title: Patients with irritable bowel syndrome-diarrhea have lower disease-specific quality of life than irritable bowel syndrome-constipation.
abstract: OBJECTIVE
  To determine effect of irritable bowel syndrome (IBS) subtype on IBS-specific quality of life (QOL) questionnaire and its subscales.
  
  
  METHODS
  We studied IBS patients visiting our functional gastroenterology disorder clinic at a tertiary care center of Unites States. IBS and IBS subtype were diagnosed using Rome-III questionnaire. QOL was assessed using IBS-QOL questionnaire. IBS-QOL assesses quality of life along eight subscales: dysphoria, interference with activities, body image, health worry, food avoidance, social reactions, sexual health, and effect on relationships. IBS-QOL and its subscales were both scored on a range of 0-100 with higher scores suggestive of better QOL. Results of overall IBS-QOL scores and subscale scores are expressed as means with 95%CI. We compared mean IBS-QOL score and its subscales among various IBS-subtypes. Analysis of variance (ANOVA) was used to compare the mean difference between more than two groups after controlling for age and gender. A post-hoc analysis using Bonferroni correction was used only when P value for ANOVA was less than 0.05.
  
  
  RESULTS
  Of 542 patients screened, 243 had IBS as per Rome-III criteria. IBS-mixed (IBS-M) was the most common IBS subtype (121 patients, 49.8%) followed by IBS- diarrhea (IBS-D) (56 patients, 23.1%), IBS-constipation (IBS-C) (54 patients, 22.2%) and IBS-unspecified (IBS-U) (12 patients, 4.9%). Overall IBS-QOL scores were significantly different among various IBS-subtypes (P = 0.01). IBS-QOL of patients with IBS-D (61.6, 95%CI: 54.0-69.1) and IBS-M (63.0, 95%CI: 58.1-68.0) was significantly lower than patients with IBS-C (74.5, 95%CI: 66.9-82.1) (P = 0.03 and 0.02 respectively). IBS-D patients scored significantly lower than IBS-C on food avoidance (45.0, 95%CI: 34.8-55.2 vs 61.1, 95%CI: 50.8-71.3, P = 0.04) and interference with activity (59.6, 95%CI: 51.4-67.7 vs 82.3, 95%CI: 74.1-90.6, P < 0.001). IBS-M patients had more interference in their activities (61.6, 95%CI: 56.3-66.9 vs 82.3, 95%CI: 74.1-90.6, P = 0.001) and greater impact on their relationships (73.3, 95%CI: 68.4-78.2 vs 84.7, 95%CI: 77.2-92.2, P = 0.02) than IBS-C patients. Patients with IBS-M also scored significantly lower than IBS-C on food avoidance (47.2, 95%CI: 40.7-53.7 vs 61.1, 95%CI: 50.8-71.3, P = 0.04) and social reaction (66.1, 95%CI: 61.1-71.1 vs 80.0, 95%CI: 72.1-87.7, P = 0.005).
  
  
  CONCLUSIONS
  IBS-D and IBS-M patients have lower IBS-QOL than IBS-C patients. Clinicians should recognize food avoidance, effects on daily activities and relationship problems in these patients.
authors.affiliation: Prashant Singh, Kyle Staller, Elaine Dai, Jennifer Newman, Shahar Castel, Braden Kuo, GI Unit, GRJ 719, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Prashant
authors.initials: P
authors.lastname: Singh
authors.affiliation: Prashant Singh, Kyle Staller, Elaine Dai, Jennifer Newman, Shahar Castel, Braden Kuo, GI Unit, GRJ 719, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Kyle
authors.initials: K
authors.lastname: Staller
authors.affiliation: Prashant Singh, Kyle Staller, Elaine Dai, Jennifer Newman, Shahar Castel, Braden Kuo, GI Unit, GRJ 719, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Barshop
authors.affiliation: Prashant Singh, Kyle Staller, Elaine Dai, Jennifer Newman, Shahar Castel, Braden Kuo, GI Unit, GRJ 719, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Elaine
authors.initials: E
authors.lastname: Dai
authors.affiliation: Prashant Singh, Kyle Staller, Elaine Dai, Jennifer Newman, Shahar Castel, Braden Kuo, GI Unit, GRJ 719, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Newman
authors.affiliation: Prashant Singh, Kyle Staller, Elaine Dai, Jennifer Newman, Shahar Castel, Braden Kuo, GI Unit, GRJ 719, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Sonia
authors.initials: S
authors.lastname: Yoon
authors.affiliation: Prashant Singh, Kyle Staller, Elaine Dai, Jennifer Newman, Shahar Castel, Braden Kuo, GI Unit, GRJ 719, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Shahar
authors.initials: S
authors.lastname: Castel
authors.affiliation: Prashant Singh, Kyle Staller, Elaine Dai, Jennifer Newman, Shahar Castel, Braden Kuo, GI Unit, GRJ 719, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Braden
authors.initials: B
authors.lastname: Kuo
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000704:Analysis of Variance; D001362:Avoidance Learning; D001900:Boston; D016009:Chi-Square Distribution; D003248:Constipation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology*; D017281:Cost of Illness; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012919:Social Behavior; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers
keywords: Constipation; Diarrhea; Irritable bowel syndrome; Irritable bowel syndrome subtype; Irritable bowel syndrome-quality of life; Quality of life