Quality of life and sleep in individuals with irritable bowel syndrome according to different diagnostic criteria and inflammatory bowel diseases: A comparison using data from a population-based survey

Abstract

Background A proportion of irritable bowel syndrome (IBS) affected patients does not fulfil Rome criteria despite considerable impairment similarly to that in patients with organic gastrointestinal diseases.
This investigation aims to examine differences regarding Mental (MQoL), Physical Quality of Life (PQoL), and sleep between IBS according to Rome III (IBS Rome), clinically defined IBS, inflammatory bowel diseases (IBD), and non-IBS/non-IBD individuals.

Methods Data from SHIP-Trend (Study of Health in Pomerania, 2008–2012), a population-based cohort study in Germany, were used.

Results Response was 50.1% (N = 4420). Prevalence was 3.5% for IBS Rome (95% confidence interval (CI): 3.0 – 4.1%, n = 148), 0.6% for clinically defined IBS (CI: 0.4 – 0.9%, n = 27), and 0.8% for IBD (CI: 0.6 – 1.1%, n = 34). Individuals with IBS Rome (4.54 (CI: –5.92; –3.17)) and clinically defined IBS (4.69 (CI: –7.82; –1.56)) had lower scores for MQoL compared to the non-IBS/non-IBD group. PQoL scores were lowered in IBS Rome (6.39 (CI: –7.89; –4.88)) and IBD (5.37 (CI: –8.51; –2.22)), but not in clinically defined IBS compared to the non-IBS/non-IBD group. IBS Rome was the only gastroenterological condition with higher odds of sleeping problems (odds ratio (OR) “falling asleep”: 1.74; CI: 1.29; 2.36; OR “remaining asleep”: 1.73; CI: 1.26; 2.38).

Conclusions IBS Rome is associated with reduced MQoL, PQoL, and sleep problems. Clinically defined IBS is associated only with reduced MQoL. Heterogeneity within IBS affected patients should be considered in clinical routine and screening for daily life impairment should be performed.

Zusammenfassung

Hintergrund Eine Subgruppe von Personen mit Reizdarmsyndrom (RDS) erfüllt trotz Einschränkungen, die denen von somatisch gastroenterologisch Erkrankten ähneln, nicht die Rom III-Kriterien.

In dieser Studie werden die mentale (MQoL) und körperliche (PQoL) Lebensqualität sowie das Schlafverhalten bei Personen verglichen, die ein RDS nach Rom III, ein klinisch definiertes RDS (ohne Erfüllung der Rom III-Kriterien), eine chronisch-entzündliche Darmerkrankung (CED) oder nichts dergleichen haben.

Methoden Es wurden Daten der SHIP-Studie (Study of Health in Pomerania, 2008–2012), einer populationsbasierten Kohortenstudie in Deutschland, ausgewertet.

Ergebnisse Die Response war 50,1% (N = 4420). Die Prävalenz betrug 3,5% für ein RDS gemäß Rom III (95% Konfidenzintervall [KI]: 3,0 – 4,1%, n = 148), 0,6% für ein klinisch definiertes RDS (KI: 0,4 – 0,9%, n = 27), und 0,8% für eine CED (KI: 0,6 – 1,1%, n = 34). Personen mit RDS gemäß Rom III (4,54 [KI: –5,92; –3,17]) und klinisch definiertem RDS (4,69 [KI: –7,82; –1,56]) hatten eine geringere MQoL als Personen aus der Subgruppe der nicht Erkrankten. Die PQoL war reduziert bei Personen mit RDS nach Rom III (6,39 [KI: –7,89; –4,88]) und CED (5,37 [KI: –8,51; –2,22]), aber nicht bei klinisch definiertem RDS im Vergleich zur Subgruppe ohne diese Erkrankungen. RDS nach Rom III war die einzige gastroenterologische Erkrankung mit einem erhöhten Odds für Schlafprobleme (odds ratio [OR] „Einschlafprobleme“: 1,74; KI: 1,29; 2,36; OR „Durchschlafprobleme“: 1,73; KI: 1,26; 2,38).

Schlussfolgerungen Ein RDS nach Rom III geht mit reduzierter MQoL, PQoL und Schlafproblemen einher. Klinisch definiertes RDS ist nur mit einer reduzierten MQoL vergesellschaftet. Im klinischen Alltag sollten die Heterogenität dieses Patientenkollektivs Beachtung finden und Beeinträchtigungen des alltäglichen Lebens erhoben werden.

Schlüsselwörter

Lebensqualität - Schlaf - Reizdarmsyndrom - Epidemiologie

Keywords

Quality of life - Sleep - Irritable bowel syndrome - Epidemiology

Publication History

Received: 07 April 2021

Accepted after revision: 23 November 2021

Article published online:
09 March 2022

• References

• 1 Enck P, Aziz Q, Barbara G. et al. Irritable bowel syndrome. Nat Rev Dis Primers 2016; 2: 16014 DOI: 10.1038/nrdp.2016.14. (PMID: 27159638)
• 2 Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 712-721 DOI: 10.1016/j.cgh.2012.02.029. (PMID: 22426087)
• 3 Schwille-Kiuntke J, Frick J-S, Zanger P. et al. Post-infectious irritable bowel syndrome--a review of the literature. Z Gastroenterol 2011; 49: 997-1003 DOI: 10.1055/s-0031-1281581. (PMID: 21811952)
• 4 Sperber AD, Shvartzman P, Friger M. et al. A comparative reappraisal of the Rome II and Rome III diagnostic criteria: are we getting closer to the 'true' prevalence of irritable bowel syndrome?. Eur J Gastroenterol Hepatol 2007; 19: 441-447 DOI: 10.1097/MEG.0b013e32801140e2. (PMID: 17489053)
• 5 Manning AP, Thompson WG, Heaton KW. et al. Towards positive diagnosis of the irritable bowel. Br Med J 1978; 2: 653-654 DOI: 10.1136/bmj.2.6138.653. (PMID: 698649)
• 6 Lacy BE, Mearin F, Chang L. et al. Bowel Disorders. Gastroenterology 2016; 150: 1393-1407 DOI: 10.1053/j.gastro.2016.02.031. (PMID: 27144627)
• 7 Camilleri M. Irritable Bowel Syndrome: Straightening the road from the Rome criteria. Neurogastroenterol Motil 2020; 32: e13957 DOI: 10.1111/nmo.13957. (PMID: 32808411)
• 8 Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology 2016; 150: 1262-1279 DOI: 10.1053/j.gastro.2016.02.032. (PMID: 27144617)
• 9 Black CJ, Yiannakou Y, Guthrie EA. et al. A Novel Method to Classify and Subgroup Patients With IBS Based on Gastrointestinal Symptoms and Psychological Profiles. Am J Gastroenterol 2021; 116: 372-381 DOI: 10.14309/ajg.0000000000000975. (PMID: 33110014)
• 10 International Classification of Diseases Version 10 (ICD-10-GM Version 2021). www.dimdi.de, last access: 08th February 2021.
• 11 Schwille-Kiuntke J, Rüdlin SL, Junne F. et al. Illness perception and health care use in individuals with irritable bowel syndrome: results from an online survey. BMC Fam Prac 2021; 22: 154 DOI: 10.1186/s12875-021-01499-5. (PMID: 34275465)
• 12 Layer P, Andresen V, Pehl C. et al. [Irritable Bowel Syndrome: German Consensus Guidelines on Definition, Pathophysiology and Management. German Society of Digestive and Metabolic Diseases (DGVS) and German Society of Neurogastroenterology and Motility (DGNM)]. Z Gastroenterol 2011; 49: 237–293 Updated version (June 2021). Available: https://www.awmf.org/uploads/tx_szleitlinien/021-016l_S3_Definition-Pathophysiologie-Diagnostik-Therapie-Reizdarmsyndroms_2021-07.pdf, last access: 12th December 2021.. DOI: 10.1055/s-0029-1245976. (PMID: 21287438)
• 13 Mujagic Z, Jonkers D, Hungin APS. et al. Use of Rome criteria for the diagnosis of irritable bowel syndrome in primary care: a survey among European countries. Eur J Gastroenterol Hepatol 2017; 29: 651-656 DOI: 10.1097/MEG.0000000000000848. (PMID: 28125426)
• 14 Spiegel BMR, Farid M, Esrailian E. et al. Is irritable bowel syndrome a diagnosis of exclusion?: a survey of primary care providers, gastroenterologists, and IBS experts. Am J Gastroenterol 2010; 105: 848-858 DOI: 10.1038/ajg.2010.47. (PMID: 20197761)
• 15 Schauer B, Grabe HJ, Ittermann T. et al. Irritable bowel syndrome, mental health, and quality of life: Data from a population-based survey in Germany (SHIP-Trend-0). Neurogastroenterol Motil 2019; 31: e13511 DOI: 10.1111/nmo.13511. (PMID: 30444067)
• 16 Völzke H, Alte D, Schmidt CO. et al. Cohort profile: the study of health in Pomerania. Int J Epidemiol 2011; 40: 294-307 DOI: 10.1093/ije/dyp394. (PMID: 20167617)
• 17 Ware JJ, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical care 1996; 34: 220-233 DOI: 10.1097/00005650-199603000-00003. (PMID: 8628042)
• 18 Stubbe B, Penzel T, Fietze I. et al. Polysomnography in a Large Population Based Study-the Study of Health in Pomerania Protocol. J Sleep Disord Manag 2016; 2: 1-5 DOI: 10.23937/2572-4053.1510010.
• 19 Longstreth GF, Thompson WG, Chey WD. et al. Functional bowel disorders. Gastroenterology 2006; 130: 1480-1491 DOI: 10.1053/j.gastro.2005.11.061. (PMID: 16678561)
• 20 Han KT, Park EC, Kim JH. et al. Is marital status associated with quality of life?. Health Qual Life Outcomes 2014; 12: 109 DOI: 10.1186/s12955-014-0109-0. (PMID: 25104276)
• 21 Ross CE, Van Willigen M. Education and the subjective quality of life. J Health Soc Behav 1997; 38: 275-297 (PMID: 9343965)
• 22 Norström F, Waenerlund A-K, Lindholm L. et al. Does unemployment contribute to poorer health-related quality of life among Swedish adults?. BMC public health 2019; 19: 457 DOI: 10.1186/s12889-019-6825-y. (PMID: 31035994)
• 23 Walker EA, Gelfand A, Katon WJ. et al. Adult health status of women with histories of childhood abuse and neglect. Am J Med 1999; 107: 332-339 DOI: 10.1016/s0002-9343(99)00235-1. (PMID: 10527034)
• 24 Emamvirdi R, Hosseinzadeh Asl N, Colakoglu FF. Health-Related Quality of Life With Regard to Smoking, Consumption of Alcohol, and Sports Participation. Iran Red Crescent Med J 2016; 18: e27919 DOI: 10.5812/ircmj.27919. (PMID: 27651950)
• 25 Addante R, Naliboff B, Shih W. et al. Predictors of Health-related Quality of Life in Irritable Bowel Syndrome Patients Compared With Healthy Individuals. J Clin Gastroenterol 2019; 53: e142-e149 DOI: 10.1097/MCG.0000000000000978. (PMID: 29351154)
• 26 Cassar GE, Youssef GJ, Knowles S. et al. Health-Related Quality of Life in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Gastroenterol Nurses 2020; 43: E102-E122 DOI: 10.1097/SGA.0000000000000530. (PMID: 32487960)
• 27 Buono JL, Carson RT, Flores NM. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea. Health Qual Life Outcomes 2017; 15: 35 DOI: 10.1186/s12955-017-0611-2. (PMID: 28196491)
• 28 Weerts ZRM, Vork L, Mujagic Z. et al. Reduction in IBS symptom severity is not paralleled by improvement in quality of life in patients with irritable bowel syndrome. Neurogastroenterol Motil 2019; 31: e13629 DOI: 10.1111/nmo.13629. (PMID: 31119844)
• 29 Basnayake C, Kamm MA, Stanley A. et al. Standard gastroenterologist versus multidisciplinary treatment for functional gastrointestinal disorders (MANTRA): an open-label, single-centre, randomised controlled trial. Lancet Gastroenterol Hepatol 2020; 5: 890-899 DOI: 10.1016/S2468-1253(20)30215-6. (PMID: 32679040)
• 30 Paré P, Gray J, Lam S. et al. Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Clin Ther 2006; 28: 1726-1735 DOI: 10.1016/j.clinthera.2006.10.010. (PMID: 17157129)
• 31 Groll D, Vanner SJ, Depew WT. et al. The IBS-36: a new quality of life measure for irritable bowel syndrome. Am J Gastroenterol 2002; 97: 962-971 DOI: 10.1111/j.1572-0241.2002.05616.x. (PMID: 12003433)
• 32 Gralnek IM, Hays RD, Kilbourne A. et al. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology 2000; 119: 654-660 DOI: 10.1097/01.mcg.0000140190.65405.fb. (PMID: 15365405)
• 33 Enck P, Leinert J, Smid M. et al. Functional Constipation and Constipation-Predominant Irritable Bowel Syndrome in the General Population: Data from the GECCO Study. Gastroenterol Res Pract 2016; 2016: 3186016 DOI: 10.1155/2016/3186016. (PMID: 26880887)
• 34 Michalsen VL, Per Olav Vandvik PO, Farup PG. Predictors of health-related quality of life in patients with irritable bowel syndrome. A cross-sectional study in Norway. Health Qual Life Outcomes 2015; 13: 113 DOI: 10.1186/s12955-015-0311-8. (PMID: 26223784)
• 35 Polster A, Van Oudenhove L, Jones M. et al. Mixture model analysis identifies irritable bowel syndrome subgroups characterised by specific profiles of gastrointestinal, extraintestinal somatic and psychological symptoms. Aliment Pharmacol Ther 2017; 46: 529-539 DOI: 10.1111/apt.14207. (PMID: 28671338)
• 36 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Arlington: American Psychiatric Association; 2013
• 37 Wallander MA, Johansson S, Ruigómez A. et al. Morbidity associated with sleep disorders in primary care: a longitudinal cohort study. Prim Care Companion J Clin Psychiatry 2007; 9: 338-345 DOI: 10.4088/pcc.v09n0502. (PMID: 17998952)
• 38 Tu Q, Heitkemper MM, Jarrett ME. et al. Sleep disturbances in irritable bowel syndrome: a systematic review. Neurogastroenterol Motil 2017; 29 (03) DOI: 10.1111/nmo.12946. (PMID: 27683238)
• 39 Fass R, Fullerton S, Tung S. et al. Sleep disturbances in clinic patients with functional bowel disorders. Am J Gastroenterol 2000; 95: 1195-2000 DOI: 10.1111/j.1572-0241.2000.02009.x. (PMID: 10811327)
• 40 Kim SY, Choung RS, Lee SK. et al. Self-reported Sleep Impairment in Functional Dyspepsia and Irritable Bowel Syndrome. J Neurogastroenterol Motil 2018; 24: 280-288 DOI: 10.5056/jnm17098. (PMID: 29605983)
• 41 Tkalcić M, Hauser G, Stimac D. Differences in the health-related quality of life, affective status, and personality between irritable bowel syndrome and inflammatory bowel disease patients. Eur J Gastroenterol Hepatol 2010; 22: 862-867 DOI: 10.1097/MEG.0b013e3283307c75. (PMID: 19701092)
• 42 Mikocka-Walus A, Knowles SR, Keefer L. et al. Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases. Inflamm Bowel Dis 2016; 22: 752-762 DOI: 10.1097/MIB.0000000000000620. (PMID: 26841224)
• 43 Ansari R, Attari F, Razjouyan H. et al. Ulcerative colitis and irritable bowel syndrome: relationships with quality of life. Eur J Gastroenterol Hepatol 2008; 20: 46-50 DOI: 10.1097/MEG.0b013e3282f16a62. (PMID: 18090990)
• 44 Zargar A, Gooraji SA, Keshavarzi B. et al. Effect of Irritable Bowel Syndrome on Sleep Quality and Quality of Life of Inflammatory Bowel Disease in Clinical Remission. Int J Prev Med 2019; 10: 10 DOI: 10.4103/ijpvm.IJPVM_364_17. (PMID: 30774844)
• 45 Ruffle JK, Tinkler L, Emmett C. et al. Constipation Predominant Irritable Bowel Syndrome and Functional Constipation Are Not Discrete Disorders: A Machine Learning Approach. Am J Gastroenterol 2021; 116: 142-151 DOI: 10.14309/ajg.0000000000000816. (PMID: 32868630)
• 46 Frieling T, Schemann M, Pehl C. Irritable bowel syndrom--a misnomer?. Z Gastroenterol 2011; 49: 577-578 DOI: 10.1055/s-0031-1273323. (PMID: 21557166)
• 47 Enck P, Frieling T, Schemann M. Irritable bowel syndrome – disection of a disease. A 13-steps polemic. Z Gastroenterol 2017; 55: e1 DOI: 10.1055/s-0043-121536. (PMID: 29310143)
• 48 Polster AV, Palsson OS, Törnblom H. et al. Subgroups of IBS patients are characterized by specific, reproducible profiles of GI and non-GI symptoms and report differences in healthcare utilization: A population-based study. Neurogastroenterol Motil 2019; 31: e13483 DOI: 10.1111/nmo.13483. (PMID: 30393924)
• 49 Van den Houte K, Carbone F, Pannemans J. et al. Prevalence and impact of self-reported irritable bowel symptoms in the general population. United European Gastroenterol J 2019; 7: 307-315 DOI: 10.1177/2050640618821804. (PMID: 31080615)
• 50 Buysse DJ, Reynolds CFr, Monk TH. et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213 DOI: 10.1016/0165-1781(89)90047-4. (PMID: 2748771)