ReviewIrritable Bowel Syndrome: Toward an Understanding of Severity
Section snippets
Methods
We conducted an English language literature search by using the MEDLINE, PsycLIT, HealthSTAR, Cochrane, and EMBASE databases for the time period 1966 through November 2004. Our search included the heading “colonic diseases functional” as well as combinations of key words such as “severity,” “severe,” and “severity of illness.” In addition, relevant studies were identified through a manual search of the references found online.
Significance of Severity
It is difficult to understand the issue of IBS severity without first understanding the definitions for IBS per se and its historical development. The first diagnostic criteria, published in 1978 by Manning et al,4 identified 6 symptoms (Table 1) that were present more commonly in patients with IBS than in patients with other gastrointestinal diseases. Neither the duration nor the severity of symptoms was evaluated as a potential means of discriminating IBS from other gastrointestinal
Components of Severity in Irritable Bowel Syndrome
Although no consensus on the standard for measuring severity exists, a global assessment of IBS severity (eg, wherein the patient is asked, “Rate the severity of your symptoms”) is an attractive measure. Similar to self-report global measures in clinical trials and QOL assessments, it encompasses one’s experience of a wide range of symptoms and bothersome factors that contribute to the self-perception of severity. This global measure is composed of several components.
Symptom intensity is
Validated Measures of Irritable Bowel Syndrome Severity
There are 2 validated measures of severity, each with its strengths and limitations. The Functional Bowel Disorder Severity Index (FBDSI)26 includes 3 clinical factors that were shown to significantly predict the physician’s rating of severity: (1) patient perception of the intensity of current abdominal pain by using a visual analogue scale, (2) number of physician visits in previous 6 months, and (3) existence of constant or frequently recurrent and disabling pain (Table 3).
The FBDSI has been
Irritable Bowel Syndrome Subtype
A study by Schmulson et al31 found no significant difference in patient-reported severity between patients with constipation- and diarrhea-predominant IBS. However, the study by Coffin et al12 found that IBS severity differed between patients with constipation, diarrhea, or alternating bowel habit, with constipation-predominant IBS reporting the greatest severity and diarrhea the lowest. This study differs from the previous study in that patients were assessed with the IBSSS and were recruited
Distribution of Severity in Irritable Bowel Syndrome
An often quoted article on IBS severity by Drossman and Thompson2 estimated the prevalence of IBS severity as 70% mild, 25% moderate, and 5% severe. Patients with mild IBS were thought to be seen predominantly in primary care, to have symptoms that correlated well with physiologic factors (eg, eating, defecation, menses, etc), and to have little association with psychosocial distress or high health care use. Patients with moderate IBS were seen predominantly in secondary care. Patients with
Summary
IBS severity has important clinical and public health implications. However, few studies have been performed to address this issue, and, to date, no consensus criteria for assessing or defining IBS severity have been established. In the literature, IBS severity has been determined by a variety of factors including overall patient assessment, IBS symptoms, extraintestinal symptoms, pain behaviors such as healthcare seeking, health-related QOL, disability due to symptoms, and refractoriness to
References (42)
- et al.
Irritable bowel syndrome, health care use, and costsa US managed care perspective
Am J Gastroenterol
(2003) - et al.
What determines severity among patients with painful functional bowel disorders?
Am J Gastroenterol
(2000) - et al.
Relationship between severity of symptoms and quality of life in 858 patients with irritable bowel syndrome
Gastroenterol Clin Biol
(2004) - et al.
Impact of differences in severity of irritable bowel syndrome (IBS) on patients’ well being and resource use
Gastroenterology
(2001) - et al.
Is there a difference between abdominal pain and discomfort in moderate to severe IBS patients?
Am J Gastroenterol
(2002) - et al.
Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome
Am J Gastroenterol
(1999) - et al.
Symptom complaints and health care seeking behavior in subjects with bowel dysfunction
Gastroenterology
(1984) - et al.
Existence of irritable bowel syndrome supported by factor analysis of symptoms in two community samples
Gastroenterology
(1990) - et al.
Further validation of the IBS-QOLa disease-specific quality-of-life questionnaire
Am J Gastroenterol
(2000) Choosing outcome variablesglobal assessment and diaries
Gastroenterology
(2004)
Perceptions of physicians and patients with organic and functional gastrointestinal diagnoses
Clin Gastroenterol Hepatol
Health status by gastrointestinal diagnosis and abuse history
Gastroenterology
Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders
Gastroenterology
Use of the Functional Bowel Disorder Severity Index (FBDSI) in a study of patients with the irritable bowel syndrome and fibromyalgia
Am J Gastroenterol
Symptom differences in moderate to severe IBS patients based on predominant bowel habit
Am J Gastroenterol
Gender-related differences in IBS symptoms
Am J Gastroenterol
IBS severity and health-related quality of life improve with age in women but not in men (abstr)
Am J Gastroenterol
AGA technical review on irritable bowel syndrome
Gastroenterology
The irritable bowel syndromereview and a graduated multicomponent treatment approach
Ann Intern Med
Alosetron in irritable bowel syndromestrategies for its use in a common gastrointestinal disorder
Drugs
Towards positive diagnosis of the irritable bowel
Br Med J
Cited by (88)
Efficacy of whole system ayurveda protocol in irritable bowel syndrome – A Randomized controlled clinical trial
2023, Journal of Ayurveda and Integrative MedicineCitation Excerpt :The severity of symptoms of IBS varies from very mild to incapacitating. The prevalence of moderate and severe cases may be underestimated [4]. IBS has significant health care cost and burden, in USA cost of IBS management per year is more than US $ 1 billion and indirect costs are more than US $ 200 million [5].
Subtypes and Severity of Irritable Bowel Syndrome Are Not Related to Patients’ Self-Reported Dietary Triggers: Results From an Online Survey in Dutch Adults
2021, Journal of the Academy of Nutrition and Dietetics5.33 - Visceral Pain: From Bench to Bedside
2020, The Senses: A Comprehensive Reference: Volume 1-7, Second EditionIrritable Bowel Syndrome and Female Patients
2016, Gastroenterology Clinics of North America
Supported in part by GlaxoSmithKline and by grants 1R01 AT01414-01 and 1R21 AT002860-01 from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (to A.L.).
Drs Lembo and Drossman have served as consultants to GlaxoSmithKline. Dr Ameen is an employee of GlaxoSmithKline.