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UEG Week Study Interpretation
Irritable bowel syndrome (IBS) is a functional disease of the digestive tract characterized by
chronic abdominal pain and changes in bowel habits.
Other comorbidities, dietary habits, lifestyle, and psychosocial factors can influence the course
of IBS.
During UEG Week 2022, Professor Madhusudan Grover's team from Mayo Clinic conducted a systematic study
of the relationship between IBS and the factors mentioned above.
"Medical community" specially invited Dr.
Jia Yifan of the Department of Gastroenterology, West China Hospital of Sichuan University to bring us a wonderful conference report, let's take a look~
How is the study done?
Between 2013 and 2020, the Mayo Clinic surveyed patients to:
- Demographic information: awareness of general, mental and social health;
- Diagnosis of psychiatric, neurological, rheumatic or gynecological diseases;
- Diet and lifestyle
.
Selection variables included specific lifestyle/eating behaviors (e.
g.
, smoking, alcohol consumption, high-fat dietary intake, fruit intake, vegetable intake, frequency of regular beverage consumption, weekly leisure activity score) and comorbidities (e.
g.
, migraine and endometriosis).
In addition, six Rome III variables (frequency of abdominal pain, reduction of abdominal pain after defecation, frequency of bowel movements, loose stools, hard stools)
were included.
The conditional logistic regression model was used to identify the factors significantly associated with IBS status, and the potential category analysis
based on model clustering was performed for IBS cases.
The ten factors most closely related to the course of IBS
40,291 patients in 54,584 cases responded to the questionnaire (74% response rate), and a total of 4,021 patients with IBS (mean age 64 years, 75% women) and 12,063 control patients were included in the study
according to exclusion criteria.
Studies have found that people with IBS often have more serious health problems, such as psychiatric disorders and other comorbidities (fibromyalgia, endometriosis, migraine and other neurological disorders).
People with IBS are more smokers and consume more fatty foods and beverages and less
fruits, vegetables, and alcohol.
The researchers identified ten factors most closely related to the course of IBS, with perceived pain (OR=1.
41) and overall health impairment (OR=2.
42) in the past 7 days being the two most relevant
.
IBS patients are divided into 3 broad categories based on variables
In addition to the 10 variables mentioned above, 16 additional variables
related to the course of IBS were included in the study.
After R language calculation, IBS patients were divided into 3 categories according to gastrointestinal symptoms, lifestyle behaviors, and the presence of extraintestinal physical and psychological comorbidities, and then divided into 7 subgroups
.
Groups with greater overall health impairment in category 1 include subgroup 1
– moderately impaired health (17%, n=689) and subgroup 2 – severely impaired health (16%, n=665).
Patients in these two subgroups had the most severe abdominal pain and the highest
perceived impairment of health.
Patients in subgroup 2 had more psychiatric comorbidities, as well as pain other than abdominal pain (migraine, fibromyalgia, and other pains).
▌Category 2
groups with significant mental and neurological abnormalities, including subgroup 3 - increased physiological neurological burden (10%, n=428), subgroup 4 - increased mental burden (20%, n=793), and subgroup 5 - increased neurological burden (16%, n=451).
。
The prevalence of psychiatric comorbidities in these three subgroups was high, but the perceived health impairment and pain were lower than the average
for the IBS cohort.
Groups with prominent defecation dysfunction in category 3
include subgroup 6 – diarrhea (12%, n=493) and subgroup 7 – constipation (12%, n=487).
Patients in these two subgroups had lower
perceived health impairment, psychiatric disorders, and other comorbidities.
Patients in subgroup 7 had the highest intake of fruits and vegetables and the lowest intake of high-fat foods, which may be related
to the patient's desire to relieve constipation by changing their diet.
total
knot
Clustering based on gastrointestinal symptoms, comorbidities of medical and psychiatric disorders, diet, and lifestyle factors provides important insights
into IBS heterogeneity.
The results suggest that clinicians should not ignore symptoms other than the gastrointestinal tract
in the process of clinical decision-making and personalized treatment of IBS patients.
In addition, these subgroups should be validated in larger cohorts to assess whether they can be used to guide clinical trials and personalized patient management
.
Reviewers
Liu Tong
- Postdoctoral fellow/assistant researcher, Department of Gastroenterology, West China Hospital, Sichuan University, MD, visiting scholar
at Oxford University. - Graduated from Qilu Medical College
of Shandong University. - He is good at the diagnosis and treatment of functional gastrointestinal diseases and early tumors of the digestive tract, and is now engaged in basic and clinical research related to the tumor microenvironment of colorectal cancer, and has published a number of SCI academic papers
as the first author and co-author.
References:
[1] Byale,A.
,Lennon,R.
J.
,Byale,S.
,Breen-Lyles,M.
,Edwinson,A.
L.
,Gupta,R.
,Lacy,B.
E.
,Olson,J.
E.
,Houghton,L.
A.
,&Grover,M.
(2022).
High-dimensional clustering of 4000 Irritable Bowel Syndrome Patients reveals Seven Distinct Disease Subsets.
Clinical gastroenterology and hepatology:the official clinical practice journal of the American Gastroenterological Association,S1542-3565(22)00917-X.
Advance online publication.
https://doi.
org/10.
1016/j.
cgh.
2022.
09.
019
