Objectives: The etiology and natural history of irritable bowel syndro
me (IBS) is poorly understood. We compared rectal sensory thresholds a
nd compliance, SCL-90 scores, and follow-up questionnaires among norma
l controls, patients with longstanding (>5 y) disease (L-IBS), and pat
ients with recent onset (<2 y) disease (R-IBS). The onset of symptoms
in R-IBS was related to specific events such as infection (n = 10), su
rgery (n = 5), and stress (n = 4), but no specific event could be iden
tified in six patients. Methods: A diagnosis of IBS was made using Man
ning criteria (greater than or equal to 3) and clinical grounds. Psych
ological data were obtained by psychometrics (SCL-90) scores. Rectal w
all compliance and thresholds for the sensation of stool and discomfor
t were evaluated using the electronic barostat. Results: The mean thre
sholds for phasic and ramp distention were similar for R-IBS and L-IBS
groups for the perception of stool and discomfort. When compared with
normals, the mean stool thresholds for phasic distention were signifi
cantly lower for L-IBS and R-IBS groups. SCL-90 scores were significan
tly increased in L-IBS in the mean phobia score (45 R-IBS vs 61 L-IBS)
, anxiety score (49 R-IBS vs 63 L-IBS), paranoia score (44 R-IBS vs 60
L-IBS), and hostility score (47 R-IBS vs 61 L-IBS) (all p < 0.05). On
follow-up questionnaire, 60% of R-IBS versus 46% of L-IBS patients in
dicated that their symptoms had improved (p < 0.05). R-IBS patients al
so experienced fewer episodes of abdominal pain per week at follow-up
than L-IBS patients (3.9 +/- 1.0 vs 8.5 +/- 1.7, respectively) (p < 0.
05). Conclusions: Our findings suggest that IBS patients with short sy
mptom duration and fewer psychological symptoms have a better prognosi
s than patients with a long history of IBS and associated psychologica
l distress, although long term prospective studies are needed.