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GI, psychological symptoms overlap in IBS-D, functional diarrhea
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Researchers from Beth Israel Deaconess Medical Center identified an overlap of gastrointestinal and psychosomatic symptoms between patients with diarrhea-predominant irritable bowel syndrome and functional diarrhea.
Anthony Lembo, MD, director of Motility Services at BIDMC, and colleagues wrote that a diagnosis of functional diarrhea requires an exclusion of IBS-D, but the Rome IV consensus statement acknowledges functional disorders, like IBS and other non-IBS diagnoses, exist on a continuum.
“No study to date has compared the clinical and psychological characteristics of patients presenting to clinic with [functional diarrhea] to those with IBS-D and it is unclear whether these entities have [an] overlapping or distinct symptom profile,” they wrote. “However, similar comparisons between functional constipation and constipation-predominant irritable bowel syndrome have reported significant gastrointestinal and psychological symptom overlap.”
Researchers recruited 48 patients with functional diarrhea and 49 patients with IBS-D, based on Rome IV criteria, to complete a detailed symptom survey that assessed GI factors, including abdominal pain and diarrhea severity, as well as patient anxiety, depression and sleep disturbances using patient-reported outcomes measurements information system (PROMIS) questionnaires.
Lembo and colleagues found that a lower proportion of patients with functional diarrhea reported abdominal pain (77.1%) compared with patients with IBS-D (100%; P < .001), but both groups had a similar proportion of patients who reported abdominal bloating and level of severity.
Additionally, the proportion of bowel movements with diarrhea did not differ between the two groups, but patients in the IBS-D group had a higher mean PROMIS T-score (P = .03). Researchers wrote that this was driven by higher levels of urgency-related distress reported in the IBS group.
However, the proportion of patients with anxiety, depression or sleep disturbance, as well as their severities, were not different between the two groups.
Lembo and colleagues wrote that there is a significant overlap in symptoms among patients with functional diarrhea and IBS-D, which suggest these conditions might be a continuum as in IBS-C and functional constipation.
“Given this overlap, a few authors have suggested the concept of painful and mild-pain constipation as clinically useful alternative to Rome IV classification of IBS-C vs. [functional constipation],” they wrote. “Given the similarities between IBS-D and [functional diarrhea], clinicians may consider classifying these patients as painful chronic diarrhea and mild pain or painless chronic diarrhea.” – by Alex Young
Disclosures: Lembo reports consulting for Alkermes, Allergen, Arena, Ironwood, Salix, Shionogi, Shire and Takeda. Please see the full study for all other authors’ relevant financial disclosures.
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