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Original Investigation
September 13, 2004

Clinical Determinants of Health-Related Quality of Life in Patients With Irritable Bowel Syndrome

Author Affiliations

From the Division of Gastroenterology, the VA Greater Los Angeles Healthcare System (Drs Spiegel, Gralnek, Dulai, and Naliboff), the Division of Digestive Diseases, The David Geffen School of Medicine at UCLA (Drs Spiegel, Gralnek, Chang, and Mayer), Centers for Neurovisceral Sciences and Women's Health (Drs Spiegel, Bolus, Chang, Mayer, and Naliboff) and for the Study of Digestive Healthcare Quality and Outcomes (Drs Spiegel, Gralnek, and Dulai), and the CURE Digestive Diseases Research Center (Drs Spiegel, Gralnek, Chang, Dulai, Mayer, and Naliboff), Los Angeles, Calif. The authors have no relevant financial interest in this article.

Arch Intern Med. 2004;164(16):1773-1780. doi:10.1001/archinte.164.16.1773

Background  Current guidelines recommend routine assessment of health-related quality of life (HRQOL) in patients with irritable bowel syndrome (IBS). However, physicians rarely have the time to measure HRQOL with the appropriate methodological rigor, and data suggest that HRQOL in patients with IBS is often estimated using inaccurate clinical gestalt. The identification of predictive factors could allow physicians to better assess HRQOL without using misleading clinical clues. We, therefore, sought to identify determinants of HRQOL in patients with IBS.

Methods  We examined 770 patients, 18 years or older, with IBS at a university-based referral center. Subjects completed a symptom questionnaire, the Symptoms Checklist–90 items psychometric checklist, and the 36-Item Short-Form Health Survey. The main outcome was HRQOL as measured by the mental and physical component scores of the 36-Item Short-Form Health Survey. We first developed a list of hypothesis-driven HRQOL predictors, and then performed multivariate regression analysis to measure the independent association of each predictor with HRQOL.

Results  Seven factors (r2 = 0.39) independently predicted physical HRQOL: (1) more than 5 physician visits per year, (2) tiring easily, (3) low in energy, (4) severe symptoms, (5) predominantly painful symptoms, (6) the feeling that there is "something seriously wrong with body," and (7) symptom flares for longer than 24 hours. Eight factors (r2 = 0.36) independently predicted mental HRQOL: (1) feeling tense, (2) feeling nervous, (3) feeling hopeless, (4) difficulty sleeping, (5) tiring easily, (6) low sexual interest, (7) IBS symptom interference with sexual function, and (8) low energy.

Conclusions  Health-related quality of life in patients with IBS is primarily related to extraintestinal symptoms rather than traditionally elicited gastrointestinal symptoms. These findings suggest that rather than focusing on physiological epiphenomena (stool characteristics and subtype of IBS) and potentially misleading clinical factors (age and disease duration), physicians might be better served to gauge global symptom severity, address anxiety, and eliminate factors contributing to chronic stress in patients with IBS.