Irritable Bowel Syndrome and Intestinal Bowel Disease Associated with IBS-Like Symptoms: Comparative Analysis of Somatoform Symptoms and Patient Psychological and Emotional Characteristics
Study Objective: To compare and analyze clinical gastrointestinal (GI) manifestations; extra-intestinal associated symptoms; and the intensity of anxiety, depression, and alexithymia in patients with irritable bowel syndrome (IBS) and with inflammatory bowel disease (IBD) in remission that is associated with IBS-like symptoms. Materials and Methods: The study was conducted from 2010 to 2015 and included 197 patients with IBS and 62 patients with IBD. The following tools were used: the Screening for Somatoform Symptoms-2 scale, the Beck Depression Inventory to assess depression, the State-Trait Anxiety Inventory (Spielberger) to measure the state and trait anxiety levels, and the Toronto Alexithymia Scale to determine the degree of alexithymia. Study Results: IBS-like symptoms were present in 38-63% of patients with IBD, which is significantly less frequent (p < 0.05) than in patients with true IBS. In patients with IBD, the range of these symptoms showed little difference from what was seen in patients with true IBS and was fully compatible with the current IBS diagnostic criteria (the Rome III Diagnostic Criteria). The only exclusion was the "improvement with defecation" symptom, which was observed at equal frequency (> 60%) in patients with true IBS and in those with IBD. An analysis of associated extra-intestinal symptoms showed that these were present in both groups but were more frequently seen in patients with true IBS; this difference was statistically significant (p < 0.05). In both groups, patients had moderate depression and state anxiety (p < 0.05). Patients who have IBS and IBD with IBS-like symptoms are at a higher risk for alexithymia. The level of trait anxiety was significantly higher (p = 0.0004) in patients with IBS than in those who had IBD with IBS-like symptoms. Conclusion: In patients who have IBD with IBS-like symptoms, both intestinal and extra-intestinal associated manifestations are similar to those seen in patients with IBS. The frequency of all these manifestations is significantly higher in true IBS. Depression and state anxiety are present in both groups. Patients with true IBS had high levels of trait anxiety.