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Clinical determinants of health-related quality of life in patients with irritable bowel syndrome.
Arch Intern Med. 2004 Sep 13; 164(16):1773-80.AI

Abstract

BACKGROUND

Current guidelines recommend routine assessment of health-related quality of life (HRQOL) in patients with irritable bowel syndrome (IBS). However, physicians rarely have the time to measure HRQOL with the appropriate methodological rigor, and data suggest that HRQOL in patients with IBS is often estimated using inaccurate clinical gestalt. The identification of predictive factors could allow physicians to better assess HRQOL without using misleading clinical clues. We, therefore, sought to identify determinants of HRQOL in patients with IBS.

METHODS

We examined 770 patients, 18 years or older, with IBS at a university-based referral center. Subjects completed a symptom questionnaire, the Symptoms Checklist-90 items psychometric checklist, and the 36-Item Short-Form Health Survey. The main outcome was HRQOL as measured by the mental and physical component scores of the 36-Item Short-Form Health Survey. We first developed a list of hypothesis-driven HRQOL predictors, and then performed multivariate regression analysis to measure the independent association of each predictor with HRQOL.

RESULTS

Seven factors (r(2) = 0.39) independently predicted physical HRQOL: (1) more than 5 physician visits per year, (2) tiring easily, (3) low in energy, (4) severe symptoms, (5) predominantly painful symptoms, (6) the feeling that there is "something seriously wrong with body," and (7) symptom flares for longer than 24 hours. Eight factors (r(2) = 0.36) independently predicted mental HRQOL: (1) feeling tense, (2) feeling nervous, (3) feeling hopeless, (4) difficulty sleeping, (5) tiring easily, (6) low sexual interest, (7) IBS symptom interference with sexual function, and (8) low energy.

CONCLUSIONS

Health-related quality of life in patients with IBS is primarily related to extraintestinal symptoms rather than traditionally elicited gastrointestinal symptoms. These findings suggest that rather than focusing on physiological epiphenomena (stool characteristics and subtype of IBS) and potentially misleading clinical factors (age and disease duration), physicians might be better served to gauge global symptom severity, address anxiety, and eliminate factors contributing to chronic stress in patients with IBS.

Authors+Show Affiliations

Division of Gastroenterology, the VA Greater Los Angeles Healthcare System, CA 90073, USA. bspiegel@ucla.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15364671

Citation

Spiegel, Brennan M R., et al. "Clinical Determinants of Health-related Quality of Life in Patients With Irritable Bowel Syndrome." Archives of Internal Medicine, vol. 164, no. 16, 2004, pp. 1773-80.
Spiegel BM, Gralnek IM, Bolus R, et al. Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Arch Intern Med. 2004;164(16):1773-80.
Spiegel, B. M., Gralnek, I. M., Bolus, R., Chang, L., Dulai, G. S., Mayer, E. A., & Naliboff, B. (2004). Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Archives of Internal Medicine, 164(16), 1773-80.
Spiegel BM, et al. Clinical Determinants of Health-related Quality of Life in Patients With Irritable Bowel Syndrome. Arch Intern Med. 2004 Sep 13;164(16):1773-80. PubMed PMID: 15364671.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. AU - Spiegel,Brennan M R, AU - Gralnek,Ian M, AU - Bolus,Roger, AU - Chang,Lin, AU - Dulai,Gareth S, AU - Mayer,Emeran A, AU - Naliboff,Bruce, PY - 2004/9/15/pubmed PY - 2005/2/16/medline PY - 2004/9/15/entrez SP - 1773 EP - 80 JF - Archives of internal medicine JO - Arch Intern Med VL - 164 IS - 16 N2 - BACKGROUND: Current guidelines recommend routine assessment of health-related quality of life (HRQOL) in patients with irritable bowel syndrome (IBS). However, physicians rarely have the time to measure HRQOL with the appropriate methodological rigor, and data suggest that HRQOL in patients with IBS is often estimated using inaccurate clinical gestalt. The identification of predictive factors could allow physicians to better assess HRQOL without using misleading clinical clues. We, therefore, sought to identify determinants of HRQOL in patients with IBS. METHODS: We examined 770 patients, 18 years or older, with IBS at a university-based referral center. Subjects completed a symptom questionnaire, the Symptoms Checklist-90 items psychometric checklist, and the 36-Item Short-Form Health Survey. The main outcome was HRQOL as measured by the mental and physical component scores of the 36-Item Short-Form Health Survey. We first developed a list of hypothesis-driven HRQOL predictors, and then performed multivariate regression analysis to measure the independent association of each predictor with HRQOL. RESULTS: Seven factors (r(2) = 0.39) independently predicted physical HRQOL: (1) more than 5 physician visits per year, (2) tiring easily, (3) low in energy, (4) severe symptoms, (5) predominantly painful symptoms, (6) the feeling that there is "something seriously wrong with body," and (7) symptom flares for longer than 24 hours. Eight factors (r(2) = 0.36) independently predicted mental HRQOL: (1) feeling tense, (2) feeling nervous, (3) feeling hopeless, (4) difficulty sleeping, (5) tiring easily, (6) low sexual interest, (7) IBS symptom interference with sexual function, and (8) low energy. CONCLUSIONS: Health-related quality of life in patients with IBS is primarily related to extraintestinal symptoms rather than traditionally elicited gastrointestinal symptoms. These findings suggest that rather than focusing on physiological epiphenomena (stool characteristics and subtype of IBS) and potentially misleading clinical factors (age and disease duration), physicians might be better served to gauge global symptom severity, address anxiety, and eliminate factors contributing to chronic stress in patients with IBS. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/15364671/Clinical_determinants_of_health_related_quality_of_life_in_patients_with_irritable_bowel_syndrome_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.164.16.1773 DB - PRIME DP - Unbound Medicine ER -