S570 Comparison of Quality of Life Between Patients With Diarrhea- and Constipation-Predominant Irritable Bowel Syndrome

Abstract

Introduction: Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain and change in the form and consistency of stool. Two subtypes of IBS are diarrhea-predominant IBS (IBS-D) and constipation-predominant IBS (IBS-C). While IBS symptoms have been shown to decrease quality of life (QOL), the effects of IBS subtypes on QOL are still unclear. The aim of this study was to compare QOL parameters in patients with IBS-D and IBS-C. Methods: Data were obtained as part of an institutional review board-approved study where participants with ROME III positive criteria for IBS-D and IBS-C completed the following validated questionnaires: Bowel Disease Questionnaire, IBS-QOL, Hospital Anxiety and Depression Scale (HADS), Symptom Checklist 90 (SCL-90). We used two sample t-test, Wilcoxon rank sum test, and Pearson chi squared to compare the results between the two groups. Results: The study included 219 patients with IBS-D and 33 with IBS-C. The participants’ demographics are reported in the Table. Most patients with IBS-C (70%) had 2-4 bowel movements (BM) per week, while 48% of patients with IBS-D had 13-26 BM per week and 13% had more than 26 BM per week. Patients with IBS-D had higher anxiety, depression, and total anxiety-depression scores on the HADS compared to patients with IBS-C (Table). Patients with IBS-D had higher scores (reflecting worse symptoms) on the somatization, obsessive compulsive, depression, anxiety, and psychoticism dimensions as measured by the SCL-90. Moreover, patients with IBS-D had higher (reflecting worse) IBS-QOL total and subscale scores on 7 out of the 8 subscales (Table). Notably, 42% of patients with IBS-D felt like they were slightly or moderately losing control of their lives because of their bowel problems, whereas 92% of patients with IBS-C reported not feeling loss of control at all. While 96% of patients with IBS-C did not feel that their life revolved around their bowel movements, 20% of patients with IBS-D reported life revolved around their bowel movements quite a bit or a great deal, specifically due to needing to be in proximity to a toilet and inability to take long trips. Conclusion: Our study shows that patients with IBS-D seem to have a worse general and IBS-specific quality of life compared to patients with IBS-C. These data reinforce the importance of considering QOL impact of IBS and opportunities for shared decision-making when discussing individual management plans for patients with IBS-D. Table 1. - Comparison of demographic factors, Hospital Anxiety and Depression Scale, and IBS-Quality of Life subscale results in 219 patients with IBS-D and 33 patients with IBS-C IBS-D IBS-C P-value Demographics Age (years), mean (SD) 41 (14) 51 (12) 0.001 % females 79 100 0.004 BMI (kg/m2), mean (SD) 30 (7) 28 (6) 0.1878 Hospital Anxiety and Depression Scale (HADS) score, mean (SD) HADS total score 8.5 (5.2) 3.4 (2.6) < 0.0001 HADS anxiety score 6 (3.6) 2.5 (1.9) < 0.0001 HADS depression score 2.5 (2.3) 0.97 (1.1) 0.0006 IBS-Quality of Life total score, mean (95% CI) Total score 30.1 (27.6, 32.5) 9.1 (6.7, 11.5) < 0.0001 IBS-Quality of Life subscales, mean (95% CI) Dysphoria 28.1 (24.8, 31.5) 4.2 (1.9, 6.4) < 0.0001 Interference with activity 37.2 (34.2, 40.2) 7.1 (4.3, 10.0) < 0.0001 Proximity to toilet important: grades (1-5) 6/27/24/20/22% 59/37/4/0/0% < 0.0001 Long trips difficult: grades (1-5) 14/32/20/19/16% 78/19/4/0/0% < 0.0001 Body image 26.9 (24.2, 29.6) 18.3 (13.6, 23.0) 0.0249 Food avoidance 52.7 (48.5, 56.9) 13.0 (8.0, 17.9) < 0.0001 Social reaction 27.5 (24.5, 30.5) 8.1 (4.0, 12.2) < 0.0001 Sexual 17.2 (14.1, 20.2) 8.3 (2.8, 13.8) 0.0425 Relationship 20.1 (17.5, 22.8) 3.7 (1.4, 6.0) < 0.0001 SD=standard deviation; CI=confidence interval. Italicized factors reflect participants’ answers on a 1-5 scale for the interference with activity subscale, with 1 being “not at all” and 5 being “extremely”; higher scores reflect worse QOL.