Rebecca Firth

Type, rather than number, of mental and physical comorbidities increases the severity of symptoms in patients with irritable bowel syndrome.

BACKGROUND & AIMS Irritable bowel syndrome (IBS) has significant mental and physical comorbidities. However, little is known about the day-to-day burden these comorbidities place on quality of life (QOL), physical and mental function, distress, and symptoms of patients. METHODS We collected cross-sectional data from 175 patients with IBS, which was diagnosed on the basis of Rome III criteria (median age, 41 years; 78% women), who were referred to 2 specialty care clinics. Patients completed psychiatric interviews, a physical comorbidity checklist, the IBS Symptom Severity Scale, the IBS-QOL instrument, the Brief Symptom Inventory, the abdominal pain intensity scale, and the Short Form-12 Health Survey. RESULTS Patients with IBS reported an average of 5 comorbidities (1 mental, 4 physical). Subjects with more comorbidities reported worse QOL after adjusting for confounding variables. Multiple linear regression analyses indicated that comorbidity type was more consistently and strongly associated with illness burden indicators than disease counts. Of 10,296 possible physical-mental comorbidity pairs, 6 of the 10 most frequent dyads involved specific conditions (generalized anxiety, depression, back pain, agoraphobia, tension headache, and insomnia). These combinations were consistently associated with greater illness and symptom burdens (QOL, mental and physical function, distress, more severe symptoms of IBS, and pain). CONCLUSIONS Comorbidities are common among patients with IBS. They are associated with distress and reduced QOL. Specific comorbidities are associated with more severe symptoms of IBS.

The Irritable Bowel Syndrome Outcome Study (IBSOS): Rationale and design of a randomized, placebo-controlled trial with 12 month follow up of self- versus clinician-administered CBT for moderate to severe irritable bowel syndrome☆

Irritable bowel syndrome is a common, oftentimes disabling, gastrointestinal disorder whose full range of symptoms has no satisfactory medical or dietary treatment. One of the few empirically validated treatments includes a specific psychological therapy called cognitive behavior therapy which, if available, is typically administered over several months by trained practitioners in tertiary care settings. There is an urgent need to develop more efficient versions of CBT that require minimal professional assistance but retain the efficacy profile of clinic based CBT. The Irritable Bowel Syndrome Outcome Study (IBSOS) is a multicenter, placebo-controlled randomized trial to evaluate whether a self-administered version of CBT is, at least as efficacious as standard CBT and more efficacious than an attention control in reducing core GI symptoms of IBS and its burden (e.g. distress, quality of life impairment, etc.) in moderately to severely affected IBS patients. Additional goals are to assess, at quarterly intervals, the durability of treatment response over a 12 month period; to identify clinically useful patient characteristics associated with outcome as a way of gaining an understanding of subgroups of participants for whom CBT is most beneficial; to identify theory-based change mechanisms (active ingredients) that explain how and why CBT works; and evaluate the economic costs and benefits of CBT. Between August 2010 when IBSOS began recruiting subjects and February 2012, the IBSOS randomized 171 of 480 patients. Findings have the potential to improve the health of IBS patients, reduce its social and economic costs, conserve scarce health care resources, and inform evidence-based practice guidelines.

Negative Aspects of Close Relationships are More Strongly Associated than Supportive Personal Relationships with Illness Burden of Irritable Bowel Syndrome

OBJECTIVE This study assessed the relative magnitude of associations between IBS outcomes and different aspects of social relationships (social support, negative interactions). METHOD Subjects included 235 Rome III diagnosed IBS patients (M age=41yrs, F=78%) without comorbid GI disease. Subjects completed a testing battery that included the Interpersonal Support Evaluation List (Social Support or SS), Negative Interaction (NI) Scale, IBS Symptom Severity Scale (IBS-SSS), IBS-QOL, BSI Depression, STAI Trait Anxiety, SOMS-7 (somatization), Perceived Stress Scale, and a medical comorbidity checklist. RESULTS After controlling for demographic variables, both SS and NI were significantly correlated with all of the clinical variables (SS rs=.20 to .36; NI rs=.17 to .53, respectively; ps<.05) save for IBS symptom severity (IBS-SSS). NI, but not SS, was positively correlated with IBS-SSS. After performing r-to-z transformations on the correlation coefficients and then comparing z-scores, the correlation between perceived stress, and NI was significantly stronger than with SS. There was no significant difference between the strength of correlations between NI and SS for depression, somatization, trait anxiety, and IBSQOL. A hierarchical linear regression identified both SS and NI as significant predictors of IBS-QOL. CONCLUSIONS Different aspects of social relationships - support and negative interactions - are associated with multiple aspects of IBS experience (e.g. stress, QOL impairment). Negative social relationships marked by conflict and adverse exchanges are more consistently and strongly related to IBS outcomes than social support.

The accuracy of patient-reported measures for GI symptoms: a comparison of real time and retrospective reports.

Obtaining accurate information about gastrointestinal (GI) symptoms is critical to achieving the goals of clinical research and practice. The accuracy of patient data is especially important for functional GI disorders (e.g., IBS) whose symptoms lack a biomarker and index illness severity and treatment response. Retrospective patient‐reported data are vulnerable to forgetting and various cognitive biases whose impact has not been systematically studied in patients with GI disorders. The aim of this study was to document the accuracy of patient‐reported GI symptoms over a reporting period (1 week) most representative of the time frame used in research and clinical care.

31 How Accurate Do IBS Patients Recall Past Abdominal Pain Intensity, Stool Frequency, and Stool Consistency?: A Comparison of Real Time Versus End-of-Week Symptom Ratings

while IL-8 (F: 10 pg/ml, NF: 61 pg/ml; p = 0.012) was significantly lower in fatigue pts compared to NF pts. No other significant differences were seen in cytokines or leukocyte subsets profiles. CONCLUSION This study shows for the first time that there are immunological differences between fatigue and non-fatigue IBD patients in remission. The signs of immune stimulation in fatigue could represent an on-going infection or autoimmune response that occurs without any clinical or histological signs of IBD and could even be indirectly or unrelated to the IBD. Further exploration of the underlying immune effects associated with fatigue is warranted to determine potential treatment options.

571 Type, Not Number, of Mental-Physical Comorbidities Increases the Severity of GI Symptoms in Patients With More Severe Irritable Bowel Syndrome

BACKGROUND: While irritable bowel syndrome (IBS) is associated with significant mental and physical comorbidity, little is known about the day to day burden (e.g., quality of life [QOL], physical and mental functioning, distress, IBS symptoms) that comorbidity imposes. METHOD: 175 Rome III-diagnosed IBS patients (M age = 41 yrs, 78% Female, 91% Caucasian) completed psychiatric assessments (MINI International Neuropsychiatric Interview), a physical comorbidity checklist as well as the IBS Symptom Severity Scale, IBSQOL, Brief Symptom Inventory (distress, BSI), abdominal pain intensity scale, and the physical (PCS) and mental (MCS) functioning scales of the SF-12 as part of baseline assessment of an NIH clinical trial. RESULTS. IBS patients in this cohort reported an avg. of 5 diagnosed comorbidities (1 mental, 4 physical). Partial correlations indicated that subjects with more comorbidities reported worse QOL after adjusting for confounding variables. The number of physical comorbidities was more strongly associated with the physical aspects of QOL, while the number of mental comorbidities was more strongly correlated with mental aspects of QOL. The number of comorbidities was unrelated to either the intensity of abdominal pain or global severity of IBS symptoms. Multiple linear regression analyses indicated that comorbidity type was more consistently and strongly associated with illness burden indicators than simple disease counts after confounding variables were held constant. Of 10, 296 possible physicalmental comorbidity pairs, 6 of the 10 most frequent dyads involved a combination of conditions (generalized anxiety disorder, major depression, back pain, agoraphobia, tension headache, insomnia) that were consistently associated with illness (QOL, mental and physical functioning, distress) and symptom (IBS symptom severity, abdominal pain intensity) burden indicators. A comorbidity dyad with consistently large effect sizes was low back pain and major depression. For these patients, scores were expected to decrease by 22 points on the IBS QOL, 10.24 on the PCS, 11.76 on the MCS, and increase by 20.61 points on the BSI in comparison to patients who are not diagnosed with MDD and LBP. For the IBS-SSS, the regression coefficient was 89.67. This means that a patient diagnosed with MDD-LBP had IBS symptom severity scores on the IBS-SSS score that, on average, are 89.67 units higher than a patient undiagnosed with MDD and LBP. CONCLUSIONS. Physical-mental comorbidity in IBS is common, associated with increased distress and QOL impairment and, for patients with specific comorbidity profiles, more severe IBS symptoms. The type of reported comorbidities, rather than their number, may be a more useful way of understanding the full scope of their impact in more severely affected IBS patients. This study was funded by NIH Grant DK77738