Characteristics of patients with overlap functional gastrointestinal disorders

Abstract

Background and Aim: Functional gastrointestinal disorders (FGIDs) are frequently overlapped. The present study was designed to (i) search the clinical differences between patients with single FGID and overlap FGIDs and (ii) define the most common FGIDs associations to identify homogenous subgroups of patients. Methods: A total of 3555 outpatients with FGID filled out the Rome III adult diagnostic questionnaire, Bristol stool form, and four 10-point Likert scales to report the severity of constipation, diarrhea, bloating, and abdominal pain. An unsupervised algorithm was used to estimate the number of groups directly from the data. A classification tree separated patients into different subgroups, according to FGIDs. Multinomial logistic regression was used to characterize the groups of patients with overlap disorders. Results: Patients reported 3.3 ± 1.9 FGIDs (range 1-10, median = 3); 736 reported only one FGID, while 2819 reported more than one FGID (3.8 ± 1.7). Patients with single FGID had higher body mass index (P < 0.001), never report irritable bowel syndrome (IBS), and rarely report fecal incontinence and anorectal pain (< 1% for each disorder). The non-supervised clustering of the 2819 patients with overlap FGIDs divided this population into 23 groups, including five groups associated with only one disorder (IBS-diarrhea, dysphagia, functional constipation, levator ani syndrome, and IBS-unspecified). Ten groups were related to two overlap disorders and eight groups to three or more disorders. Three disorders were not explicitly associated with a given group: IBS-mixed, proctalgia fugax, and nonspecific anorectal pain. Conclusion:Patients with FGID mostly report overlap disorders in a limited number of associations, each significantly associated with a few disorders.

Experiencing multiple concurrent functional gastrointestinal disorders is associated with greater symptom severity and worse quality of life in chronic constipation and defecation disorders

“…The prevalence of several, often termed overlapping, FGIDs in tertiary gastroenterology centers has been reported between 48%-79.3%. 20,23,38,39 We report an even higher prevalence of 85%, suggesting that patients with chronic constipation and FDD are more likely to suffer comorbid FGIDs than other gastroenterology patients, which is an important consideration for their management.…”

“…Another limitation of our study was the low proportion of males. Although female predominance is common in FGID studies, 23,40,54 and likely reflects increased prevalence in women, it may limit the generalizability of the results to males. Finally, while meticulous adjustments to Rome II questionnaires allowed for consistent FGID diagnosis according to Rome III, our adjustments are nonvalidated, representing a possible limitation.…”

“…Additionally, comorbid FGIDs have been associated with greater symptom severity in multiple studies. 17,[20][21][22][23][24][25] However, assessment of coexistent FGIDs in patients presenting specifically with chronic constipation, or those defined by abnormal physiology (e.g., FDD), is relatively unstudied.…”

“…Recent community‐based studies have demonstrated that concurrent, also known as overlapping, FGIDs are frequent and are associated with higher levels of somatization, 16 increased doctor visits, 17,18 and worse quality of life, 15,18,19 compared to patients with a single FGID. Additionally, comorbid FGIDs have been associated with greater symptom severity in multiple studies 17,20–25 . However, assessment of coexistent FGIDs in patients presenting specifically with chronic constipation, or those defined by abnormal physiology (e.g., FDD), is relatively unstudied.…”

Psychological status of patients with functional anorectal pain and treatment efficacy of paroxetine in alleviating the symptoms: a retrospective study

“…Symptoms of FAP may be intermittent or continuous during the days and deteriorating in the night due to the supine position 11 , 12 . Moreover, functional gastrointestinal symptoms might be also associated with obesity 13 and eating disorders 9 , 14 . Thus, a significant proportion of FAP patients are experiencing unsatisfactory quality of life 15 – 17 .…”