Functional gastrointestinal disorders in inflammatory bowel disease: Impact on quality of life and psychological status

Background and Aim: In inflammatory bowel disease (IBD), ongoing gastrointestinal (GI) symptoms consistent with coexistent functional GI disorders (FGID) might occur. It is uncertain what effect these symptoms have on health-related quality of life (HRQoL) and psychological comorbidity. The aim of the present study was to identify interrelationships among IBD, symptoms consistent with FGID, HRQoL, and psychological comorbidity. Methods: A total of 256 consecutive IBD patients had diagnoses and disease activity verified at case-note review. Patients completed a contemporaneous survey assessing HRQoL, anxiety/depression, and GI symptoms (classified by Rome III criteria). Results: Of 162 respondents (response rate: 63%), 95 (58.6%) had Crohn's disease and 63 (38.8%) had ulcerative colitis. By Rome III criteria, 66% met criteria for at least one FGID. Those with significant (Hospital Anxiety and Depression Scale >= 8) anxiety and/or depression were more likely to meet criteria for coexistent FGID (78% vs 22% and 89% vs 11%, respectively; each P < 0.001). A "load effect" was noted, such that the number of symptoms consistent with FGID in each patient correlated positively with anxiety and depression and negatively with HRQoL. Symptoms of any coexistent FGID were highly prevalent, even in those with currently-inactive IBD (57%). Conclusions: Symptoms consistent with FGID are highly prevalent in IBD and correlate with greater psychological comorbidity and poorer HRQoL in a "load-dependent" fashion. Therapy directed either at symptom load or psychological comorbidity might independently improve HRQoL in IBD.