A Novel Method to Classify and Subgroup Patients With IBS Based on Gastrointestinal Symptoms and Psychological Profiles.

Published on Feb 1, 2021in The American Journal of Gastroenterology10.171
· DOI :10.14309/AJG.0000000000000975
Christopher J Black13
Estimated H-index: 13
(St James's University Hospital),
Yan Yiannakou13
Estimated H-index: 13
(County Durham and Darlington NHS Foundation Trust)
+ 3 AuthorsAlexander C. Ford86
Estimated H-index: 86
(St James's University Hospital)
Sources
Abstract
INTRODUCTION: Conventionally, patients with irritable bowel syndrome (IBS) are subgrouped based on their predominant bowel habit. Given the relevance of psychological comorbidity to IBS symptoms, our aim was to explore an alternative approach to subgrouping by incorporating factors beyond stool form and frequency. METHODS: We collected demographic, symptom, and psychological health data from 1,375 adult subjects in the community who self-identified as having IBS, identifying 2 cohorts meeting either Rome III or Rome IV criteria. In each cohort, we performed latent class analysis, a method of model-based clustering, to identify specific subgroups (clusters). For each cluster, we drew a radar plot and compared these by visual inspection, describing cluster characteristics. RESULTS: In total, 1,080 individuals met the Rome III criteria for IBS, and 811 met the Rome IV criteria. In both cohorts, a 7-cluster model was the optimum solution, and the characteristics of the clusters were almost identical between Rome III and IV. Four clusters were defined by the pattern of gastrointestinal symptoms (loose stools and urgency or hard stools and bloating), further differentiated by the presence of abdominal pain not relieved by defecation, and by the extent of psychological comorbidity. Two clusters had below-average gastrointestinal symptoms, differentiated by the extent of psychological comorbidity. The final cluster had well-above-average gastrointestinal symptoms and high levels of psychological comorbidity. The proportion of subjects with severe IBS symptom scores, high levels of perceived stress, and high levels of gastrointestinal symptom–specific anxiety was significantly higher in clusters with high psychological comorbidity (P < 0.001). DISCUSSION: Latent class analysis identified 7 distinct IBS subgroups characterized by varying degrees of gastrointestinal symptoms, extraintestinal symptoms, and psychological comorbidity. Further research is needed to assess whether they might be used to direct treatment.
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#1Christopher J Black (University of Leeds)H-Index: 13
#2Yan Yiannakou (County Durham and Darlington NHS Foundation Trust)H-Index: 13
Last. Alexander C. Ford (University of Leeds)H-Index: 86
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BACKGROUND: Gastrointestinal symptom-specific anxiety and somatization have both been associated with higher symptom severity in patients with irritable bowel syndrome (IBS); however, this relationship has not been explored fully. Moreover, the performance of the visceral sensitivity index (VSI) for measuring gastrointestinal symptom-specific anxiety has not been examined in a UK population. We conducted a cross-sectional survey to examine these issues. METHODS: Gastrointestinal symptom-specific...
14 CitationsSource
#1Christopher J Black (University of Leeds)H-Index: 13
#2Nicholas E Burr (University of Leeds)H-Index: 14
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 3 authors...
: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder affecting 1 in 10 people and associated with poor psychological health, reduced quality of life, and increased health care expenditure.1 The etiology is complex and incompletely understood.2 Approximately one-third of patients have IBS with constipation (IBS-C),1 for which there are licensed therapies available in the United States. We summarized comparative efficacy of these in a recent network meta-analysis of randomized c...
26 CitationsSource
#1Christopher J BlackH-Index: 13
#2Elyse R. ThakurH-Index: 1
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Objectives National guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We performed a systematic review and network meta-analysis to try to resolve this uncertainty. Design We searched the medical literature through January 2020 for randomised controlled trials (RCTs) assessing efficacy of psychological therapies for adults with IBS, c...
33 CitationsSource
#1Christopher R Burton (Northern General Hospital)H-Index: 38
#2Per Fink (Aarhus University Hospital)H-Index: 55
Last. Winfried Rief (University of Marburg)H-Index: 94
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BACKGROUND: Functional somatic symptoms and disorders are common and complex phenomena involving both bodily and brain processes. They pose major challenges across medical specialties. These disorders are common and have significant impacts on patients' quality of life and healthcare costs. MAIN BODY: We outline five problems pointing to the need for a new classification: (1) developments in understanding aetiological mechanisms; (2) the current division of disorders according to the treating sp...
24 CitationsSource
#1Christopher J Black (University of Leeds)H-Index: 13
#2Yan Yiannakou (County Durham and Darlington NHS Foundation Trust)H-Index: 13
Last. Alexander C. Ford (University of Leeds)H-Index: 86
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Objectives Few studies have examined the effects of applying the Rome IV criteria for irritable bowel syndrome (IBS) vs the previous standard, the Rome III criteria. We conducted a cross-sectional survey of individuals who self-identify as having IBS to examine this issue. Methods We collected complete demographic, symptom, mood, and psychological health data from 1375 adults who self-identified as having IBS, but were not recruited from a referral population. We applied the Rome III and the Rom...
29 CitationsSource
#1Christopher J Black (University of Leeds)H-Index: 13
#2Nicholas E Burr (University of Leeds)H-Index: 14
Last. Alexander C. Ford (University of Leeds)H-Index: 86
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Objective Over half of patients with IBS have either diarrhoea (IBS-D) or a mixed stool pattern (IBS-M). The relative efficacy of licenced pharmacological therapies is unclear in the absence of head-to-head trials. We conducted a network meta-analysis to resolve this uncertainty. Design We searched MEDLINE, Embase, Embase Classic, the Cochrane central register of controlled trials, and Clinicaltrials.gov through January 2019 to identify randomised controlled trials (RCTs) assessing the efficacy ...
49 CitationsSource
#1Hazel Everitt (University of Southampton)H-Index: 22
#2Sabine Landau ('KCL': King's College London)H-Index: 70
Last. Rona Moss-Morris ('KCL': King's College London)H-Index: 70
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Summary Background Irritable bowel syndrome (IBS) is common, affecting 10–20% of the adult population worldwide, with many people reporting ongoing symptoms despite first-line therapies. Cognitive behavioural therapy (CBT) is recommended in guidelines for refractory IBS but there is insufficient access to CBT for IBS and uncertainty about whether benefits last in the longer term. Assessing Cognitive behavioural Therapy for IBS (ACTIB) was a large, randomised, controlled trial of two forms of CBT...
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Last. Margaret M. Heitkemper (UW: University of Washington)H-Index: 50
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: A large amount of interindividual variability exists in symptom experiences of persons with irritable bowel syndrome (IBS). Thus, consideration of multiple symptoms to identify distinct symptom subgroups may be useful in directing personalized health strategies for symptom management. We aimed to identify latent classes (i.e., subgroups) of persons with IBS who share similar patterns of symptoms using symptom-related variables (six groups of daily diary symptoms, cognitive beliefs about IBS, a...
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#1Hazel Everitt (University of Southampton)H-Index: 22
#2Sabine Landau (University of Cambridge)H-Index: 70
Last. Rona Moss-Morris (University of Cambridge)H-Index: 70
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Objective To evaluate the clinical effectiveness of two modes of cognitive–behavioural therapy (CBT) for IBS compared with treatment as usual (TAU) in refractory IBS. Design A three-arm randomised controlled trial assessing telephone-delivered CBT (TCBT), web-based CBT (WCBT) with minimal therapist support, and TAU. Blinding participants and therapists was not possible. Chief investigator, assessors and statisticians were blinded. Participants were adults with refractory IBS (clinically signific...
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Last. Vahid Zamani (Babol University of Medical Sciences)H-Index: 4
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BACKGROUND: Irritable bowel syndrome (IBS) is a common and potential disabling functional gastrointestinal disorder. Studies have revealed a possible association between IBS and psychological problems, such as anxiety and depression. Existing systematic reviews have addressed only the levels of anxiety or depression in patients with IBS. AIM: To investigate systematically the prevalence of anxiety or depression in IBS patients METHODS: A literature search was conducted using the related keywords...
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Cited By14
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#1Vivek C. Goodoory (University of Leeds)
#2Lesley A. Houghton (University of Leeds)H-Index: 53
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ABSTRACT Objectives Irritable bowel syndrome (IBS) is a chronic functional bowel disorder diagnosed using the Rome criteria, which have evolved since their original description 30 years ago. Little is known about the effects on the natural history of IBS of moving to the latest iteration, Rome IV, from the previous Rome III criteria. We conducted a 12-month longitudinal follow-up study examining this. Methods We collected complete demographic, symptom, mood, and psychological health data at base...
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#1Heidi M Staudacher (Deakin University)H-Index: 20
#2Antonina Mikocka-Walus (Deakin University)H-Index: 29
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Summary The frequent co-occurrence of irritable bowel syndrome and the common mental disorders of anxiety and depression is well established. A range of biological and psychosocial disease mechanisms are common to both disorders, many of which contribute to a dysregulated gut–brain axis. Clinical and subthreshold psychological comorbidity adds to the functional impairment and disease burden in individuals with irritable bowel syndrome. Progress is being made with regard to understanding irritabl...
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#1Christopher J Black (University of Leeds)H-Index: 13
#2Alexander C. Ford (University of Leeds)H-Index: 86
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#1Christopher J Black (St James's University Hospital)H-Index: 13
#2Alexander C. Ford (St James's University Hospital)H-Index: 86
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#1Brigida Barberio (UNIPD: University of Padua)H-Index: 7
#2Yan Yiannakou (County Durham and Darlington NHS Foundation Trust)H-Index: 13
Last. Alexander C. Ford (University of Leeds)H-Index: 86
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ABSTRACT Objectives Disorders of gut-brain interaction, such as irritable bowel syndrome (IBS) and functional dyspepsia (FD) frequently overlap, but the impact of this on the natural history is unknown. We examined this issue in a longitudinal follow-up study conducted in a large cohort of individuals. Methods We collected complete demographic, symptom, mood, and psychological health data from 1374 adults who self-identified as having IBS. We applied the Rome IV criteria to examine what proporti...
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#1Vivek C. Goodoory (County Durham and Darlington NHS Foundation Trust)
#2Antonina Mikocka-Walus (University of Leeds)H-Index: 1
Last. Alexander C. FordH-Index: 86
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INTRODUCTION Psychological comorbidities are associated with irritable bowel syndrome (IBS), but little is known about their cumulative effect on its prognosis. We examined this issue in a longitudinal 12-month follow-up study. METHODS We collected complete demographic, symptom, and psychological comorbidity data (anxiety, depression, somatic symptom disorder, perceived stress, and gastrointestinal symptom-specific anxiety) at baseline from 807 adults who met Rome IV criteria for IBS. At 12 mont...
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#1Christopher J Black (University of Leeds)H-Index: 13
#2Yan Yiannakou (County Durham and Darlington NHS Foundation Trust)H-Index: 13
Last. Alexander C. Ford (University of Leeds)H-Index: 86
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BACKGROUND Conventionally, irritable bowel syndrome (IBS) is subgrouped using predominant stool form, yet it is a complex disorder, with multiple biopsychosocial contributors. We previously derived and validated a latent class model subgrouping people with IBS into seven clusters based on gastrointestinal and extraintestinal symptoms and psychological profile. AIMS To conduct longitudinal follow-up examining the natural history and prognostic value of these clusters. METHODS Participants complet...
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