Intestinal symptoms and psychological factors jointly affect quality of life of patients with irritable bowel syndrome with diarrhea.
BACKGROUND
Patients with irritable bowel syndrome (IBS) have significantly reduced quality of life (QOL). Although intestinal and extraintestinal symptoms, as well as comorbid psychological disorders, may reduce the QOL of IBS patients, the primary determinant of QOL in these patients remains unclear. This study aimed to identify the main factors affecting QOL in patients with IBS with diarrhea (IBS-D).


METHODS
Consecutive patients meeting the Rome III Diagnostic Criteria for IBS-D were enrolled in this study. Patients with organic diseases were excluded. The intestinal symptoms, psychological states and QOL of these patients were evaluated using IBS-specific symptom questionnaires, the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), and the Chinese version of the IBS-QOL instrument. Overall scores for intestinal symptoms were calculated by frequency and degree.


RESULTS
This study enrolled 227 IBS-D patients, of mean age 44.68 ± 10.81 years. Their mean overall IBS-QOL score was 71.68 ± 18.54, with the lowest score being for food avoidance (53.71 ± 26.92). Overall IBS-QOL score correlated negatively with overall scores of intestinal symptoms and HAMD and HAMA scores (p < 0.001 each). Overall intestinal symptoms scores correlated negatively with HAMD and HAMA scores (p < 0.001 each). Scores of HAMD, HAMA and structural factors (i.e., anxiety/somatization, cognitive disorder, psychomotor retardation, psychic anxiety, and somatic anxiety) were significantly higher in female than in male patients (p < 0.01). Food avoidance and social reaction scores of female patients were significantly lower than those of male patients (p < 0.05 each). The degree of defecation urgency, frequency of passing mucus and psychomotor retardation were independent factors predicting reduced QOL in IBS-D patients.


CONCLUSIONS
Intestinal symptoms and psychological factors jointly reduce the QOL of IBS-D patients, with gender differences in the impact of both factors on QOL.
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China. zhuliming_2000@aliyun.com.
Liming
L
Zhu
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China. huangdannn@126.com.|Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. huangdannn@126.com.
Dan
D
Huang
Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China. shill@pumch.cn.
Lili
L
Shi
Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. mdlianglx@126.com.
Liexin
L
Liang
Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China. xutaosd@126.com.
Tao
T
Xu
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China. lygchangmin@163.com.
Min
M
Chang
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China. mgdavid@126.com.
Wei
W
Chen
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China. wudong061002@aliyun.com.
Dong
D
Wu
Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. zhangfacan@126.com.
Facan
F
Zhang
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China. fangxiucai2@aliyun.com.
Xiucai
X
Fang
D000328:Adult; D001007:Anxiety; D015897:Comorbidity; D003967:Diarrhea / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life / Q000523:psychology*; D012737:Sex Factors; D011795:Surveys and Questionnaires