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Characterization of episodes of irritable bowel syndrome using ecological momentary assessment.
Am J Gastroenterol. 2011 Oct; 106(10):1813-20.AJ

Abstract

OBJECTIVES

Patients with irritable bowel syndrome (IBS) report that symptoms occur as episodes. The nature and frequency of episodes have not been well studied.

METHODS

Using modified ecological momentary assessment (EMA), we examined clinical factors attributed to IBS symptom episodes and compared them with nonsymptom episode periods in patients with IBS-D (N=21), IBS-C (N=18), or IBS-M (N=19), and healthy controls (N=19). Symptoms were rated over 14 days on a visual ordinal scale (VOS: 0-10) randomly in morning, midday, and evening, and at wake up, bedtime, prebowel movement, and postbowel movement. Scores were evaluated for total group and across subgroups and between EMA and daily diary cards on the same day.

RESULTS

Subjects (n=57/59) reported symptom episodes 34% of the time. Episodes showed significantly higher pain levels (3.6 vs. 1.64, P<0.0001), bloating (4.57 vs. 3.02, P<0.0001), stress (3.54 vs. 2.59, P<0.0001), and decreased well-being (5.29 vs. 6.16, P<0.0001). Episode frequency/2 weeks was greatest for IBS-D (10.7±7.05) than IBS-C (8.4±5.76) and IBS-M (7.1±4.45) (P=nonsignificant). IBS-D also had shorter episodes (9 h 23 min) compared with IBS-M (15 h 01 min) and IBS-C (15 h 25 min) (P<0.04). Stool frequency and looser consistency were greater with IBS-D and similar between IBS-C and IBS-M. Abdominal pain was the greatest predictor of episode status. Diary card ratings of pain and stool frequency overestimate levels reported by EMA.

CONCLUSIONS

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.

Authors+Show Affiliations

UNC Center for Functional GI and Motility Disorders, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 27599-7080, USA. stephan_weinland@med.unc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21647206

Citation

Weinland, Stephan R., et al. "Characterization of Episodes of Irritable Bowel Syndrome Using Ecological Momentary Assessment." The American Journal of Gastroenterology, vol. 106, no. 10, 2011, pp. 1813-20.
Weinland SR, Morris CB, Hu Y, et al. Characterization of episodes of irritable bowel syndrome using ecological momentary assessment. Am J Gastroenterol. 2011;106(10):1813-20.
Weinland, S. R., Morris, C. B., Hu, Y., Leserman, J., Bangdiwala, S. I., & Drossman, D. A. (2011). Characterization of episodes of irritable bowel syndrome using ecological momentary assessment. The American Journal of Gastroenterology, 106(10), 1813-20. https://doi.org/10.1038/ajg.2011.170
Weinland SR, et al. Characterization of Episodes of Irritable Bowel Syndrome Using Ecological Momentary Assessment. Am J Gastroenterol. 2011;106(10):1813-20. PubMed PMID: 21647206.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization of episodes of irritable bowel syndrome using ecological momentary assessment. AU - Weinland,Stephan R, AU - Morris,Carolyn B, AU - Hu,Yuming, AU - Leserman,Jane, AU - Bangdiwala,Shrikant I, AU - Drossman,Douglas A, Y1 - 2011/06/07/ PY - 2011/6/8/entrez PY - 2011/6/8/pubmed PY - 2011/12/13/medline SP - 1813 EP - 20 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 106 IS - 10 N2 - OBJECTIVES: Patients with irritable bowel syndrome (IBS) report that symptoms occur as episodes. The nature and frequency of episodes have not been well studied. METHODS: Using modified ecological momentary assessment (EMA), we examined clinical factors attributed to IBS symptom episodes and compared them with nonsymptom episode periods in patients with IBS-D (N=21), IBS-C (N=18), or IBS-M (N=19), and healthy controls (N=19). Symptoms were rated over 14 days on a visual ordinal scale (VOS: 0-10) randomly in morning, midday, and evening, and at wake up, bedtime, prebowel movement, and postbowel movement. Scores were evaluated for total group and across subgroups and between EMA and daily diary cards on the same day. RESULTS: Subjects (n=57/59) reported symptom episodes 34% of the time. Episodes showed significantly higher pain levels (3.6 vs. 1.64, P<0.0001), bloating (4.57 vs. 3.02, P<0.0001), stress (3.54 vs. 2.59, P<0.0001), and decreased well-being (5.29 vs. 6.16, P<0.0001). Episode frequency/2 weeks was greatest for IBS-D (10.7±7.05) than IBS-C (8.4±5.76) and IBS-M (7.1±4.45) (P=nonsignificant). IBS-D also had shorter episodes (9 h 23 min) compared with IBS-M (15 h 01 min) and IBS-C (15 h 25 min) (P<0.04). Stool frequency and looser consistency were greater with IBS-D and similar between IBS-C and IBS-M. Abdominal pain was the greatest predictor of episode status. Diary card ratings of pain and stool frequency overestimate levels reported by EMA. CONCLUSIONS: 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. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/21647206/Characterization_of_episodes_of_irritable_bowel_syndrome_using_ecological_momentary_assessment_ L2 - https://Insights.ovid.com/pubmed?pmid=21647206 DB - PRIME DP - Unbound Medicine ER -