Symptom duration in patients with irritable bowel syndrome.
OBJECTIVE
The etiology and natural history of irritable bowel syndrome (IBS) is poorly understood. We compared rectal sensory thresholds and compliance, SCL-90 scores, and follow-up questionnaires among normal controls, patients with longstanding ( > 5 y) disease (L-IBS), and patients with recent onset ( > 2 y) disease (R-IBS). The onset of symptoms in R-IBS was related to specific events such as infection (n = 10), surgery (n = 5), and stress (n = 4), but no specific event could be identified in six patients.


METHODS
A diagnosis of IBS was made using Manning criteria ( > or = 3) and clinical grounds. Psychological data were obtained by psychometrics (SCL-90) scores. Rectal wall compliance and thresholds for the sensation of stool and discomfort were evaluated using the electronic barostat.


RESULTS
The mean thresholds for phasic and ramp distention were similar for R-IBS and L-IBS groups for the perception of stool and discomfort. When compared with normals, the mean stool thresholds for phasic distention were significantly lower for L-IBS and R-IBS groups. SCL-90 scores were significantly increased in L-IBS in the mean phobia score (45 R-IBS vs 61 L-IBS), anxiety score (49 R-IBS vs 63 L-IBS), paranoia score (44 R-IBS vs 60 L-IBS), and hostility score (47 R-IBS vs 61 L-IBS) (all p < 0.05). On follow-up questionnaire, 60% of R-IBS versus 46% of L-IBS patients indicated that their symptoms had improved (p < 0.05). R-IBS patients also experienced fewer episodes of abdominal pain per week at follow-up than L-IBS patients (3.9 +/- 1.0 vs 8.5 +/- 1.7, respectively) (p < 0.05).


CONCLUSIONS
Our findings suggest that IBS patients with short symptom duration and fewer psychological symptoms have a better prognosis than patients with a long history of IBS and associated psychological distress, although long term prospective studies are needed.
Lembo
T
T
VA/UCLA CURE Gastroenteric Biology Center, USA.
Fullerton
S
S
Diehl
D
D
Raeen
H
H
Munakata
J
J
Naliboff
B
B
Mayer
E A
EA
D000293:Adolescent; D000328:Adult; D003109:Colonic Diseases, Functional / Q000503:physiopathology* / Q000523:psychology*; D003187:Compliance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011594:Psychometrics; D012007:Rectum / Q000503:physiopathology; D012684:Sensory Thresholds / Q000502:physiology; D011795:Surveys and Questionnaires; D013997:Time Factors