Depression, somatization linked to postprandial symptoms in IBS patients
Psychosocial morbidities are linked to higher levels of gastrointestinal symptoms in patients with irritable bowel syndrome, and specifically, depression and somatization are linked to increased postprandial symptoms, according to recent research.
“Our understanding of the relationship between levels of psychological symptoms and postprandial sensations or symptoms in IBS is incomplete,” the researchers wrote. “The aim of this study therefore was to study the relationship between anxiety, depression, and somatization levels on the one hand and GI symptom levels before and after a standard breakfast on the other hand, in IBS patients.”
They prospectively evaluated 193 patients (74.1% women; mean age, 41.3 years; mean BMI, 24 kg/m2) diagnosed with IBS based on Rome II (65.3%) or III criteria from Sahlgrenska University Hospital in Sweden between 2005 and 2008.
After fasting overnight, patients completed visual analogue scales assessing the severity of abdominal pain, bloating, nausea, gas and fullness before eating a standard breakfast, and again every 30 minutes after eating up to 4 hours.
Patients also completed validated questionnaires to report levels of anxiety, depression, somatization (only the Rome II cohort), IBS symptoms and comorbid functional dyspepsia. The researchers used linear mixed models, controlling for comorbid functional dyspepsia, to evaluate the link between the above variables and the course of GI symptoms over time.
They found significant main effects of anxiety levels on fullness and bloating (P < .04), and of depression levels on abdominal pain (P = .007), which reflected “a general upward shift of the entire symptom curve.” They also observed the main effects of somatization levels on all five symptoms independent of anxiety and depression (P < .0001).
Further, depression-by-time interactions were observed for nausea and gas (P < .03), and somatization-by-time interactions were observed for bloating (P = .005) and nausea (P = .02). A nonsignificant trend was also observed for interactions between somatization and abdominal pain, which showed patients with higher levels of somatization had “a steeper increase in pain rating in the early postprandial period.”
The researchers concluded their evidence shows “that meal ingestion and level of psychological distress not only contribute independently to increased GI symptom reporting in IBS, but that they may in some cases interact with psychological symptoms, particularly depression and somatization, being associated with enhanced postprandial GI symptom responses. These findings are relevant to increase our understanding of the multifactorial nature of IBS, as well as clinically in that postprandial worsening of symptoms should lead not only to dietary, but also psychological assessment focusing on depression and somatization.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.