Su1371 Non-Traumatic Stressful Events At the Time of Abdominal Pain Onset Is a Marker of Current Psychological but Not GI Health in More Severe IBS Patients

Abstract

BACKGROUND. IBS is a chronic, potentially disabling GI disorder that affects up to 50 million Americans. Despite its prevalence, IBS symptoms of a significant proportion of individuals go unrecognized or untreated. Efforts to improve case detection by encouraging MDs to adopt Rome diagnostic criteria have been suboptimal. An alternative approach is to improve symptom reporting through the use of self-administered checklists or screeners that increase individuals' awareness and knowledge of the diagnostic symptoms of IBS. When shared with the treating gastroenterologist (GE), information derived from symptom checklists have potential to improve diagnostic accuracy, conserve time and resources, strengthen patient engagement, and help patients obtain improved quality of life and relief for the disorder for which they seek care. These goals have been hampered by the lack of a brief, easy to administer, simple to score/interpret, and validated measure.AIM. To examine the diagnostic accuracy of a brief (4 True-False questions) screening tool of IBS symptoms based on Rome III criteria. METHOD. 384 IBS patients (80% F; M age = 41 yrs.) completed the IBS screener (4-IBS) that was embedded in a test battery administered at pretreatment assessment of an NIH trial for IBS. Assessment included the IBS Symptom Severity Scale, IBS QOL, Brief Symptom Inventory (distress), SF-12, Visceral Sensitivity Inventory (VSI, fear of visceral sensation). Administration time was < 1 minute. GI symptoms were assessed by a board certified GE who confirmed Rome diagnosis (‘gold standard') in all cases. GEs were blind to patient responses to the 4-IBS when Rome diagnosis was made. RESULTS. Agreement between GE diagnosis and 4-IBS screener diagnosis was good to excellent. The 4-IBS symptom screener correctly diagnosed IBS in 71% of IBS-C patients and 75% of IBSD patients. Agreement was strongest (90%) for IBS-M patients. Patients for whom there was greatest agreement between self-report and GE diagnosis were characterized by stronger fears of GI symptoms (VSI, p<.05).CONCLUSION. Data corroborated the diagnostic validity of a brief, self-report IBS screener for identifying patients likely to meet Rome criteria for IBS. While a clinical evaluation is necessary to confirm IBS and rule out other potential conditions whose GI symptoms mimic those of IBS, the 4-IBS screener may prove useful for identifying IBS patients in busy clinical settings. A self-screener may be particularly useful for early identification of patients who drive health care use. For patients with stronger fears of GI symptoms (high VSI), their hypervigilance to core IBS symptoms and features (e.g., pain onset associated with change in stool consistency) may promote accurate diagnosis of IBS relative to less fearful patients with lower attentional focus to visceral sensations. Acknowledgements: NIH grant DK77738