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Neurogastroenterology and motility
PWE-052 Phenotyping the early morning rush (EMR) in patients with diarrhoea predominant irritable bowel syndrome (IBS-D)
  1. K Garsed1,
  2. M Hastings2,
  3. C Lam1,
  4. P Whorwell2,
  5. R Spiller1
  1. 1Nottingham Digestive Diseases Centre NHIR BRU, University of Nottingham, Nottingham, UK
  2. 2Neurogastroenterology and Motility, Wythenshawe Hospital, Manchester, UK


Introduction A proportion of patients with IBS-D describe frequent bowel movements first thing in the morning. While most clinicians recognise the phenomenon there is currently no definition of this “early morning rush” and no data describing the subgroup of patients who experience this disabling symptom which frequently impacts on their quality of life and ability to work.

Methods 119 patients meeting the Rome 3 criteria for IBS-D and 20 age and sex matched healthy volunteers (HV) completed a 1-week stool diary, hospital anxiety and depression score (HADS), and personal health questionnaire (PHQ-12). They also completed an IBS severity score (IBSSS) and IBS quality of life score (IBSQOL) as part of entry into a clinical trial. Whole gut transit (WGT) was measured during the placebo arm using the radio-opaque marker method. EMR was defined as ≥2 bowel movements within 1 h, between midnight and midday. Patients and HV were divided into 3 subgroups, those with ≤2 days/week EMR = normal morning rush (NMR), those with 3–4 days/week EMR = moderate morning rush (MMR), and those with 5–7 days/week with EMR =severe morning rush (SMR).

Results 16% of patients had MMR and 15% of patients had SMR, all HV had NMR. Those with SMR had greater psychological distress (sum of the HADS score) than those with NMR, 19.11 (±1.8) vs 13.48 (±0.8) p=0.021, and more somatic symptoms (PHQ-12), 9.2 (±0.9) vs 6.5 (±0.4) p=0.02. The SMR group had greater mean daily stool frequency than those with NMR and MMR 5.6 (3.5–8.2) vs 2.14 (1.7–3.0) and 3.7 (2.7–4.4) p<0.0001 with a higher IBSSS 366 (±18.4) vs 296.6 (±9.4) and 295.9 (±17.2) p=0.005, this was accompanied by a lower IBSQOL 334.3 (±21.1) vs 467.3 (±17.9) and 467.3 (±33.4) p=0.004. WGT (in hours) was significantly faster in the SMR group 7 (5.5–15) vs 19 (10–39) in the NMR and 16 (8.5–24.5) in the MMR groups p=0.03.

Conclusion Around 1/3 of IBS patients suffer from early morning rush. Those severely affected represent a group with a worse quality of life, greater psychological distress and more somatic symptoms. This is associated with faster whole gut transit and increased stool frequency. A third of the patients with SMR dropped out of the trial compared to <10% in the other groups making this a challenging subgroup to study.

Competing interests None declared.

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