Impact of symptom severity in patients with diarrhoea-predominant irritable bowel syndrome (IBS-D): results from two separate surveys of HCPs and patients with IBS-D

Anton Emmanuel,Hans Törnblom,Richard William Goosey,Stephen Baker,Gwen Wiseman

doi:10.1186/s12876-020-01252-9

Abstract

BackgroundManagement of diarrhoea-predominant irritable bowel syndrome (IBS-D) is generally based on patient-reported symptoms; however, limited information on symptom severity exists. The objective of the study was to assess the impact of IBS-D severity on patient burden and patient and healthcare professional attitudes towards IBS.MethodsWe conducted two web-based surveys of healthcare professionals and patients from Australia, Canada and Europe. We analysed patient characteristics and attitudes by IBS-D severity, which was assessed retrospectively using a composite of four variables: worst abdominal pain, IBS symptom frequency, Bristol Stool Form Scale and quality of life.ResultsOf 679 healthcare professional respondents, one-third routinely classified patients by severity. The patient survey was completed by 513 patients with mild (26%), moderate (33%) and severe (41%) IBS-D, classified using the composite scale. Age, sex and treatment satisfaction did not change with severity; however, 19% of patients classified with severe IBS-D agreed with the statement: ‘When my IBS is bad, I wish I was dead’ versus 4 and 7% of patients with mild and moderate IBS-D, respectively (p < 0.05). Significantly more patients classified with severe IBS-D reported medication use versus mild IBS-D.ConclusionCompared with milder symptoms, severe IBS-D was associated with increased medication use and a negative perspective of IBS-D. This highlights the need for a validated severity scale to inform treatment decisions.

Highlights

Management of diarrhoea-predominant irritable bowel syndrome (IBS-D) is generally based on patient-reported symptoms; limited information on symptom severity exists
Patients who selfreport severe Irritable bowel syndrome (IBS)-D have been described as experiencing greater impairments in health-related quality of life (QoL), increased work and activity impairment and increased healthcare resource use compared to patients who self-report mild or moderate IBS-D [5,6,7,8,9]
The Rome IV criteria state that IBS treatment should be dependent upon symptom type and severity [2]; no validated scale is suggested to assess this beyond those available for IBS as a whole, such as the Birmingham-IBS questionnaire, functional bowel disorder severity index and the IBS symptom severity scale (IBS-SSS)

Summary

Introduction

Management of diarrhoea-predominant irritable bowel syndrome (IBS-D) is generally based on patient-reported symptoms; limited information on symptom severity exists. The Rome IV criteria state that IBS treatment should be dependent upon symptom type and severity [2] (for example, linaclotide is recommended for patients with moderate-to-severe IBS-C [10]); no validated scale is suggested to assess this beyond those available for IBS as a whole, such as the Birmingham-IBS questionnaire, functional bowel disorder severity index and the IBS symptom severity scale (IBS-SSS) These scales do not take into account the multifactorial diagnostic approach set out by the Rome IV criteria [4, 11,12,13,14] and are not specific to IBS-D or IBS-C. Classification of IBS-D severity is dependent upon the type of scale used and whether the patient or physician makes the severity definition, as well as variables such as symptom intensity, time of assessment and degree of disability or impairment [15]

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