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The Effect of Somatization on Gastrointestinal and Extraintestinal Symptoms of IBS
      01/26/04 03:26 PM

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The Effect of Somatization on Gastrointestinal and Extraintestinal Symptoms of IBS

Lin Chang, MD

Psychosocial disturbances (eg, depression, anxiety, stressful life events, and somatization) are commonly found in patients with IBS, particularly those with more severe symptoms or those seen in tertiary referral populations.[17] In addition, extraintestinal symptoms, such as fatigue, myalgias, sleep, and sexual disturbances are also frequently reported by patients with IBS.[18] The association between psychosocial factors and extraintestinal symptoms in IBS is not well understood.

Crowell and colleagues[19] studied the influence of somatization (measured by the psychological questionnaire SCL-90R) on gastrointestinal and extraintestinal symptoms in IBS consulters in 133 consecutive Rome-positive IBS patients. Abdominal pain, pain sites, and upper and lower gastrointestinal symptoms were reported to a significantly greater degree by patients with IBS with elevated scores for somatization. In addition, somatization scores significantly correlated with the presence of extraintestinal symptoms such as chronic fatigue, temporomandibular joint, low back pain, and both anxiety and panic attacks. Patients with IBS with elevated scores for somatization also had reduced functional abilities and QOL.

The study authors concluded that IBS is a heterogeneous disorder in which the presence of multiple gastrointestinal and nongastrointestinal symptoms could be a marker for psychologic factors that could play a role in the etiology, healthcare utilization, and treatment outcome of IBS. It is still not known whether the increased prevalence of extraintestinal symptoms is due to coexistent psychologic disorders that may share similar symptoms with IBS, or if the gastrointestinal, extraintestinal, and psychologic symptoms all result from a shared central pathophysiologic mechanism underlying IBS. However, this study supports the concept that somatization is an important confounding factor that should be considered when evaluating or interpreting data on gastrointestinal, extraintestinal, and other psychologic symptoms in IBS.

These IBS symptom-related studies reiterate the challenges of diagnosing IBS and of understanding the underlying clinical relevance and pathophysiologic mechanisms of specific symptoms, including altered bowel habits, other gastrointestinal symptoms, and extraintestinal symptoms. Future studies that can help establish a biologic marker(s) for IBS would be important in overcoming these challenges.

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