LEVEL OF CHRONIC LIFE STRESS PREDICTS CLINICAL OUTCOME IN IRRITABLE-BOWEL-SYNDROME

Background-Life stress contributes to symptom onset and exacerbation i n the majority of patients with irritable bowel syndrome (IBS) and fun ctional dyspepsia (FD); research evidence is conflicting, however, as to the strength of these effects. Aims-To test prospectively the relat ion of chronic life stress threat to subsequent symptom intensity over time. Patients-One hundred and seventeen consecutive outpatients sati sfying the modified Rome criteria for IBS (66% with one or more concur rent FD syndromes) participated. Methods-The life stress and symptom i ntensity measures were determined from interview data collected indepe ndently at entry, and at six and 16 months; these measures assessed th e potency of chronic life stress threat during the prior six months or more, and the severity and frequency of IBS and FD symptoms during th e following two weeks. Results-Chronic life stress threat was a powerf ul predictor of subsequent symptom intensity, explaining 97% of the va riance on this measure over 16 months. No patient exposed to even one chronic highly threatening stressor improved clinically (by 50%) over the 16 months; all patients who improved did so in the absence of such a stressor. Conclusion-The level of chronic life stress threat predic ts the clinical outcome in most patients with IBS/FD.