Functional bowel symptoms, fibromyalgia and fatigue: A food-induced triad?

Abstract

Objective.Patients with perceived food hypersensitivity typically present with multiple health complaints. We aimed to assess the severity of their intestinal and extra-intestinal symptoms.Materials and methods.In a prospective study, 84 patients referred to our outpatient clinic for investigation of perceived food hypersensitivity were enrolled consecutively. Irritable bowel syndrome (IBS) was diagnosed according to the Rome III criteria. Severity and impact of bowel symptoms, fatigue and musculoskeletal pain were evaluated by using the following questionnaires: The IBS Severity Scoring System (IBS-SSS), the Fatigue Impact Scale (FIS), the FibroFatigue Scale (FFS), and visual analogue scales (VAS) for scoring of musculoskeletal pain.Results.All but one patient were diagnosed with IBS, 58% with severe symptoms. Extra-intestinal symptoms suggestive of chronic fatigue and fibromyalgia were demonstrated in 85% and 71%, respectively. Neither IgE-mediated food allergy nor organic pathology could explain the patients' symptoms. Nevertheless, malabsorption of fat was demonstrated in 10 of 38 subjects.Conclusions.Perceived food hypersensitivity may be associated with severe, debilitating illness. The comorbid triad of IBS, chronic fatigue, and musculoskeletal pain is striking and may point to a common underlying cause.

Fecal fat excretion in irritable bowel syndrome

“…However, assessment of fecal fat excretion, being a cumbersome procedure, is seldom performed in the investigation of such patients [1]. In two recent studies published in Scandinavian Journal of Gastroenterology, the authors measured fecal fat excretion in two IBS populations, one with post-infectious IBS (PI-IBS) [2] and one with perceived food hypersensitivity (FH-IBS) [3]. Here the authors summarize and comment on their experience.…”

Gut gateway to generalized pain

“…However, this concept implies nothing about where and how the abnormality begins. According to our personal experience, the patients regularly report abdominal complaints, often years before the appearance of musculoskeletal pain [5]. Also, a majority of the patients feel that diet helps, at least for their food intolerances.…”

The spectrum of noncoeliac gluten sensitivity

“…27 Furthermore, patients with IBS who report adverse food reactions tend to have more severe symptoms, associated subjective health complaints of musculoskeletal pains and chronic fatigue, and reduced quality of life compared with patients with IBS without food sensitivities. [27][28][29] These adverse reactions can be due to an allergy, intolerance or sensitivity. In accordance with the Rome Foundation Working Group, an allergy implies a specific immune response (IgE-mediated or non-IgEmediated) that occurs reproducibly on exposure to a particular food component.…”