Quality of life and psychometric evaluation of patients diagnosed with irritable bowel syndrome: an observational cohort study

ABSTRACT BACKGROUND: Very few data are available for evaluating health-related quality of life among people with irritable bowel syndrome (IBS) and even fewer data are available in relation to anxiety and depression status among these patients. OBJECTIVES: To evaluate the quality of life, anxiety and depression status of patients with IBS. DESIGN AND SETTING: Observational cohort study conducted in a tertiary-care university hospital. METHODS: Patients who had recently been diagnosed with IBS and who had been followed up for IBS-specific treatment for at least three months were included. A quality of life (QoL) survey, the Beck Anxiety Index (BAI) and the Hamilton Depression Index (HAM-D) were applied to the patients. RESULTS: In total, 274 patients with IBS were included in the study cohort. These patients presented very high baseline scores for anxiety and depression, and very poor QoL results. CONCLUSION: Our study showed that IBS had a very high impact on these patients, regarding their anxiety and depression levels, alongside very poor results relating to quality of life.

What do Cochrane systematic reviews say about the management of irritable bowel syndrome?

ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a clinical disorder associated with high socioeconomic burden. Despite its importance, management of IBS remains difficult and several interventions have been hypothesized as beneficial for this condition. This study identified and summarized all Cochrane systematic reviews (SRs) about the effects of interventions for managing IBS patients. DESIGN AND SETTING: Review of systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: Review of Cochrane SRs addressing interventions for IBS. RESULTS: We included six SRs assessing acupuncture, bulking agents, antispasmodics, antidepressants, herbal medicines, homeopathy, hypnotherapy and psychological therapy for IBS. The certainty of evidence ranged from unknown to moderate, mainly due to imprecision in the estimates and high risk of bias from the primary studies included. There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life, compared with sham acupuncture. There was also very low certainty of evidence that homeopathic asafoetida, used alone or in association with nux, was better than placebo regarding self-reported overall improvement. CONCLUSION: There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life. Further well-designed and well-conducted randomized clinical trials are needed in order to reduce the uncertainties regarding the most commonly used interventions for patients with IBS.

Assessing the sleep quality and depression-anxiety-stress in irritable bowel syndrome patients / Avaliação da qualidade do sono e de depressão, ansiedade e estresse em pacientes com síndrome do intestino irritável

ABSTRACT BACKGROUND Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders with chronic abdominal pain and altered bowel habit without any organic reason. Sleep disorders may be associated to IBS. OBJECTIVE We aimed to assess sleep disturbances and depression-anxiety-stress in IBS patients. METHODS In this analytical cross sectional study from November 2013 to May 2014, A total of 123 IBS patients were recruited by simple random sampling. IBS was diagnosed using ROME-III criteria. Demographic and basic data were driven from all patients then Pittsburg Sleep Quality Index questionnaire was utilized to estimate sleep quality and DASS (depression anxiety stress scale) questionnaire was filled out for depression, anxiety and stress. RESULTS The mean age of patients was 29±9, where 48 cases (39%) were male. Twelve cases (10%) had a background disease. Types of IBS in patients were included 38% diarrhea, 42% constipation and 20% mixed. From all IBS patients 87 (71%) cases had depression, 97 (79%) patients stress, 94 (76%) patients had anxiety. Seventy-six (62%) cases of IBS patients had poor sleep quality. Simultaneously employing predictors demonstrate that gender, background disease, and type of IBS did not statistically significant. On the other hand, depression (P=0.034, OR=2.35), anxiety (P=0.011, OR=3.022), and stress (P=0.029, OR=2.77) were significantly effect on sleep quality in poor sleepers. CONCLUSION Many of IBS patients is suffering from poor sleep quality. It seems that sleep disorder should be considered and treated in this patients.

RESUMO CONTEXTO A síndrome do intestino irritável (SII) é um dos transtornos gastrointestinais funcionais mais comuns, com dor abdominal crônica e alteração do hábito intestinal sem motivo orgânico aparente. Distúrbios do sono podem estar associados à SII. OBJETIVO Avaliar distúrbios do sono e sinais de depressão, ansiedade e estresse em pacientes com SII. MÉTODOS Através de estudo analítico transversal, observou-se entre de novembro de 2013 e maio 2014, um total de 123 pacientes com SII, recrutados por amostragem aleatória simples. A SII foi diagnosticada usando-se os critérios de Roma III. Dados demográficos e básicos foram obtidos de todos os pacientes e o questionário de índice de qualidade de sono de Pittsburg foi utilizado para estimar a qualidade do sono; o questionário DASS (escala de depressão ansiedade stress) foi preenchido para depressão, ansiedade e stress. RESULTADOS A média de idade dos pacientes foi de 29±9 anos, sendo 48 (39%) do sexo masculino. Doze (10%) tinham alguma doença associada. Nos subtipos de SII foram incluídos 38% com diarreia, 42% com constipação e 20% de forma alternada. Do total, 87 (71%), pacientes tinham depressão, o estresse foi observado em 97 (79%) e 94 (76%) tinham ansiedade. Setenta e seis (62%) pacientes com SII tinham sono de má qualidade. A análise de preditores, empregados simultaneamente, demonstrou que o gênero, a doença associada e o tipo de SII não foram estatisticamente significantes. Por outro lado, depressão (P=0,034, OR=2,35), ansiedade (P=0.011, OR=3.022) e stress (P=0,029, OR=2,77) contribuíram significativamente no efeito da má qualidade do sono. CONCLUSÃO A maioria dos pacientes com SII tem sono de má qualidade. Recomenda-se que o distúrbio do sono deva ser considerado e tratado nestes pacientes.

Narrativas de pacientes con síndrome de intestino irritable: análisis de casos / Narratives of patients with irritable bowel syndrome: analysis of cases

Irritable bowel syndrome (IBS) is a psychosomatic disease whose prevalence has increased considerably in recent years. IBS tends to present comorbidity with other psychopathological conditions such as anxiety, phobias, hypochondria and depression, which makes the medical and psychotherapeutic treatment more complex. There is little empirical evidence on psychotherapeutic treatments to help patients cope with these symptoms. The purpose if this study is to describe the narratives of patients with IBS and explore the role that these narratives play in the establishment and persistence of the disease. Two female IBS-patients were selected and an in depth interview was conducted. The dialogue was transcribed and data were analyzed using the biographical approach. The results show that patients have high levels of alexithymia, operational thinking and difficulties in emotional expression; confirming the main features of psychosomatic personality. It is proposed to define specific psychotherapeutic approaches for each patient according to their personality inferred through their narratives, rather than a unified approved technique for all patients with this disease...

El síndrome de intestino irritable (SII) es una enfermedad psicosomática cuya prevalencia ha aumentado considerablemente en los últimos años. Tiende a presentar comorbilidad con otros cuadros psicopatológicos como la ansiedad, fobias, hipocondría y depresión, lo cual otorga mayor complejidad al tratamiento médico y psicoterapéutico. Existe escasa evidencia empírica sobre tratamientos psicoterapéuticos que ayuden a estos pacientes a lidiar con la sintomatología. El presente trabajo tuvo por objetivo describir las narrativas de pacientes que padecen SII y explorar el rol que cumplen estas narrativas en la constitución y mantenimiento de la enfermedad. Se seleccionaron dos pacientes de sexo femenino con diagnóstico médico de SII y se realizó una entrevista en profundidad. El diálogo fue transcrito a texto y los datos fueron analizados desde el enfoque biográfico. Los resultados muestran que las pacientes padecen altos niveles de alexitimia, pensamiento operatorio y dificultades en la expresión emocional; confirmando las principales características de la personalidad psicosomática. Se propone definir abordajes psicoterapéutico específicos a cada paciente de acuerdo a su personalidad inferida a través de sus narrativas, más que una técnica homologada unificada para todos los pacientes que padecen esta enfermedad...

Assesment of psychiatric symptoms and co-morbidities in patients with irritable bowel syndrome / Evaluación de los síntomas psiquiátricos y las comorbilidades en pacientes con el síndrome del intestino isrritable

AIM: To determine the psychiatric symptom assesment of patients seeking treatment for irritable bowel syndrome (IBS) and to demonstrate the presence of more complicated psychiatric disorders. SUBJECTS AND METHOD: The participants were recruited from patients who were attending internal medicine and gastroenterology clinics and who fullfilled the Rome III criteria for IBS. Fifty patients with IBS (IBS group) and 50 patients with complaints other than gastrointestinal symptoms (control group) were randomly selected. All participants were screened by the Structured Clinical Interview for DSM-IV (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Check list - 90 (Revised) [SCL-90-R]. RESULTS: Seventeen patients (34%) and three control subjects (6%) had at least one psychiatric diagnosis (p = 0.001). Global severity index (GSI) total scores and SCL-90-R items were significantly higher in the IBS group than the control group (0.92 ± 0.46 vs 0.358 ± 0.19, p < 0.001). Beck anxiety inventory and BDI scores were higher in the IBS group than the control group (p < 0.001). Axis-I psychiatric disorders diagnosed with SCID-I were significantly higher in the IBS group (34% vs 6%) [p = 0.001]. Among the Axis-I disorders, somatoform and anxiety disorders were higher in the patient group than in the control subjects (p = 0.002 and p = 0.0057) whereas there was no difference for mood disorders (p = 0.204). Seven (14%) of the patients and two (4%) of the control subjects had at least one Axis-II psychiatric disorder diagnosed with SCID-II without any significance (p = 0.159). CONCLUSION: These findings suggest that except for mood and personality disorders, almost all psychiatric symptoms and disease co-morbities with IBS are higher than in the sample without IBS. We can easily use SCL-90-R, BAI and BDI in internal medicine and gastroenterology clinics to detect psychiatric symptom levels and then to refer patients to a psychiatrist for further evaluation and treatment.

OBJETIVO: Determinar la evaluación del síntoma psiquiátrico de pacientes que buscan tratamiento para el síndrome del intestino irritable (IBS), y demostrar la presencia de trastornos psiquiátricos más complicados. SUJETOS Y MÉTODO: Los participantes reclutados fueron pacientes que asistían a clínicas de medicina interna y gastroenterología, y satisfacían los criterios de Roma III para el IBS Cincuenta pacientes con IBS (grupo IBS) y 50 pacientes aquejados de otras dolencias no gastrointestinales (grupo control) fueron seleccionados al azar. Todos los participantes pasaron por el tamiz de la Entrevista Clínica Estructurada para DSM-IV (SCID-I), el Inventario de Depresión de Beck (BDI), el Inventario de Ansiedad de Beck (BAI), y el Listado de Síntomas-90 (Revisado) [SCL-90-R]. RESULTADOS: Diecisiete pacientes (34%) y tres sujetos de control (6%) tenían al menos un diagnóstico psiquiátrico (p = 0.001). Las puntuaciones totales del índice de severidad global (GSI) y los ítems del SCL-90-R fueron significativamente más altos en el grupo de IBS que en el grupo control (0.92 ± 0.46 frente a 0.358 ± 0.19, p < 0.001). Las puntuaciones del Inventario de Ansiedad de Beck y BDI fueron más altas en el grupo IBS que el grupo control (p < 0.001). Los trastornos psiquiátricos del eje I diagnosticados con SCID-I fueron significativamente más altos en el grupo IBS (34% vs. 6%) [p = 0.001]. Entre los desórdenes del Eje I, los trastornos somatoformos y los trastornos de ansiedad fueron más altos en el grupo de pacientes que en los sujetos del control (p = 0.002) y (p = 0.0057), en tanto que no hubo ninguna diferencia en cuanto a los trastornos de estados de ánimo (p = 0.204). Siete (14%) de los pacientes y dos (4%) de los sujetos del control tuvieron por lo menos un trastorno psiquiátrico del eje II diagnosticados con el SCID-II sin ninguna significación (p = 0.159). CONCLUSIÓN: Estos hallazgos sugieren que salvo el caso de los trastornos de estados de ánimo y personalidad, casi todos los síntomas psiquiátricos y comorbilidades con el IBS son más altos que en la muestra sin IBS. Se puede usar con facilidad el SCL-90-R, el BAI y el BDI en las clínicas de medicina interna y gastroenterología para detectar los niveles de síntomas psiquiátricos, y remitir entonces a los pacientes a un psiquiatra para ulterior evaluación y tratamiento.

[Comparison the personality characteristics between male and female patients with irritable bowel syndrome [IBS]]

Irritable Bowel Syndrome [IBS] is the most common gastrointestinal disorder in clinical medicine, since it is not founded biological basis for it, role of psychological causes is investigated in creation of it. To compare the personality characteristics between three groups of patients with Diarrhea dominant, Constipation dominant and dominant of Altering type and investigating the gender, family background of IBS and length of illness. Eighty five patients were selected through temporal classical random method and included of 21 patients with Diarrhea dominant, 30 patients with Constipation dominant and 340 patient with Altering type]. Patients were diagnosed by a gastroenterologist and using the ROME criteria after clinical evaluation and endoscopy. Personality inventory [NEOPI-R] made by Mc Crue and Kosta containing big five personality factors was used for investigating the samples personality characteristics. Demographic characteristics and other groups were recognized by question made at the first of main questionnaire. The groups eperated of each other. Analysis of data indicated that there were no significantly differences between the personality characterisrics in three groups of patients. Extraversion was significantly higher in patients with family background of IBS and patients who had IBS more than six mounth and had reported stress gained higher score at neuroticism in comparison with patients who had IBS less than 6 month and had not report stress. Psychological factors participated at quality of illness experience. Neuroticism may be correlated with quality of illness experience [with stress and high length of illness]. Thus personality characteristics should be considred as an important factor in improvement of IBS patients by psychiatrics and specialists

Influência da resposta individual ao estresse e das comorbidades psiquiátricas na síndrome do intestino irritável: [revisão] / Influence of individual response to stress and psychiatric comorbidity in irritable bowel syndrome: [review]

CONTEXTO: A síndrome do intestino irritável (SII) é um distúrbio clínico comum, porém ainda pouco compreendida, uma vez que o desenvolvimento dos seus sintomas está fortemente relacionado ao estresse, ansiedade e depressão. OBJETIVOS: Revisar a literatura a fim de verificar se, de fato, existe influência do estresse e das comorbidades psiquiátricas no desenvolvimento, diagnóstico e tratamento para os portadores da SII. MÉTODOS: A revisão foi realizada por meio de pesquisa na base de dados MedLine e Lilacs entre 1990 e 2009, usando-se as palavras-chave "estresse", "comportamento", "psiquiatria" e "síndrome do intestino irritável". RESULTADOS: Foram selecionados 38 artigos que relacionaram a síndrome do intestino irritável à reação individual ao estresse e comorbidade psiquiátrica, incluindo ansiedade e depressão. CONCLUSÃO: A reatividade do indivíduo ao estresse e os fatores psicossociais desempenham um papel etiológico importante, embora não determinante, podendo interferir no funcionamento intestinal mediante a alteração na motilidade ou espasmo, na diminuição ou aumento de secreção e,finalmente, na irritação. É necessário desenvolver uma metodologia para definir e medir a somatização para o auxílio no diagnóstico clínico e a inclusão dos fatores psicossociais relacionados ao desenvolvimento e persistência dos sintomas nos critérios diagnósticos para a SII.

BACKGROUND: The irritable bowel syndrome (IBS) is a common clinical disorder, however, still poorly understood since the development of symptoms is strongly related to stress, anxiety and depression. OBJECTIVES: To review the literature in order to determine whether, in fact, there is the influence of stress and psychiatric comorbidity in the development, diagnosis and treatment for patients with IBS. METHODS: The review was conducted by searching the database MedLine and Lilacs from 1990 to 2009 using the keywords "stress", "behavior", "psychiatry" and "irritable bowel syndrome". RESULTS: Were selected 38 articles that related irritable bowel syndrome to the individual reaction to stress and psychiatric comorbidity, including anxiety and depression. DISCUSSION: The reactivity of the individual to stress and psychosocial factors play an important etiologic role, although not conclusive, and may interfere with intestinal functioning by altering its motility or spasm, reduction or increase in secretion and, finally, in irritation. It is necessary to develop a methodology for defining and measuring somatization to aid in clinical diagnosis and the inclusion of psychosocial factors related to the development and persistence of symptoms in the diagnostic criteria for IBS.

Síndrome do intestino irritável: um exercício em análise funcional do comportamento / Irritable bowel syndrome: an exercise in functional analysis of behavior

Na Síndrome do Intestino Irritável (SII), há a alteração na frequência das evacuações intestinais associadas ao quadro de desconforto abdominal. A etiologia desse problema de saúde ainda é pouco conhecida. A literatura psicológica fornece suporte para a compreensão da SII por meio do modelo de estresse, do modelo de motilidade intestinal induzida por contingências e do modelo operante. Neste estudo foi realizado um exercício em análise funcional do comportamento com uma portadora de SII por meio de entrevistas e automonitoramento (AM) prolongado dos sintomas e das atividades diárias, para verificar a existência de relações funcionais entre esses eventos. A participante apresentava um quadro de diarreia que teve remissão durante um período de férias, em função de alteração das demandas acadêmicas. Seus sintomas pareciam adiar atividades aversivas, indicando o controle operante. Este estudo demonstrou a possibilidade de se utilizar a análise funcional como um instrumento capaz de ajudar na compreensão da SII.

Irritable Bowel Syndrome (IBS) is characterized by an alteration of the frequency of the intestinal evacuations, which are associated with abdominal discomfort. The etiology of this health problem is not very well known yet. The psychological literature offers support to IBS comprehension by stress model, adjunctive bowel motility model and operant model. This study was an exercise in functional analysis of behavior with a woman, IBS patient, through interviews and self-monitoring (SM) of daily activities and the symptoms to verify the existence of functional relations between these two events. The participant showed a diarrhea symptom which had a consistent remission during a period of vacation, as a function of changes in the academic demands. Her symptoms seemed postponing aversive activities, indicating the operant control. This study demonstrated the possibility of using functional analysis as an instrument capable of helping in SII comprehension.

effect of Benson relaxation therapy on anxiety level and severity of symptoms in patients with irritable bowel syndrome

Irritable bowel syndrome [IBS] is the most common functional bowel disorder. Stress triggers or aggravates it's symptoms. This investigation is carried out to determine the effect of Benson relaxation therapy on anxiety level and severity of symptoms in patients with irritable bowel syndrome. In this clinical trial 30 patients with irritable bowel syndrom were randomly divided into case and control groups. The control group was treated by only usual medical therapy but the case group was treated by combined medical-relaxational therapy. The two groups continued therapy for three months. Anxiety level and gastrointestinal symptoms of case and control groups were compared at three different times [two weeks before intervention and one week and three months after intervention]. Also, patients were asked to document 6 common gastrointestinal symptoms in their daily symptom diaries, 2 weeks before intervention to 3 months after intervention. At the end of each week, these symptoms were compared in the two groups. Data was analyzed using chi square, Man - Whitney U and Wilcoxon tests. Mean state and trait anxiety of the case and control groups two weeks before and one week after intervention did not show significant difference. But the results after 3 months showed a significant difference [p<0.001].The mean severity of gastrointestinal symptoms, 2 weeks before intervention, was significantly higher in case group, but the comparison of gastrointestinal symptoms severity, 1 week after intervention, did not show any significant difference between the two groups, and 3 months after intervention a significant difference was observed in the two groups [the control group had more severe symptoms than the case group]. The comparison of 6 common gastrointestinal symptoms based on weekly self-report showed that abdominal pain, eructation and distention were significantly lower in case group, but there was no significant difference between diarrhea and constipation. Three months Benson relaxation therapy significantly decreased the state and trait anxiety level and severity of symptoms in patients with irritable bowel syndrome

Calidad de vida, ansiedad y depresión en pacientes con diagnóstico de síndrome de colon irritable / Quality of life, anxiety and depression in patients diagnosed with irritable bowel syndrome (IBS)

El propósito de este estudio fue evaluar la calidad de vida, ansiedad y depresión en 73 personas diagnosticadas con Síndrome de Colon Irritable (SCI) y observar si existe relación entre estas variables. Para ello se utilizó el cuestionario de calidad de vida SF36 y la escala de ansiedad y depresión hospitalaria HAD. No se observó un detrimento severo en la calidad de vida de estos pacientes probablemente debido a que algunas dimensiones que han demostrado tener un impacto importante sobre ella, se encontraban altamente preservadas. Por otro lado la ansiedad y depresión se relacionaron significativamente con algunas dimensiones de la calidad de vida de estos pacientes. Los resultados encontrados confirman la importancia de considerar los factores psicológicos sobre la percepción de calidad de vida de los pacientes con SCI, no solo por las puntuaciones obtenidas en estas escalas sino por la correlación entre ellas, que consolidan un patrón de calidad de vida particularmente asociado a factores cognitivos, emocionales y sociales.