A systematic review of the association between fibromyalgia and functional gastrointestinal disorders

Abstract

Background Fibromyalgia and functional gastrointestinal disorders are frequently encountered in clinical settings. Common to both is significant burden on individuals and health care systems, an elusive aetiology and several comorbid conditions. While a relationship between irritable bowel syndrome and fibromyalgia has been demonstrated, a broader review of the relationship between fibromyalgia and other functional gut disorders has not been undertaken. Objectives This paper reports a systematic review of the published literature, identifying the comorbidity of functional gastrointestinal disorders in people with fibromyalgia. We discuss the clinical implications, limitations of current research, and areas of interest for future research Methods A systematic review of the databases Medline, Embase, CINAHL and Web of Science was undertaken in June 2019. Results were screened for original articles meeting strict criteria for identification of functional gastrointestinal disorders in adult subjects with fibromyalgia. ResultsFourteen articles were included investigating 1340 subjects with fibromyalgia, 363 healthy controls and 441 subjects with other pathologies. Functional gut disorders were matched to Rome II criteria for reporting and comparison. In addition to increased abdominal pain and functional bloating/gas, irritable bowel of mixed-pattern and constipation-types were more prevalent that diarrhoea-predominant irritable bowel in adults with fibromyalgia. One study reported the range of functional gastrointestinal disorders. Conclusion Existing research has focused on the relationship between irritable bowel syndrome and fibromyalgia, but sub-typing of irritable bowel syndrome is generally overlooked. A strong association with a range of functional gastrointestinal disorders is suggested. Further investigation is needed to determine the prevalence and relevance of the range of functional gastrointestinal disorders in patients with fibromyalgia.

Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review

“…Fibromyalgics present with constipation at up to double the rate of those with diarrhoea [11,70], which correlates with severity of fibromyalgia symptoms [70]. Constipation is associated with higher methane production [71], yet both Pimentel's studies reported elevations in hydrogen gas [17,69].…”

“…Fibromyalgia is associated with a range of somatic symptoms and gastrointestinal disorders. Our group have recently conducted a systematic review of the comorbidity of FGID in fibromyalgia and found this area to be under-explored, with the majority of studies focusing on irritable bowel syndrome (IBS) [11]. IBS has been associated with alterations in the composition and diversity of the gastrointestinal microbiota [12].…”

Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review

“…Fibromyalgics present with constipation at up to double the rate of those with diarrhoea (12,69), which correlates with severity of fibromyalgia symptoms (69). Constipation is associated with higher methane production (70), yet both Pimentel's studies reported elevations in hydrogen gas (26,68).…”

“…Individuals with comorbidity report higher symptom severity and poorer quality of life (10,11). To date, the majority of studies on FGIDs have focused on irritable bowel syndrome (IBS) (12), which has been associated with alterations in the composition and diversity of the gastrointestinal microbiota (13).…”

Estrogen receptors in pain modulation: cellular signaling

“…In particular, women with endometriosis are more sensitive to pain and susceptible to chronic pelvic pain [ 44 ]. In addition, there is a consensus that fibromyalgia is more prevalent in women [ 45 ], and treatment of dysmenorrhea with hormonal contraceptives can reduce the risk of fibromyalgia [ 46 ]. These phenomena indicate that estrogen may contribute to inflammatory pain.…”