Original articlesReview articleSomatic comorbidities of irritable bowel syndrome: A systematic analysis
Introduction
In irritable bowel syndrome (IBS) patients, somatic (intestinal and extraintestinal) comorbidities, particularly extraintestinal symptoms, are present twice as much as in controls [1]. The appearance of comorbidities in patients with IBS is associated with reduction in quality of life [1] and increased health care seeking, with a consecutive rise in costs. More than 65% of the expenses incurred by IBS patients can be attributed to extraintestinal indications [2]. Moreover, a positive correlation between the appearance of one or more IBS-related somatic comorbid conditions and the severity of IBS symptoms, as well as the occurrence of anxiety and depression, was detected [3], [4]. Vandvik et al. [5] revealed a positive correlation between the incidence of somatic comorbidities and higher levels of mood disorder, health anxiety, neuroticism, adverse life events, reduced quality of life, and increased health care seeking, compared to IBS patients without somatic comorbidities.
Various concepts explaining this phenomenon (e.g., similarities in underlying pathophysiological mechanisms such as visceral hypersensitivity and dysregulation of the autonomic nervous system) have been proposed [6].
Section snippets
Intestinal comorbidities
Besides the considerable overlap between functional gastrointestinal disorders, current data suggest that IBS patients also suffer from various intestinal comorbidities (Fig. 1).
IBS and intestinal comorbidities: key messages
A wide spectrum of diagnostic procedures is necessary to exclude other conditions when IBS is suspected to be the cause of abdominal complaints due to the broad overlap between various gastrointestinal diseases. Furthermore, in the individual patient, dominating symptoms often vary over time, making it even harder to categorize the IBS subtype according to Rome criteria, which is essential for an adequate therapeutic procedure. Besides the characterization of the leading symptoms, it is
Extraintestinal comorbidities
IBS patients, as well as patients with other functional gastrointestinal diseases, remarkably more often suffer from extraintestinal comorbidities than patients with nonfunctional gastrointestinal diseases (Fig. 2). Comparison of epidemiological studies showed a high variance of data. Among others, this can be attributed to different study conditions in primary, secondary, and tertiary care, and different definitions of diseases, as well as diverse classification of patient subgroups.
IBS and extraintestinal comorbidities: key messages
Except for BHR, there is clear evidence that the mentioned extragastrointestinal symptoms are significantly more common in IBS patients than in controls. The best-documented nonpsychiatric extraintestinal comorbidities are fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain. The evidence supporting a common underlying etiology is unconvincing. Common psychological features or physiological mechanisms are possible but have not been proven yet.
The observation that IBS patients
Common pathophysiological mechanisms in IBS and somatic comorbidities
The frequency of intestinal and extraintestinal comorbidities in IBS suggests that the underlying pathophysiological mechanisms are not confined to the respective organ, but rather involve superior systems such as the autonomic nervous system and the brain–gut axis.
Regarding their clinical manifestation, obviously many similarities can be found between IBS and the most frequent somatic comorbidities (FM, chronic fatigue syndrome, chronic pelvic pain, and TMJ). In all of these diseases,
IBS patients with somatic comorbidities: subgroup or part of a global disorder?
Factor analyses proved that IBS occurs independently of FD and other functional gastrointestinal diseases [87], [88], [89]. Moreover, IBS shows a wide overlap with FM, chronic fatigue syndrome, anxiety, and depression, although the single diagnoses are autonomous. This argues against a global disease.
Furthermore, other multivariate statistical analyses also indicated that comorbidities of IBS are independent diseases [57], [90], and there is clear evidence that IBS, FM, and chronic fatigue
References (91)
- et al.
Comorbid conditions in patients with irritable bowel syndrome: data from a national IBS awareness registry
Gastroenterology
(2001) - et al.
Costs of care for irritable bowel syndrome patients in a health maintenance organization
Am J Gastroenterol
(2001) - et al.
Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?
Gastroenterology
(2002) - et al.
Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time
Gastroenterology
(1995) - et al.
Dyspeptic symptoms and gastric emptying in the irritable bowel Syndrome
Am J Gastroenterol
(2002) - et al.
Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea
Am J Gastroenterol
(2003) - et al.
Fructose intolerance: an under-recognized problem
Am J Gastroenterol
(2003) - et al.
AGA technical review on irritable bowel syndrome
Gastroenterology
(2002) Diet and the irritable bowel syndrome
Gastroenterol Clin North Am
(1991)- et al.
Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors
Am J Gastroenterol
(2002)
Is irritable bowel syndrome a low-grade inflammatory bowel disease?
Gastroenterol Clin North Am
Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis
Am J Med
Pharmacological therapies in fibromyalgia
Best Pract Res Clin Rheumatol
Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications
Am J Gastroenterol
Autonomic regulation of cardiac function during sleep in patients with irritable bowel syndrome
Am J Gastroenterol
Autonomic testing in patients with chronic fatigue syndrome
Am J Med
Does the chronic fatigue syndrome involve the autonomic nervous system?
Am J Med
Differences in somatic perception in female patients with irritable bowel syndrome with and without fibromyalgia
Pain
Comorbid disorders and symptoms in irritable bowel syndrome (IBS) compared to other gastroenterology patients
Gastroenterology
Interstitial cystitis: unexplained associations with other chronic disease and pain syndromes
Urology
Airway responsiveness to inhaled methacholine in patients with irritable bowel syndrome
Gastroenterology
Non-alimentary aspects of the irritable bowel syndrome
J Psychosom Res
Abnormal REM sleep in the irritable bowel syndrome
Gastroenterology
Symptom patterns in long-duration chronic fatigue syndrome
J Psychosom Res
Functional somatic syndromes: one or many?
Lancet
Existence of irritable bowel syndrome supported by factor analysis of symptoms in two community samples
Gastroenterology
Extra-intestinal symptoms in patients with irritable bowel syndrome (IBS)
Gastroenterology
Irritable bowel-type symptoms in HMO examinees. Prevalence, demographics, and clinical correlates
Dig Dis Sci
Chronic pelvic pain and gynecological symptoms in women with irritable bowel syndrome
J Psychosom Obstet Gynaecol
Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications
Aliment Pharmacol Ther
Dyspepsia in consulters and non-consulters: prevalence, health-care seeking behaviour and risk factors
Eur J Gastroenterol Hepatol
Impact of coexisting irritable bowel syndrome on symptoms and pathophysiological mechanisms in functional dyspepsia
Am J Gastroenterol
Consultations and referrals for dyspepsia in general practice—a one year database survey
Postgrad Med J
Studying the overlap between IBS and GERD: a systematic review of the literature
Dig Dis Sci
Gastrointestinal motility in patients with the irritable bowel syndrome
Scand J Gastroenterol
Rome II. The functional gastrointestinal disorders
Subtyping the irritable bowel syndrome by predominant bowel habit: Rome II versus Rome III
Aliment Pharmacol Ther
US householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact
Dig Dis Sci
Fecal incontinence: a woman's view
Am J Gastroenterol
Fecal incontinence: a clinical approach
Mt Sinai J Med
Postpartum fecal incontinence is more common in women with irritable bowel syndrome
Dis Colon Rectum
Relationship of underlying abnormalities in rectal sensitivity and compliance to distension with symptoms in irritable bowel syndrome
Digestion
Sugar malabsorption in functional bowel disease: clinical implications
Am J Gastroenterol
The clinical significance of disaccharide maldigestion
Am J Clin Nutr
Clinically relevant breath tests in gastroenterological diagnostics—recommendations of the German Society for Neurogastroenterology and Motility as well as the German Society for Digestive and Metabolic Diseases
Z Gastroenterol
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2021, The Lancet Gastroenterology and HepatologyCitation Excerpt :Other features that aid a diagnosis of IBS include the presence of symptoms compatible with another functional gastrointestinal disorder (emanating from other gastrointestinal regions, such as the oesophagus or gastroduodenum), which can be seen in about a third of IBS cases and correlate positively with increased health impairment and health-care use.15 Moreover, patients with IBS commonly report somatic symptoms, which are medically unexplained extraintestinal complaints.16 Prevalent somatic symptoms include back pain, limb pain, headaches, chest pain, dizziness, fainting spells, palpitations, breathlessness, menstrual cramps, dyspareunia, insomnia, and lethargy.