Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea.
OBJECTIVE
Distinguishing between irritable bowel syndrome (IBS) and functional dyspepsia can be challenging because of the variations in symptom patterns, which commonly overlap. However, the overlap is poorly quantified, and it is equally uncertain whether symptom patterns differ in subgroups of IBS arbitrarily defined by primary bowel patterns of constipation (IBS-C) and diarrhea (IBS-D). We aimed to determine and to compare the distribution of GI symptoms, both, upper and lower, among IBS-C and IBS-D patients.


METHODS
A total of 121 consecutive patients presenting with a diagnosis of IBS were grouped according to primary bowel symptoms as IBS-C (58 women and 18 men, mean age 47 +/- 17 yr) or IBS-D (26 women and 19 men, mean age 47 +/- 15 yr). The Hopkins Bowel Symptom Questionnaire, which includes a brief Quality of Life assessment, and the Hopkins Symptom Checklist 90-Revised were completed by all patients at intake.


RESULTS
IBS-C patients reported significantly more overall GI symptoms when compared to patients with IBS-D (6.67 vs 4.62, respectively, p<0.001). Abdominal pain patterns differed in patients with IBS-C versus IBS-D (lower abdominal pain: 40.8% vs 24.4% p=0.05 and upper abdominal pain: 36.8% vs 24.4%, respectively). Bloating was substantially more common in IBS-C patients (75%) than in IBS-D (40.9%). There were no significant differences in personality subscales by IBS subgroup; however, somatization was positively associated with multiple symptom reports and was negatively correlated with quality of life.


CONCLUSIONS
Upper GI symptoms consistent with functional dyspepsia were more frequent in IBS-C. Although there was considerable overlap of upper and lower GI symptoms in patients with IBS-C and IBS-D, the former had more frequent lower abdominal pain and bloating.
Talley
Nicholas J
NJ
Mayo Foundation, Mayo Medical School, Rochester, Minnesota 55905, USA.
Dennis
Eslie Helen
EH
Schettler-Duncan
V Ann
VA
Lacy
Brian E
BE
Olden
Kevin W
KW
Crowell
Michael D
MD
D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003248:Constipation / Q000175:diagnosis / Q000453:epidemiology*; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology*; D004415:Dyspepsia / Q000175:diagnosis*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires