Evaluation of health related quality of life in irritable bowel syndrome patients

Raika Jamali Arsia Jamali Maryam Poorrahnama Abdollah Omidi Bardia Jamali Neda Moslemi 0 Reza Ansari Shahab Dolatshahi Naser Ebrahimi Daryani 0 Laser Research Center of Dentistry, Dental Research Center, Tehran University of Medical Sciences , Tehran , Iran Background: Quality of life (QOL) is an important measure in the management of Irritable Bowel Syndrome (IBS). Controversy exists in the findings of studies evaluating QOL in IBS subtypes, and little is known about this issue in Iranian patients. Determination of the factors affecting QOL in IBS patients may influence treatment outcomes. The aims of this study are to: 1) compare QOL between subtypes in a sample of Iranian IBS patients, 2) determine the factors associated with QOL in IBS. Methods: This cross sectional study included two hundred and fifty IBS patients with the mean age ( standard deviation) of 31.62 ( 11.93) years that were referred to outpatient gastroenterology clinic. IBS patients were diagnosed based on Rome-3 criteria by a gastroenterologist, and then they were categorized into three subtypes according to the predominant type of bowel habit. The QOL specific for IBS, Stait-trait anxiety inventory, and Beck depression inventory-2 questioners were used to evaluate QOL, anxiety, and depression symptoms, respectively. Results: The mean QOL scores in IBS mixed subtype (71.7 25.57), constipation predominant subtype (80.28 25.57), and diarrhea predominant subtype (76.43 19.13) were not different. (P value: 0.05) In multivariate linear regression analysis, anxiety symptom scores were inversely correlated with QOL scores. [Standardized beta: -0.43, (95% confidence interval: -0.70, -0.39), P value: < 0.01] Conclusion: It seems reasonable to manage anxiety symptoms properly in IBS patients since this might increase their QOL. - Background Irritable Bowel Syndrome (IBS) is a common gastrointestinal disease [1]. It is associated with significant direct health-care costs and indirect costs related to impaired work productivity [2]. IBS patients are diagnosed based on Rome criteria and are categorized into different subtypes according to the predominant type of bowel habit [3]. IBS seems to have a great impact on the health related quality of life (QOL) of the patients [4]. The use of health related QOL assessments have come to interest for better understanding of the biopsychosocial model in the functional gastrointestinal disorders [5]. Controversy exists in results of previous studies about QOL in different IBS subtypes [6-11]. This finding might be related to differences in cultural (such as genetic, nutritional, and socio-demographical) and psychiatric co-morbidities (such as depression and generalized anxiety disorder) in the studied populations. It seems reasonable to determine QOL in different IBS subtypes, and identify the factors affecting QOL in IBS patients, since these findings may influence treatment outcomes. While there are substantial data on comparison of QOL in IBS subtypes and factors independently associated with it in other countries, there is a paucity of literature on this issue in Iranian patients. According to the result of previous studies some important variables that seemed to affect QOL in IBS patients (such as, depression and anxiety symptoms, self reported symptom severity, educational status, marital status, geographic distribution, age, gender, and IBS subtype) were selected and evaluated in this study [12-14]. This study was designed to: 1) compare QOL between IBS subtypes in a sample of Iranian patients, 2) determine the factors independently associated with QOL in these patients. Methods Ethical considerations This study was performed according to the ethical standards for human experimentation. The clinical research committee of Kashan Shahid Beheshti Hospital approved the study protocol (No. 6173). After explaining the aim of the study, a written informed consent was obtained. Patients and methods This cross sectional study was performed on consecutively selected IBS patients, older than 14 years, who referred to outpatient gastroenterology clinic of Kashan Shahid Beheshti Hospital between March and November 2010. Patients with the following criteria were excluded from the study: 1) known organic gastrointestinal diseases, 2) history of abdominal trauma, surgery, or hospital admission for evaluation of abdominal pain, 3) exacerbation of bowel symptoms with consumption of milk or milk products, 4) alarm signs, 5) abnormal laboratory (hematological and biochemical profiles including thyroid function tests, anti tissue transglutaminase antibodies, stool exam, and urinalysis) findings, 6) abnormal findings in barium contrast radiographies, or in upper and lower gastrointestinal endoscopies. Alarm signs consist of new onset of symptoms at fifty years or older, weight loss, nocturnal diarrhea, anemia, dysphagia, bloody stools, and family history of cancer [3]. Upper Gastrointestinal endoscopy and colonoscopy with multiple duodenal and colon biopsies were performed by an expert board certified gastroenterologist for the evaluation of organic diseases including celiac disease and microscopic colitis. Gastrointestinal diseases were diagnosed based on the history, physical examination, laboratory data, imaging, and endoscopic studies that were performed by the same gastroenterologist. IBS and its subtypes were diagnosed according to Rome-3 criteria in the absence of alarm signs [3]. Those participants who were eligible for the study were included. IBS with constipation (IBS-C) subtype was diagnosed if hard or lumpy stools were present in more than 25% and loose (mushy) or watery stools in less than 25% of bowel movements. IBS with diarrhea (IBS-D) subtype was diagnosed if hard or lumpy stools were present in less than 25% and loose (mushy) or watery stools in more than 25% of bowel movements. Mixed IBS (IBSM) subtype was diagnosed if hard or lumpy stools in more than 25% and loose (mushy) or watery stools were present in more than 25% of bowel movements [3]. The consistency of stool was defined according to patient report, using Bristol form scale [15]. Hard or lumpy stools were defined if separate hard lumps like nuts (difficult to pass) or sausage shaped but lumpy stools were present. Loose (mushy) or watery stools were defined if fluffy pieces with ragged edges, a mushy stool or watery, no solid pieces, or liquid stools were present. Questionnaires Health related quality of life questionnaire Disease specific QOL for IBS (IBS-QOL) is a thirty fouritem self-report questionnaire. This questionnaire is especially designed to evaluate QOL in IBS patients [16]. A five point Likert response scale (0 to 4) was used to measure how much each statement described the respondents feelings (not at all, slightly, moderately, quite a bit, and extremely or a great deal). The questionnaire evaluated eight subscales: dysphoria, interference with activities, body image, health w (...truncated)