Wang Xiao Jing, Ebbert Jon O, Loftus Connor G, Rosedahl Jordan K, Philpot Lindsey M
Gastroenterology and Hepatology, Mayo Clinic, Minnesota, Rochester, USA.
Community Internal Medicine, Mayo Clinic, Minnesota, Rochester, USA.
Neurogastroenterol Motil. 2023 Apr;35(4):e14546. doi: 10.1111/nmo.14546. Epub 2023 Feb 19.
Irritable bowel syndrome (IBS) is characterized as a central sensitization syndrome (CSS), a group of conditions including fibromyalgia, chronic fatigue, and restless leg syndrome (RLS) among others with frequent comorbidities of anxiety, depression, and chemical sensitivity. The prevalence of comorbid conditions and their impact on IBS symptom severity and quality of life in rural community populations has not been described.
We administered a cross-sectional survey to patients with a documented CSS diagnosis in rural primary care practices to evaluate the relationship between CSS diagnoses, quality of life, symptom severity, and interactions with healthcare providers utilizing validated questionnaires. Subgroup analysis was performed on the IBS cohort. Mayo Clinic IRB approved the study.
Seven hundred seventy-five individuals out of 5000 completed the survey (15.5% response rate) with 264 (34%) reporting IBS. Only 3% (n = 8) of IBS patients reported IBS alone without comorbid CSS condition. Most respondents reported overlapping migraine (196, 74%), depression (183, 69%), anxiety (171, 64%), and fibromyalgia (139, 52%). IBS patients with more than two comorbid CS condition showed significantly higher symptom severity with linear increase. Quality of life was lower in IBS with comorbid conditions, particularly in patients with IBS and RLS (mean EQ5-D 0.36 vs. 0.8 in IBS only, p < 0.01). Quality of life declined as number of comorbid conditions increased.
CONCLUSIONS & INFERENCES: Patients with IBS often have multiple CS disorders which increases symptom severity and lowers quality of life. Understanding the impact of multiple CSS diagnoses and treating these as a global condition may improve patient experience.
肠易激综合征（IBS）被归类为一种中枢敏化综合征（CSS），这是一组病症，包括纤维肌痛、慢性疲劳和不宁腿综合征（RLS）等，常伴有焦虑、抑郁和化学敏感性等共病情况。农村社区人群中共病情况的患病率及其对IBS症状严重程度和生活质量的影响尚未见描述。
我们对农村基层医疗实践中确诊为CSS的患者进行了一项横断面调查，以利用经过验证的问卷评估CSS诊断、生活质量、症状严重程度以及与医疗服务提供者之间的相互作用之间的关系。对IBS队列进行了亚组分析。梅奥诊所机构审查委员会批准了该研究。
5000人中775人完成了调查（回复率15.5%），其中264人（34%）报告患有IBS。只有3%（n = 8）的IBS患者报告仅患有IBS，无共病CSS情况。大多数受访者报告有重叠性偏头痛（196人，74%）、抑郁症（183人，69%）、焦虑症（171人，64%）和纤维肌痛（139人，52%）。患有两种以上共病CS情况的IBS患者症状严重程度明显更高，呈线性增加。伴有共病情况的IBS患者生活质量较低，尤其是患有IBS和RLS的患者（平均EQ5-D评分为0.36，而仅患有IBS的患者为0.8，p < 0.01）。生活质量随着共病情况数量的增加而下降。
IBS患者常患有多种CS疾病，这会增加症状严重程度并降低生活质量。了解多种CSS诊断的影响并将其作为一个整体病症进行治疗可能会改善患者体验。
