Irritable Bowel Syndrome: Biopsychosocial Manifestations and Management

Abstract

Introduction: Irritable bowel syndrome (IBS) is the most commonly diagnosed functional gastrointestinal disorder. Links between IBS and PTSD have been described in a previous study. Elimination of foods high in fermented oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is suggested for relief from IBS symptoms. High fructose corn syrup (HFCS) belongs to the FODMAP food family. Camden, NJ is considered to be a “food desert”, where dietary choices may be restricted due to lack of access to fresh, healthy ingredients and meals. This may result in increased consumption of foods high in HCFS. Thus, the interplay between IBS, societal circumstances and psychological disorders may all play a role in the course of the disease, and affect clinical management of patients. Methods: We looked into the medical records of 969 IBS patients with respect to demographic details, type of IBS, BMI, history of GI procedures, smoking, alcohol consumption, medications, current and past Helicobacter pylori infection, diabetes, hypertension, cholesterol, psychological disorders, adherence to a low-FODMAP diet, consumption of HCFS, and other known food triggers. We are now collecting patient surveys in order to fill in gaps in the dietary information from the chart review. USDA data was used in order to identify foods particularly high in HFCS Results: 83% IBS patients were female and 39% were obese. 78% patients were Caucasian (Figure 1). Significant percentage of our IBS patients has one or more psychological disorders. 519, 265, 92, 87 and 21 IBS patients had depression, anxiety, bipolar, PTSD, and psychosis, respectively (Figure 2). IBS-unsubtyped was most common (Figure 3). 240 out of 270 IBS patients with data about H. pylori infection did not have past or current infection. The few surveys collected so far suggest that consumption of HFCS is indeed high in our IBS patients.2782_A Figure 1. Demographics of IBS patients. Respective percentages are presented2782_B Figure 2. Psychiatric diagnoses of IBS patients. Presentation is based on respective numbers as some patients had more than one disorder.2782_C Figure 3. Types of IBS. Respective percentages are presented.Conclusion: Our data shows strong correlation between IBS and certain psychological disorders. With the help of ongoing surveys, we should be able to decipher the underlying dietary influences on IBS. This will help identify “problem areas” where access to healthy food options is difficult. We will also further explore lack of H. pylori infection in our IBS patients as Helicobacter has been hypothesized to confer protection against inflammatory disorders. Our study will allow earlier identification of risk factors to aid in treatment of IBS and its associated psychological disorders.