Fifty two chronic clinic attenders with irritable bowel syndrome were compared with 97 newly referred patients in respect of physical symptoms and psychiatric status. Profound differences between the two groups emerged. Many abdominal and non-colonic symptoms were perceived as much more severe in chronic attenders compared with first time attenders (p less than 0.0001 for abdominal pain and abdominal distension). Chronic attenders were much more likely to complain of constant symptoms (p less than 0.05), and the social consequences of their illness were much more striking (p less than 0.0001). There was, however, no difference in the prevalence of psychiatric morbidity in the two groups. Clinical trials and other investigations of the irritable bowel syndrome are usually conducted on hospital outpatient populations. The results of this study indicate that the patient populations used for these purposes need to be carefully defined.
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