Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain?
Xiu-Cai Fang, Wen-Juan Fan, Douglas D Drossman, Shao-Mei Han, Mei-Yun Ke
Xiu-Cai Fang, Wen-Juan Fan, Mei-Yun Ke, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Wen-Juan Fan, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, Hubei Province, China
Douglas D Drossman, Center of Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC 27517, United States
Douglas D Drossman, Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, Durham, NC 27713, United States
Douglas D Drossman, Rome Foundation, Rome Foundation, Raleigh, NC 27614, United States
Shao-Mei Han, Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing 100005, China
Author contributions: Fang XC was responsible for study concept and design, data collection and interpretation, and drafting and revision of the manuscript; Fan WJ participated in data collection, data analysis, and figure drafting; Drossman DD was responsible for critical revision; Han SM participated in data analysis; Ke MY participated in critical revision; all authors approved the final version of the manuscript as submitted.
Supported by the Program of International S & T Cooperation, No. 2014DFA31850; the National Natural Science Foundation of China, No. 81870379 and No. 81370488; and the Project of the National Key Technologies R & D Program in the 11th Five Year Plan period, No. 2007BAI04B01.
Institutional review board statement: This study was reviewed and approved by the Peking Union Medical College Hospital Ethics Committee, No. S-234.
Informed consent statement: All study participants provided oral or written consent to participate before study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xiu-Cai Fang, MD, Professor, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China. fangxiucai2@aliyun.com
Received: January 19, 2022
Peer-review started: January 19, 2022
First decision: April 10, 2022
Revised: April 19, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: September 7, 2022
BACKGROUND
The Rome IV criteria eliminated abdominal discomfort for irritable bowel syndrome (IBS), which was previously included in Rome III. There are questions as to whether IBS patients with abdominal discomfort (seen in Rome III but not Rome IV) are different from those with abdominal pain (Rome IV).
AIM
To compare bowel symptoms and psychosocial features in IBS patients diagnosed with Rome III criteria with abdominal discomfort, abdominal pain, and pain & discomfort.
METHODS
We studied IBS patients meeting Rome III criteria. We administered the IBS symptom questionnaire, psychological status, and IBS quality of life. Patients were classified according to the predominant abdominal symptom associated with defecation into an only pain group, only discomfort group, and pain & discomfort group. We compared bowel symptoms, extraintestinal symptoms, IBS quality of life, psychological status and healthcare-seeking behaviors, and efficacy among the three groups. Finally, we tested risk factors for symptom reporting in IBS patients.
RESULTS
Of the 367 Rome III IBS patients enrolled, 33.8% (124 cases) failed to meet Rome IV criteria for an IBS diagnosis. There were no meaningful differences between the pain group (n = 233) and the discomfort group (n = 83) for the following: (1) Frequency of defecatory abdominal pain or discomfort; (2) Bowel habits; (3) Coexisting extragastrointestinal pain; (4) Comorbid anxiety and depression; and (5) IBS quality of life scores except more patients in the discomfort group reported mild symptom than the pain group (22.9% vs 9.0%). There is a significant tendency for patients to report their defecatory and non-defecatory abdominal symptom as pain alone, or discomfort alone, or pain & discomfort (all P < 0.001).
CONCLUSION
IBS patients with abdominal discomfort have similar bowel symptoms and psychosocial features to those with abdominal pain. IBS symptoms manifesting abdominal pain or discomfort may primarily be due to different sensation and reporting experience.
Core Tip: It is generally accepted that abdominal pain is the most predominant symptom of irritable bowel syndrome (IBS), and Rome IV eliminated abdominal discomfort as diagnostic criteria for IBS. Asian studies showed about one-third of IBS patients diagnosed using Rome III criteria had abdominal discomfort alone. In this study, we compared bowel symptoms, extraintestinal symptoms, IBS-quality of life, psychological status and healthcare-seeking behaviors, and efficacy between the abdominal pain and abdominal discomfort groups expecting to find a difference between the two groups but did not. We also assessed risk factors for symptom reporting for IBS patients.
