Characterization of Episodes of Irritable Bowel Syndrome Using Ecological Momentary Assessment

Weinland, Stephan R.; Morris, Carolyn; Hu, Yuming; Leserman, Jane; Bangdiwala, Shrikant I.; Drossman, Douglas A.

doi:10.1038/ajg.2011.170

Cited by 41 publications

(56 citation statements)

References 18 publications

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“…However, even when using prospective diaries, the timing of when patients record symptoms may be an important variable. In one study IBS patients reported more symptoms on a diary completed at the end of the day as compared to five assessments a day for 14 days [43]. We also limited the number of symptom comparisons we made (activity interference and Composite IBS Symptom Score) to reduce the chance of a type 1 error.…”

Section: Discussionmentioning

confidence: 99%

Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome

et al. 2014

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Background Alterations in gastrointestinal (GI) permeability and immune measures are present in some patients with irritable bowel syndrome (IBS) but the relationship to symptoms is poorly defined. In adults with IBS, we compared permeability, unstimulated peripheral blood monocyte (PBMC) interleukin-10 (IL-10) levels, IBS life interference, and gastrointestinal (GI) and psychological distress symptoms. Methods In 88 women and 18 men with IBS, GI permeability was quantitated as percent recovery of urinary sucrose and the lactulose/mannitol (L/M) ratio. IL-10 was measured in supernatants from 72-hour incubated, unstimulated PBMCs. Participants completed a 4-week daily diary recording IBS life interference on daily activities and work, IBS symptoms, and psychological distress symptoms. They also completed the Brief Symptom Inventory and Composite International Diagnostic Interview. Results The L/M ratio but not percent sucrose recovery was significantly correlated with IBS interference with activities and work and retrospectively measured anxiety and depression. Unstimulated PBMC production of IL-10 correlated significantly with IBS interference with daily work, IBS symptom score, and abdominal pain. We identified a subgroup of IBS subjects with higher IL-10 and/or higher L/M ratio who had substantially higher IBS interference and IBS symptom scores. Conclusions Our findings suggest a distinct subgroup of IBS patients with alterations in gut barrier function. This subgroup is characterized by increased GI permeability and/or increased PBMC production of IL-10. These physiologic alterations reflect more severe IBS as measured by interference of IBS with daily activities and daily IBS symptoms.

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Section: Discussionmentioning

confidence: 99%

Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome

et al. 2014

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“…Although detailed, the scale doesn’t directly assess abdominal pain frequency when compared to the API. Likely the most accurate scale thus far has been developed by Weinland et al [64]; where patients electronically characterize their pain and associated physical and psychological symptoms during each pain episode – thereby eliminating recall bias. At the time of this study’s inception, such a scale was not available and the API was felt to be the most optimal measure for abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients

Srinath

Goyal

Zimmerman

et al. 2014

Inflammatory Bowel Diseases

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Background Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) Evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD, (2) Determine predictors of abdominal pain in Crohn’s disease (CD) and ulcerative colitis (UC). Methods 765 patients ages 9–17 with IBD seen over 3 years at two sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms. Results 217 patients with IBD (161 CD, 56 UC) were depressed. 163 (120 CD, 43 UC) patients had complete API scores. In CD, abdominal pain was associated with depression (r=0.33; p<0.001), diarrhea (r=0.34; p=0.001), ESR (r=0.22; p=0.02), low albumin (r=0.24; p=.01), weight loss (r=0.33; p=0.001), and abdominal tenderness (r=0.38, p=0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (p=0.03), weight loss (p=0.04), and abdominal tenderness (p=0.01) predicted pain for CD patients. In UC, pain was associated with depression (r=0.46; p=0.002) and nocturnal stools (r=.32; p=.046). In the multivariate model with these significant correlates 23% of the variance was explained, and only depression (p=0.02) predicted pain. Conclusions The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications.

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“…Although this entity were not well studied currently, some studies has reported IBS-M is more similar to IBS-C than IBS-D based on similarities in stool frequency, consistency, psychological symptoms and a higher likelihood of transition between these 2 subtypes longitudinally. 32,33 In the present study, it appears that clinical symptoms of IBS-M tend to more resemble IBS-C than IBS-D. Therefore, there might be a considerable movement from IBS-C to IBS-M, but despite several times' review of medical chart including history of medication such as laxative and antidiarrheal or longitudinal symptom change, 35 IBS-M patients in the present study could not be subclassified into either of IBS-D or IBS-C.…”

Section: Discussionmentioning

confidence: 99%

Association Between SLC6A4 Serotonin Transporter Gene Lainked Polymorphic Region and ADRA2A −1291C>G and Irritable Bowel Syndrome in Korea

Choi

Hwang

Kim

et al. 2014

J Neurogastroenterol Motil

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Background/AimsDespite numerous studies on the relation of genetic polymorphisms with irritable bowel syndrome (IBS), the results still remain inconclusive. The aim of this study was to assess the possible association between SLC6A4 serotonin transporter gene linked polymorphic region (5-HTTLPR), ADRA2A −1291C>G, GNB3 825C>T, CCK1R intron 779T>C and TRPV1 945G>C polymorphisms and IBS based on Rome III criteria in Korea. MethodsStudy subjects were prospectively recruited from visitors to Seoul National University Bundang Hospital between July 2009 and January 2014. Ninety-nine IBS patients and 171 healthy controls were enrolled. Polymorphisms of above-mentioned 5 genes were genotyped. Serum serotonin from 101 participants was measured by ELISA and compared according to SLC6A4 5-HTTLPR polymorphisms and IBS subtypes. ResultsRegarding SLC6A4 5-HTTLPR polymorphism, L/L genotype was significantly associated with the total IBS, constipation predominant IBS (IBS-C) and mixture of diarrhea and constipation IBS (IBS-M) (adjusted OR: 4.35, 95% CI: 1.04-16.67; adjusted OR: 11.11, 95% CI: 1.69-50.00 and adjusted OR: 5.56, 95% CI: 1.05-33.33, respectively). Carrying ADRA2A −1291G allele was significantly associated with total IBS and diarrhea predominant IBS (adjusted OR: 3.37, 95% CI: 1.16-9.77 and adjusted OR: 5.64, 95% CI: 1.18-27.01, respectively). IBS-C patients showed reduced level of serum serotonin compared to controls and patients with diarrhea predominant IBS (50.2 ng/mL vs. 69.0 ng/mL and 92.9 ng/mL, P = 0.017 and P = 0.001, respectively).

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Characterization of Episodes of Irritable Bowel Syndrome Using Ecological Momentary Assessment

Abstract: Episodes of IBS are associated with greater pain (strongest relationship), bloating, and stress scores, and poorer global well-being. Compared with IBS-D, IBS-C and IBS-M are similar in clinical features. Patients overreport pain and stool frequency by diary compared with EMA.

Cited by 41 publications

References 18 publications

Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome

Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome

Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients

Association Between SLC6A4 Serotonin Transporter Gene Lainked Polymorphic Region and ADRA2A −1291C>G and Irritable Bowel Syndrome in Korea

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