Quality of life in patients with irritable bowel syndrome seen in referralcenters versus primary care: The impact of gender and predominant bowel pattern

Background: Quality of lift: (QOL) is reduced in patients with irritable bo wel syndrome (IBS) and little is known about differences in QOL in relation to referral status, gender and predominant bowel pattern in ISS patients. This study aimed to explore these relationships. Methods: 343 patients with IBS according to the Pome I criteria (251 females, 92 males) completed fiv e different self-administered questionnaires to evaluate QOL. There were 11 9 patients with diarrhea-predominant IBS (IBS-D), 93 with constipation-pred ominant IBS (IBS-C) and 131 with alternating constipation and diarrhea (IBS -A). The study group comprised 209 hospital outpatients and 134 primary car e patients. The questionnaires were mailed to the patients with an overall response rate of 88%. Results: QOL was reduced in hospital outpatients comp ared to primary care patients, but only in females. IBS subgroup (IBS-D), p hysical fatigue and general health independently predicted referral to a ga stroenterologist. Females had lower QOL than males. No differences, except in severity of diarrhea and constipation, were observed between IBS subgrou ps. Perceived fatigue was related to well-being, psychological and gastroin testinal symptoms. Independent predictors for fatigue were depression, trai t anxiety, general health and vitality, along with eating dysfunction and f emale sex. Conclusion: IBS female patients seen in referral centers versus primary care is a highly selected group with reduced QOL. QOL in IBS is aff ected by gender, but not by subgroup. Our findings have implications for th e generalizability of results in IBS trials. Fatigue is a common symptom in IBS that correlates to general well-being and psychological and subjective gastrointestinal symptoms.