Help For Irritable Bowel Syndrome (IBS) - Education, Support, & Self Help for Irritable Bowel Syndrome   
Heather & Company View Cart  
Shop for IBSIBS Message BoardsIBS News & ReviewsStore Finder  
Home
IBS Diet & Recipes
IBS Books
IBS Supplements
Yoga for IBS
Hypnosis for IBS
Tummy Teas

All Boards >> Irritable Bowel Syndrome Research Library

HeatherAdministrator

Reged: 12/09/02
Posts: 7389
Loc: Seattle, WA
IBS Subgroups by Bowel Habit Predominance
      01/26/04 03:13 PM

IBS Subgroups by Bowel Habit Predominance

Lin Chang, MD

Although there are symptom-based Rome II diagnostic criteria for IBS and for the subgroups of IBS with diarrhea and IBS with constipation, the subgroup criteria are not evidence-based and were developed using expert opinion.

A study was performed to develop a symptom-based algorithm to classify patients with IBS into 3 subgroups: IBS with constipation, IBS with diarrhea, and IBS with alternating symptoms.[15] Similar to the methodology used in the previously mentioned IBS study assessing burden of illness,[8] clinical characteristics and gastrointestinal symptoms were gathered in an IBS patient population comprising members of the Intestinal Disease Foundation (n = 1340). Expert opinion was used to define symptom criteria for each subgroup. A hierarchical classification algorithm was developed based on the frequency of patients experiencing a combination of relevant gastrointestinal symptoms (diarrhea, constipation, and other Rome symptom criteria for IBS and functional constipation). The classification of patients with IBS by this algorithm was then compared with that determined by the Rome II criteria for subgroup classification. Of the 657 (49%) members who responded to the survey, 430 (65%) had IBS. The symptom-based algorithm classified 40% with IBS with diarrhea, 33% with IBS with constipation, and 12% with IBS alternating symptoms. Using the Rome II criteria, 31% had IBS with diarrhea, 10% had IBS with constipation, 41% had IBS with alternating symptoms, and 18% were unclassified.

The study authors concluded that the symptom-based algorithm was "more reflective" of the estimated prevalence of IBS subgroups in the general population. A few relevant points should be considered when interpreting these results: (1) the symptoms used in the algorithm consist of more constipation symptoms than diarrhea symptoms, and therefore may bias the classification towards IBS with constipation; (2) there are only symptom-based Rome II criteria for IBS with diarrhea and IBS with constipation, but not IBS with alternating symptoms; therefore, patients who do not meet criteria for IBS with diarrhea or IBS with constipation are in an intermediate group with no absolute criteria -- this may explain the significant number of unclassified IBS patients; and (3) the symptoms used to determine subgroups in the algorithm were based on expert opinion and were not evidence-based.

A study by Locke and colleagues[16] specifically addressed the symptom profile in a community population that self-reported having alternating constipation and diarrhea. Four thousand twenty-nine randomly selected households were sent gastrointestinal symptom questionnaires and 2718 respondents were eligible for the analysis; 9.2%, 2.5%, and 7.6% of respondents reported their usual bowel pattern as constipation, diarrhea, or alternating diarrhea and constipation, respectively. The respondents were not required to meet diagnostic criteria for IBS (ie, presence of chronic or recurrent abdominal pain or discomfort associated with altered bowel habits). In general, self-report of bowel pattern approximated symptom criteria. Eighty-three percent of individuals with self-reported constipation met constipation symptom criteria; 67% of individuals self-reporting diarrhea met criteria for diarrhea. Among those individuals with alternating bowel habits (mean age 54 years, 63% women), 59% met symptom criteria for constipation, 35% met criteria for diarrhea, 20% met criteria for both, and 25% did not meet criteria for either. Predictive symptoms of alternators were incomplete evacuation and the presence of mucus.

Clearly, additional studies need to be performed to more accurately classify patients with IBS into bowel habit subgroups and characterize symptoms in patients with IBS with alternating symptoms (which is lacking in the literature). But first, it should be determined whether subclassifying IBS into these subgroups is even clinically relevant for patient care and research studies, given the fluctuation of IBS symptoms over time.

References
Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol Ther. 1997;11:1019-1030.
Gralnek IM, Hays RD, Kilbourne A, Naliboff B, Mayer EA. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. 2000;119:654-60.
Frank L, Kleinman L, Rentz A, Ciesla G, Kim JJ, Zacker C. Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. Clin Ther. 2002;24:675-689.
Hungin P, Chang L, Barghout V, Kahler K. The impact of IBS on absenteeism and work productivity: United States and eight European countries. Am J Gastroenterol. 2003;98:S227. [Abstract # 687]
Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500-1151.
Dean BB, Aguilar D, Barghout V, Kahler K, Groves D, Ofman JJ. Impairments in worker productivity and health-related quality of life among employees with irritable bowel syndrome: Does bowel habit predominance make a difference? Am J Gastroenterol. 98:S233, 2003. [Abstract # 703]
Palsson OS, Whitehead WE, Barghout V, et al. IBS severity and health-related quality of life improve with age in women but not in men. Am J Gastroenterol. 98:S272, 2003. [Abstract #818]
Gore M, Frech F, Tai K-S, Nguyen AB, Shetzline MA. Burden of illness in patients with irritable bowel syndrome with constipation. Am J Gastroenterol. 2003;98:S219. [Abstract # 662]
Whitehead WE, Cheskin LJ, Heller BR, et al. Evidence for exacerbation of irritable bowel syndrome during menses. Gastroenterology. 1990;98:1485-1489.
Kennedy TM, Jones RH. Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population. Br J Surg. 2000;87:1568-1563.
Longstreth GF, Yao JF. Irritable bowel syndrome and surgery in HMO health examinees. Am J Gastroenterol. 2003;98:S265. [Abstract #797]
Ganguly R, Barghout V, Pannicker S, Martin BC. Prevalence of GI related surgical procedures among Medicaid eligible patients with and without irritable bowel syndrome. Am J Gastroenterol. 2003 98:S274-S275. [Abstract # 825]
Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999; 45(suppl II):1143-1147.
Dean BB, Aguilar D, Barghout V, Kahler K, Groves D, Ofman JJ. Identifying IBS patients using Rome II symptom criteria: 3- or 12-month reporting? Am J Gastroenterol. 2003;98:S235-S236. [Abstract # 711]
Gore M, Frech F, Nguyen AB, Tai K-S, Shetzline MA. Development of a new symptom-based algorithm for classifying IBS patients into IBS subgroups. Am J Gastroenterol. 2003;98:S219. [Abstract # 663]
Locke GR, Zinsmeister AR, Melton LJ, Talley NJ. Who is an "alternator?" -- a population based study. Am J Gastroenterol. 2003;98:S275. [Abstract # 828]
Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108-2131.
Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140-1156.
Crowell MD, Schettler VA, Lacy BE, Jones MP, Olden KW, Whitehead WE. Impact of somatization on gastrointestinal (GI) and extra-intestinal comorbidities in IBS. Am J Gastroenterol. 2003;98:S271-S272. [Abstract #816]
Muller-Lissner SA, Fumagalli I, Bardhan KD, et al. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther. 2001;15:1655-1666.
Camilleri M, Northcutt AR, Kong S, Dukes GE, McSorley D, Mangel AW. Efficacy and safety of alosetron in women with irritable bowel syndrome: A randomised placebo-controlled trial. Lancet. 2000;355:1035-1040.
Dunger-Baldauf C, Nyhlin H, Rueegg P, Wagner A. Subject's global assessment of satisfactory relief as a measure to assess treatment effect in clinical trials in irritable bowel syndrome (IBS). Am J Gastroenterol. 2003;98:S269. [Abstract #809]
Prather CM, Camilleri M, Zinsmeister AR, McKinzie S, Thomforde G. Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome. Gastroenterology. 2000;118:463-468.
Talley N, Kamm M, Mueller-Lissner S, et al. Tegaserod is effective in relieving the multiple symptoms of constipation: Results from a 12-week multinational study in patients with chronic constipation. Am J Gastroenterol. 2003;98:S269-S270. [Abstract #810]
Kariv R, Tiomny E, Grenshpon R, Waisman G, Halpern Z. Low-dose naltrexone for the treatment of irritable bowel syndrome. Am J Gastroenterol. 2003 98:S268. [Abstract #805]



http://www.medscape.com/viewarticle/463421

--------------------
Heather is the Administrator of the IBS Message Boards. She’s the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

Post Extras Print Post   Remind Me!     Notify Moderator

Entire thread
Subject Posted by Posted on
* General IBS / Bowel Dysfunction HeatherAdministrator 07/14/03 01:56 PM
. * Sleep Measures Can Help Predict Next-Day Symptoms in IBS Female Patients HeatherAdministrator   09/17/14 02:27 PM
. * Domestic violence may trigger irritable bowel syndrome HeatherAdministrator   09/17/14 02:15 PM
. * All IBS subtypes have similar symptom severity HeatherAdministrator   09/05/14 03:50 PM
. * Gut microbiome can diagnose colorectal cancer? HeatherAdministrator   08/12/14 11:21 AM
. * Sacral nerve stimulation does not help IBS HeatherAdministrator   07/15/14 02:57 PM
. * Small Study of IBS Patients Suggests Symptom Improvement with Fecal Microbiota Transplant HeatherAdministrator   06/27/14 04:15 PM
. * Vitamin D Role in Fecal Incontinence? HeatherAdministrator   05/22/14 05:03 PM
.