title: Functional bowel symptoms, fibromyalgia and fatigue: a food-induced triad?
abstract: OBJECTIVE
  Patients with perceived food hypersensitivity typically present with multiple health complaints. We aimed to assess the severity of their intestinal and extra-intestinal symptoms.
  
  
  METHODS
  In a prospective study, 84 patients referred to our outpatient clinic for investigation of perceived food hypersensitivity were enrolled consecutively. Irritable bowel syndrome (IBS) was diagnosed according to the Rome III criteria. Severity and impact of bowel symptoms, fatigue and musculoskeletal pain were evaluated by using the following questionnaires: The IBS Severity Scoring System (IBS-SSS), the Fatigue Impact Scale (FIS), the FibroFatigue Scale (FFS), and visual analogue scales (VAS) for scoring of musculoskeletal pain.
  
  
  RESULTS
  All but one patient were diagnosed with IBS, 58% with severe symptoms. Extra-intestinal symptoms suggestive of chronic fatigue and fibromyalgia were demonstrated in 85% and 71%, respectively. Neither IgE-mediated food allergy nor organic pathology could explain the patients' symptoms. Nevertheless, malabsorption of fat was demonstrated in 10 of 38 subjects.
  
  
  CONCLUSIONS
  Perceived food hypersensitivity may be associated with severe, debilitating illness. The comorbid triad of IBS, chronic fatigue, and musculoskeletal pain is striking and may point to a common underlying cause.
authors.affiliation: Department of Medicine, Unger-Vetlesen's Institute, Lovisenberg Diakonale Hospital, Oslo, 0440, Norway. Arnold.Berstad@med.uib.no
authors.forename: Arnold
authors.initials: A
authors.lastname: Berstad
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Undseth
authors.forename: Ragna
authors.initials: R
authors.lastname: Lind
authors.forename: Jørgen
authors.initials: J
authors.lastname: Valeur
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005221:Fatigue / Q000150:complications*; D005260:Female; D005356:Fibromyalgia / Q000150:complications*; D005512:Food Hypersensitivity / Q000150:complications* / Q000523:psychology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications*; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000150:complications; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult