Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2015; 21(26): 8103-8109
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8103
Patients with irritable bowel syndrome-diarrhea have lower disease-specific quality of life than irritable bowel syndrome-constipation
Prashant Singh, Kyle Staller, Kenneth Barshop, Elaine Dai, Jennifer Newman, Sonia Yoon, Shahar Castel, Braden Kuo
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
Kenneth Barshop, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, United States
Sonia Yoon, Division of Gastroenterology, Weill Cornell Medical College, New York, NY 10021, United States
Author contributions: Singh P, Staller K and Kuo B designed the research; Barshop K, Dai E, Castel S and Newman J collected the data and entered the data; Singh P and Staller K analyzed the data; Singh P and Staller K wrote the manuscript; Barshop K, Dai E, Castel S and Newman J also revised the manuscript; Yoon S and Kuo B gave critical inputs to the manuscript.
Institutional review board statement: The study was reviewed and approved by the Massachusetts General Hospital Institutional Review Board (Protocol number: 2012P002255/MGH).
Conflict-of-interest statement: Dr. Braden Kuo has received fees for serving as consultant for Takeda, Furiex Pharmaceuticals and Genova Dignostics; and reveived research funding from Furiex Pharmaceuticals.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: Braden Kuo, MD, GI Unit, GRJ 719, Department of Medicine, Massachussets General Hospital, 55 Fruit Street, Boston, MA 02124, United States.
Telephone: +1-617-7246038 Fax: +1-617-7262047
Received: December 2, 2014
Peer-review started: December 4, 2014
First decision: January 8, 2015
Revised: February 5, 2015
Accepted: March 30, 2015
Article in press: March 31, 2015
Published online: July 14, 2015

AIM: 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).

CONCLUSION: 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.

Keywords: Irritable bowel syndrome, Irritable bowel syndrome subtype, Quality of life, Irritable bowel syndrome-quality of life, Constipation, Diarrhea

Core tip: There is paucity of data on effect of irritable bowel syndrome (IBS)-subtype on disease specific quality of life as most of the earlier studies have utilized general questionnaires like SF-36 etc. We studied the effect of IBS subtype on IBS-specific quality of life (QOL), the most validated disease specific questionnaire for IBS. We found that IBS-diarrhea (IBS-D) and IBS-mixed (IBS-M) have lower disease specific QOL than IBS-constipation patients. Our study also points out that clinicians should pay special attention to certain domains of QOL such as food avoidance, relationship problems, effect on daily activities and social reaction in patients with IBS-D and IBS-M as these domains significantly affect QOL in these patients.