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Letter
Cluster’s last stand
  1. S C Howell1,
  2. G D Eslick2,
  3. N J Talley3
  1. 1School of Public Health, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
  2. 2Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
  3. 3Center for Enteric Neurosciences and Translational Epidemiological Research (CENTER), Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to:
    Mr S C Howell
    School of Public Health, The University of Sydney, Nepean Hospital, Level 5, South Block, PO Box 63, Penrith, NSW 2751, Australia; HowellSwahs.nsw.gov.au

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    Guthrie and colleagues (Gut 2003;52:1616–22) described the results of cluster analysis in a patient sample with severe irritable bowel syndrome (IBS). Their analysis investigated a broad range of factors in addition to symptoms; these included psychosocial measures (psychiatric involvement, health service encounters, quality of life) and physiological parameters (rectal thresholds). The authors have demonstrated that severe IBS can be classified according to non-symptom characteristics and, in particular, according to the level of psychological distress, service encounters, and rectal sensitivity. They describe three groups which they labelled “distressed high utilisers,” “distressed low utilisers”, and “tolerant low utilisers.” The authors defend their analysis on clinical grounds and point to treatment implications for each of these …

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