IBS, but they lacked knowledge, and their practices toward this condition were inappropriate.
    Saudi Journal of Gastroenterology 05/2012; 18(3):173-81. DOI:10.4103/1319-3767.96450 · 1.12 Impact Factor
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    • "The severity of IBS has been shown to relate not only to the number of days in pain or the number of days in bed, but also to deficits in the patient's QoL, and together these factors often prompt patients to seek medical care (Hahn, 1997; Williams, 2006). Predictors of the impact of IBS on HRQoL include the severity of symptoms, duration of symptom flares, abnormalities in mood or anxiety, and signs of poor vitality such as reduced energy level, sleep, and sexual drive (Spiegel, 2004). "
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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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    • "Our findings call for research to establish the impact of comorbidity on use of health resources and quality of life in different clinical settings. We suggest that future research to improve treatment for patients with IBS should take into consideration comorbidity as a main driver for health resource use and reduced quality of life [21]. The comorbidity of IBS has implications for choice of interventions (e.g mind body intervention) and outcomes in design of treatment trials [22,23]. "
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    ABSTRACT: Irritable bowel syndrome (IBS) is associated with other disorders (comorbidity), reduced quality of life and increased use of health resources. We aimed to explore the impact of comorbidity on cost of health care in patients with IBS in general practice. In this cohort study 208 consecutive patients with IBS (Rome II) were recruited. Sociodemographic data, IBS symptoms, and comorbidity (somatic symptoms, organic diseases and psychiatric disorders) were assessed at baseline. Based on a follow up interview after 6-9 months and use of medical records, IBS and non-IBS related health resource use were measured as consultations, hospitalisations, use of medications and alternative health care products and sick leave days. Costs were calculated by national tariffs and reported in Norwegian Kroner (NOK, 1 EURO equals 8 NOK). Multivariate analyses were performed to identify predictors of costs. A total of 164 patients (mean age 52 years, 69% female, median duration of IBS 17 years) were available at follow up, 143 patients (88%) had consulted their GP of whom 31 (19%) had consulted for IBS. Mean number of sick- leave days for IBS and comorbidity were 1.7 and 16.3 respectively (p < 0.01), costs related to IBS and comorbidity were 954 NOK and 14854 NOK respectively (p < 0.001). Age, organic diseases and somatic symptoms, but not IBS severity, were significant predictors for total costs. Costs for health resource use among patients with IBS in general practice were largely explained by comorbidity, which generated ten times the costs for IBS.
    BMC Gastroenterology 03/2010; 10(1):31. DOI:10.1186/1471-230X-10-31 · 2.37 Impact Factor
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