Symptom management needs of patients with irritable bowel syndrome and concurrent anxiety and/or depression: A qualitative study

Kamp, Kendra; Morgan, Hailey; Yoo, Linda; Munson, Sean A.; Heitkemper, Margaret; Levy, Rona L.

doi:10.1111/jan.15532

Cited by 4 publications

(3 citation statements)

References 74 publications

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“…When a non-mental-health provider becomes aware of a diagnosed co-occurring psychological disorder, such as anxiety or depression, the patient’s clinical response to treatment of that disorder must be assessed regardless of whether its onset was before or after diagnosis of IBS. Under-managed anxiety and depression are common and can negatively affect responses to the treatment of IBS 136 , 137 . When assessing responses to psychological treatment of IBS, progress must be measured in the physical and psychological domains.…”

Section: Guidelines For Non-specialists and Practice Outside An Integ...mentioning

confidence: 99%

Irritable bowel syndrome and mental health comorbidity — approach to multidisciplinary management

Staudacher

Black

Teasdale

et al. 2023

Nat Rev Gastroenterol Hepatol

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Irritable bowel syndrome (IBS) affects 5–10% of the global population. Up to one-third of people with IBS also experience anxiety or depression. Gastrointestinal and psychological symptoms both drive health-care use in people with IBS, but psychological comorbidity seems to be more important for long-term quality of life. An integrated care approach that addresses gastrointestinal symptoms with nutrition and brain–gut behaviour therapies is considered the gold standard. However, best practice for the treatment of individuals with IBS who have a comorbid psychological condition is unclear. Given the rising prevalence of mental health disorders, discussion of the challenges of implementing therapy for people with IBS and anxiety and depression is critical. In this Review, we draw upon our expertise in gastroenterology, nutrition science and psychology to highlight common challenges that arise when managing patients with IBS and co-occurring anxiety and depression, and provide recommendations for tailoring clinical assessment and treatment. We provide best practice recommendations, including dietary and behavioural interventions that could be applied by non-specialists and clinicians working outside an integrated care model.

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Section: Guidelines For Non-specialists and Practice Outside An Integ...mentioning

confidence: 99%

Irritable bowel syndrome and mental health comorbidity — approach to multidisciplinary management

Staudacher

Black

Teasdale

et al. 2023

Nat Rev Gastroenterol Hepatol

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“…The direct nursing costs of IBS in various nations range from 1.5 to 4.3 billion dollars ( Müller-Lissner and Pirk, 2002 ; Zhang et al, 2016 ; Goodoory et al, 2022 ), and the combined direct and indirect economic losses due to FD in the U.S. reach approximately 18 billion dollars annually ( Lacy et al, 2013 ). Moreover, the overlap of FD and IBS symptoms, along with their psychosomatic comorbidities, aggravates the economic burden significantly ( Huang et al, 2023 ; Kamp et al, 2023 ; Staudacher et al, 2023 ). Furthermore, these disorders also have a profound impact on quality of life, often leading to reduced work capacity and unnecessary surgeries due to misdiagnoses, thereby posing challenges to healthcare and society ( Drossman et al, 1993 ; Buono et al, 2017 ; Aziz et al, 2018 ; Black et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Deciphering the brain-gut axis: elucidating the link between cerebral cortex structures and functional gastrointestinal disorders via integrated Mendelian randomization

Xu,

Ning,

Zhang

et al. 2024

Front. Neurosci.

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BackgroundObservational studies have suggested associations between functional gastrointestinal disorders (FGIDs) and variations in the cerebral cortex. However, the causality of these relationships remains unclear, confounded by anxiety and depression. To clarify these causal relationships and explore the mediating roles of anxiety and depression, we applied univariate, multivariable, and mediation Mendelian randomization (MR) analyses.MethodWe utilized genome-wide association study (GWAS) summary data from the FinnGen database and the ENIGMA consortium, identifying genetic variants associated with irritable bowel syndrome (IBS), functional dyspepsia (FD), and cerebral cortex structures. Data on anxiety and depression came from FinnGen and a large meta-analysis. Utilizing a bidirectional univariate MR approach, we explored correlations between FD, IBS, and cortex variations. Then, independent effects were assessed through multivariable MR. A meta-analysis of these results, incorporating data from two cohorts, aimed to increase precision. We also explored the potential mediating roles of anxiety and depression.ResultsOur findings indicate a negative causal correlation between FD and the thickness of the rostral anterior cingulate cortex (rACC) across both global and regional adjustments (β = −0.142, 95% confidence interval (CI): −0.209 to-0.074, P.FDR = 0.004; β = −0.112, 95%CI: −0.163 to-0.006, P.FDR = 0.003) and a positive causal correlation with the globally adjusted thickness of the superior frontal gyrus (SFG) (β = 0.107, 95%CI: 0.062 to 0.153, P.FDR = 0.001). The causal correlation with the rACC persisted after multiple variable adjustments (β = −0.137, 95% CI: −0.187 to-0.087, P.FDR = 1.81 × 10−5; β = −0.109, 95%CI: −0.158 to-0.06, P.FDR = 0.002). A significant causal association was found between globally adjusted surface area of the caudal anterior cingulate cortex (cACC) and IBS (odds ratio = 1.267, 95%CI: 1.128 to 1.424, P.FDR = 0.02). The analysis showed that neither anxiety nor depression mediated the relationship between FGIDs and cerebral cortex structures.ConclusionOur research provides significant MR evidence of a bidirectional causal relationship between FGIDs and the cerebral cortex structures. This evidence not only confirms the two-way communication along the brain-gut axis but also illuminates the underlying pathophysiology, paving the way for identifying potential therapeutic approaches.

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“…Symptoms of anxiety and depression thus seem to be interwoven as part of the clinical as well as the pathophysiological picture characterizing patients with IBS [14], with direct as well as indirect effects on GI symptoms [15] and their severity [16]. Screening for anxiety and depression should therefore always be part of a clinical assessment of patients presenting symptoms of IBS and the level and characteristics of psychological distress should be taken into account when treating patients who have the disorder [17].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Self-Reported Executive Function in Patients with Irritable Bowel Syndrome Using a Machine-Learning Framework

Lundervold

Hillestad

Lied

et al. 2023

JCM

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Introduction: Irritable bowel syndrome (IBS) is characterized as a disorder of the gut–brain interaction (DGBI). Here, we explored the presence of problems related to executive function (EF) in patients with IBS and tested the relative importance of cognitive features involved in EF. Methods: A total of 44 patients with IBS and 22 healthy controls (HCs) completed the Behavior Rating Inventory of Executive Function (BRIEF-A), used to identify nine EF features. The PyCaret 3.0 machine-learning library in Python was used to explore the data, generate a robust model to classify patients with IBS versus HCs and identify the relative importance of the EF features in this model. The robustness of the model was evaluated by training the model on a subset of data and testing it on the unseen, hold-out dataset. Results: The explorative analysis showed that patients with IBS reported significantly more severe EF problems than the HC group on measures of working memory function, initiation, cognitive flexibility and emotional control. Impairment at a level in need of clinical attention was found in up to 40% on some of these scales. When the nine EF features were used as input to a collection of different binary classifiers, the Extreme Gradient Boosting algorithm (XGBoost) showed superior performance. The working memory subscale was consistently selected with the strongest importance in this model, followed by planning and emotional control. The goodness of the machine-learning model was confirmed in an unseen dataset by correctly classifying 85% of the IBS patients. Conclusions: The results showed the presence of EF-related problems in patients with IBS, with a substantial impact of problems related to working memory function. These results suggest that EF should be part of an assessment procedure when a patient presents other symptoms of IBS and that working memory function should be considered a target when treating patients with the disorder. Further studies should include measures of EF as part of the symptom cluster characterizing patients with IBS and other DGBIs.

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Symptom management needs of patients with irritable bowel syndrome and concurrent anxiety and/or depression: A qualitative study

Cited by 4 publications

References 74 publications

Irritable bowel syndrome and mental health comorbidity — approach to multidisciplinary management

Irritable bowel syndrome and mental health comorbidity — approach to multidisciplinary management

Deciphering the brain-gut axis: elucidating the link between cerebral cortex structures and functional gastrointestinal disorders via integrated Mendelian randomization

Assessment of Self-Reported Executive Function in Patients with Irritable Bowel Syndrome Using a Machine-Learning Framework

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