Symptom differences in moderate ito severe IBS patients based on predominant bowel habit

OBJECTIVE: We sought to determine if irritable bowel syndrome (IBS) patient s with different bowel habit predominance differ in self-reported viscerose nsory symptoms related to the upper and lower gastrointestinal (GI) tract, somatosensory symptoms, and constitutional functions. METHODS: Six hundred and twenty-five Pome criteria-positive IBS patients co mpleted a bowel symptom questionnaire (BSQ), psychological symptom checklis t (SCL-90), and health status (SF-36). Bowel habit predominance for IBS pat ients was determined using the Pome criteria for functional constipation (I BS-C; n = 140) and functional diarrhea (IBS-D; n = 216). The BSQ included q uestions about viscerosensory symptoms of the upper (chest pressure, bloati ng, fullness, early satiety, nausea) and lower GI tract (bloating, pain, in complete evacuation), somatosensory symptoms related to the musculoskeletal system (pain in neck/shoulders, lower back/hip, muscles/joints), and const itutional functions (sleep, appetite, libido). Analysis was further conduct ed between the IBS-C and IBS-D patients, controlling for gender and quality of sleep, and using the Bonferroni correction to control for multiple comp arisons. RESULTS: Female gender was more prevalent among IBS-C than IBS-D (77% vs 56 .1%, p < 0.01), whereas age did not differ (40.2 +/- 1.2 yr vs 39.5 +/- 1.0 yr). Symptoms referred to the upper GI were more prevalent in IBS-C than I BS-D: early satiety (56.7% vs 33.9%, p < 0.004), fullness (63.2% vs 38.5%, p < 0.05), and a trend for upper bloating (80.3 vs 62.6%). IBS-C patients r eported higher severity ratings for lower GI bloating (p < 0.001). IBS-C mo re commonly reported musculoskeletal symptoms (92.2% vs 75.4%, p < 0.001), as well as impairment in sleep (31.3 vs 17.5%, p < 0.009), appetite (35.0% vs 18.4%, p < 0.015) and sexual function (45.2% vs 33.1%, p < 0.0021). Ther e were no differences in SCL-90 and SF-36 scores. CONCLUSIONS: Compared with the IBS-D group, the IBS-C patients show greater prevalence of a wide range of symptoms referred to the upper and lower abd omen, musculoskeletal, and constitutional functions. These findings may be related to differences in autonomic or perceptual responses to visceral and somatic stimuli, and are likely to have implications for treatment respons es in the two subgroups. ((C) 1999 by Am. Coll. of Gastroenterology).