Gastrointestinal symptoms - an illness burden that affects daily work in patients with IBS

Åshild Faresjö, Susanna Walter, Anna-Karin Norlin, Tomas Faresjö, Michael P Jones, Åshild Faresjö, Susanna Walter, Anna-Karin Norlin, Tomas Faresjö, Michael P Jones

Abstract

Background: Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disorder characterised by recurrent abdominal pain and disturbed bowel habits and unclear aetiology. IBS is also associated with psychosocial factors, impaired quality of life and lost work productivity. This study sought to determine whether the association between IBS and lost work productivity might be accounted for by poor coping strategies and loss of confidence in the healthcare system.

Methods: Case-control design was employed sampling IBS and non-gastrointestinal (non-GI) primary healthcare seekers in a defined region in Sweden. Non-GI patients were of similar age and sex distribution to the IBS patients. Questionnaires applied in this study included instruments designed to measure confidence in the social security system and in the community, as well as questions about whether gastrointestinal problems might affect working life and Sense of coherence (SOC) questionnaire. The study's primary hypothesis was evaluated via an a priori path model.

Results: Statistically significant differences were found between IBS cases (n = 305) and controls (n = 369) concerning abdominal pain or discomfort affecting everyday performance at work (p < 0.0001). IBS cases also showed significantly lower (p = 0.001) confidence in public healthcare. The study's hypothesis was supported with the finding of a statistically significant indirect association via poor coping strategies, although the indirect associations were lesser in magnitude than the direct association.

Conclusions: This study found a clear association between clinically diagnosed IBS status and interference in work by gastrointestinal symptoms in which sense of coherence might be of importance.

Keywords: Confidence in public health; Disease burden; IBS; Sense of coherence.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Analytic framework for the study - A model of potential direct and indirect factors affecting daily performance at work

References

    1. Longstreath GF. Definition and classification of irritable bowel syndrome. Current consensus and controversies. Gastroenterol Clin N Am. 2005;34(2):173–187. doi: 10.1016/j.gtc.2005.02.011.
    1. Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, Jones R, Kumar D, Rubin G, Trudgill W, Whorwell P. Clinical services committee of the British Society of Gastroenterology. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut. 2007;56(12):170–198.
    1. Agrèus L, Svärdsudd K, Nyren O, Tibblin G. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology. 1995;109:671–680. doi: 10.1016/0016-5085(95)90373-9.
    1. Thompson WG, Heaton KW, Smyth C. Irritable bowel syndrome in general practice: prevalence, characteristics and referral. Gut. 2000;46:78–82. doi: 10.1136/gut.46.1.78.
    1. Faresjö Å, Grodzinsky E, Johansson S, Wallander MA, Foldevi M. Patients with irritable bowel syndrome in Swedish primary care. Eur J Gen Pract. 2006;12:88–90. doi: 10.1080/13814780600872937.
    1. Guilera M, Balboa A, Mearin F. Bowel habit subtypes and temporal patterns in irritable bowel syndrome: systemic review. Am J Gastroentrol. 2005;100(5):1174–1846. doi: 10.1111/j.1572-0241.2005.40674.x.
    1. Mayer EA, Labus JS, Tillisch K, Cole SW, Baldi P. Towards a system view of IBS. Nat Rev Gastroenterol Hepatol. 2015;12(10):592–605. doi: 10.1038/nrgastro.2015.121.
    1. Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2011;12(8):453–466. doi: 10.1038/nrn3071.
    1. Camilleri M. Peripheral mechanisms in irritable bowel syndrome. The New England J Med. 2012;367(17):1626–1635. doi: 10.1056/NEJMra1207068.
    1. Camilleri M, Katzka DA. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. Genetic epidemiology and pharmacogenetics in irritable bowel syndrome. Am J Phys. 2012;302(10):G1075–G1084.
    1. Camilleri M, Lasch K, Zhou W. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. The influence of increased permeability, inflammation, and pain in irritable bowel syndrome. Am J Phys. 2012;303(7):G775–G785.
    1. Lee YJ, Park KS. Irritable bowel syndrome: emerging paradigm in pathophysiology. World J Gastroenterol. 2014;20(10):2456–2469. doi: 10.3748/wjg.v20.i10.2456.
    1. Feng B, La JH, Schwartz ES, Gebhart GF. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. Neural and neuro and neuro-immune mechanisms of visceral hypersensitivity in irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2012;302(10):G1085–G1098. doi: 10.1152/ajpgi.00542.2011.
    1. Herschbach P, Henrich G, Von Rad M. Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behaviour? Psychosom Med. 1999;61:148–153. doi: 10.1097/00006842-199903000-00005.
    1. El Serag HB, Olden K, Bjorkman D. Health-related quality of life among persons with irritable bowel syndrome a systematic review. Aliment Pharmacol Ther. 2002;16:1171–1185. doi: 10.1046/j.1365-2036.2002.01290.x.
    1. Faresjö Å, Grodzinsky E, Johansson S, Wallander MA, Timpka T, Åkerlind I. A population based case-control study of work and psychosocial problems in patients with irritable bowel syndrome – women are more seriously affected than men. Am J Gastroenterol. 2007;102(2):371–379. doi: 10.1111/j.1572-0241.2006.01012.x.
    1. Grodzinsky G, Walter S, Viktorsson L, Carlsson AK, Jones MP, Faresjö Å. More negative self-esteem and inferior coping strategies among patients diagnosed with IBS compared with patients without IBS-a case-control study in primary care. BMC Fam Pract. 2015;16:6. doi: 10.1186/s12875-015-0225-x.
    1. Crane C, Martin M. Social learning, affective state and passive coping in irritable bowel syndrome and inflammatory bowel disease. Gen Hosp Psychiatry. 2004;26(1):50–58. doi: 10.1016/j.genhosppsych.2003.07.005.
    1. Elsenbruch S. Abdominal pain in irritable bowel syndrome: a review of putative psychological neural and neuro-immune mechanisms. Brain, Behaviour and Immunity. 2011;25(3):386–394. doi: 10.1016/j.bbi.2010.11.010.
    1. Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil. 2011;17(2):131–139. doi: 10.5056/jnm.2011.17.2.131.
    1. Talley Nicholas J., Weaver Amy L., Zinsmeister Alan R., Melton L. Joseph. Onset and Disappearance of Gastrointestinal Symptoms and Functional Gastrointestinal Disorders. American Journal of Epidemiology. 1992;136(2):165–177. doi: 10.1093/oxfordjournals.aje.a116483.
    1. Dean BB, Aguilar D, Barghout V, Kahler KH, Frech F, Groves D, Ofman JJ. Impairment in work productivity and health-related quality of life in patients with IBS. Am J Manag Care. 2005;11:S17–S26.
    1. Spiegel BM. The burden of IBS: looking at metrics. Curr Gastroenterol Rep. 2009;11(4):265–266. doi: 10.1007/s11894-009-0039-x.
    1. Di Bonaventura M, Shawn XS, Bolge SC, Wagner JS, Mody R. Health-related quality of life, work productivity and health care resource use associated with constipation predominant irritable bowel syndrome. Curr Med Res Opin. 2011;27(11):2213–2222. doi: 10.1185/03007995.2011.623157.
    1. Simrèn M, Palsson OS, Heyman S, Bajor A, Törnblom H, Whitehead WE. Fecal incontinence in irritable bowel syndrome: prevalence and associated factors in Swedish and American patients. Neurogastroenterol Moti. 2017;29:e12919. doi: 10.1111/nmo.12919.
    1. Voth J, Sirois FM. The role of self-blame and responsibility in adjustment to inflammatory bowel disease. Rehabil Psychol. 2009;54:99–100. doi: 10.1037/a0014739.
    1. Drossman DA, Leserman J, Li Z, Keefe F, Hu YJ, Toomey TC. Effects of coping on health outcome among women with gastrointestinal disorders. Psychosom Med. 2000;62(3):309–317. doi: 10.1097/00006842-200005000-00004.
    1. Grodzinsky E, Hallert C, Faresjö T, Bergfors E, Faresjö Å. Could gastrointestinal disorders differ in two close but divergent social environments? Int J Health Geogr. 2012;11(1):5. doi: 10.1186/1476-072X-11-5.
    1. Statistics-Sweden. Employment, working hours and work environment 1994-95. Sveriges Officiella Statistik. Stockholm: Statistiska Centralbyrån (SCB), 1998 (in Swedish).
    1. Whitehead WE. Validation Working Team, Rome Questionnaire Committee. Development and validation of ROME III diagnostic questionnaire. In: Drossman DA, Corazziari, Delvaux M ,eds ROME III. The functional Gastrointestinal Disorders, 3rd edn. McLean, 2006.s
    1. Antonovsky A. Unraveling the mystery of health: how people manage stress and stay well: san Francicso. USA: Jossey-Bass; 1987.
    1. Langius A, Bjorwell H, Antonovsky A. The sense of coherence concept and its relation to personality traits in Swedish sample. Scand J Caring Sci. 1992;6:165–167. doi: 10.1111/j.1471-6712.1992.tb00146.x.
    1. Nilsson B, Holmgren I, Stegmayr B, Westman G. Sense of coherence-stability over time and relation to health, disease and psychosocial changes in a general population: a longitudinal study. Public Health. 2003;1:297–304.
    1. Engel G. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129–136. doi: 10.1126/science.847460.
    1. Drossman DA. Gastrointestinal illness and the biopsychosocial model. Psychosom Med. 1998;60(3):258–25867. doi: 10.1097/00006842-199805000-00007.
    1. Frändemark Å, Jakobsson E, Törnblom H, Simrèn M, Jakobsson S. Fatigue: a distressing symptom for patients with irritable bowel syndrome. Neurogastroenterol Motil. 2017;29:e12898. doi: 10.1111/nmo.12898.
    1. Silk DB. Impact of irritable bowel syndrome on personal relationships and working practice. Eur J Gastroenterol Hepatol. 2001;13(11):1327–1332. doi: 10.1097/00042737-200111000-00011.
    1. Hahn BA, Kirchdoefer LJ, Fullerton S, Mayer E. Patient-perceived severity of irritable bowel syndrome in relations to symptoms, health, resource utilization and quality of life. Aliment Pharmacol Ther. 1997;11:553–559. doi: 10.1046/j.1365-2036.1997.00160.x.
    1. Sperber AD, Carmel S, Atzmon Y, Weisberg I, Shalit Y, Neumann L, Fich A, Buskila D. The sense of coherence index and the irritable bowel syndrome: a cross-sectional comparison among irritable bowel syndrome patients with and without coexisting fibromyalgia, irritable bowel syndrome non-patients and controls. Scand J Gastroenterol. 1999;34(3):259–263. doi: 10.1080/00365529950173654.
    1. Motzer SA, Hertig V, Jarett M, Heitkamper MM. Sense of coherence and quality of life in women with and without irritable bowel syndrome. Nurs Res. 2003;52(5):329–337. doi: 10.1097/00006199-200309000-00007.
    1. Phillips K, Wright BJ, Kent S. Psychosocial predictors of irritable bowel syndrome diagnosis and symptoms severity. J Psychosom Res. 2013;75(5):467–474. doi: 10.1016/j.jpsychores.2013.08.002.
    1. Delvaux M, Denis P, Allemand H. Sexual abuse is more frequently reported by IBS patients than patients with organic digestive diseases or controls. Results of a multicenter inquiry. French Club of Digestive Motility Eur J Gastroenterol Hepatol. 1997;9:345–352. doi: 10.1097/00042737-199704000-00006.
    1. Kendall-Tackett KA. Physiological correlates of childhood abuse: chronic in PTSD, depression, and irritable bowel syndrome. Child Abuse Negl. 2000;24:799–810. doi: 10.1016/S0145-2134(00)00136-8.
    1. Baccini F, Pallotta N, Calabreze E, Pezzotti P, Corazziari E. Prevalence of sexual and physical abuse and its relationship with symptom manifestations in patients with chronic organic and functional gastrointestinal disorders. Dig Liver Dis. 2003;35:256–261. doi: 10.1016/S1590-8658(03)00075-6.
    1. Arch GM, III, Hueston WJ. Using other people’s data: the ins and outs of secondary data analysis. Fam Med. 1997;29(8):568–571.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe