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Gastroenterology
Beware the
Irritable Bowel
Deciphering the overlap of symptoms
By Susan Andersen, PhD, RN, FNP-BC
➼ As Sharon sat in the lobby waiting
to be called for her annual exam, she
realized she was checking off questionnaire
answers in nearly every body system.
Headaches, diarrhea, constipation,
bloating, flatulence, abdominal pain and
cramping, frequent mouth sores, fatigue,
depression, an itchy rash that would not
go away … How long had she felt this
way She couldn’t remember. “Just how
sick am I” she wondered.
This is a typical scenario for a patient
presenting with a functional bowel disorder,
which despite its symptomatic
nature has no identifiable mechanical
cause. Functional bowel disorders include
irritable bowel syndrome (IBS), functional
diarrhea and chronic constipation.
Celiac disease and gluten sensitivity
cause symptoms similar to those of IBS,
but these are not considered functional
bowel disorders.
The fact that 33% to 90% of people
who experience IBS symptoms do not
consult a healthcare provider contributes
to the variability in prevalence estimates. 2
Most IBS patients in Western countries
are never diagnosed, with the exception
of the United Kingdom and Italy, where
about half of positive cases are identified.
Predictors of healthcare-seeking include
severity of abdominal pain and distention,
Rome criteria status (http://romecriteria.
org/assets/pdf/19_RomeIII_apA_885-898.
pdf) and impact on mood and lifestyle.
Studies show that patients experience
symptoms between 5 and 13 years prior
to diagnosis. Although comorbidity with
other GI disorders or mortality is not
associated with IBS, no cure has been
identified. One review found the mean
direct costs of IBS management to be
$619 per patient annually, with total direct
costs of $1.35 billion. 6 Productivity losses
in the United States range from $335 to
$748 per patient, for an annual total of
$205 million due to lost workdays. Costs
to patients with celiac disease were $4,000
(all patients) to $10,000 (men) higher
annually than for healthy controls. 7 From
these numbers, we can extrapolate that
if 1% of the U.S. population is affected
by IBS, the annual healthcare costs are
$124.4 million to $311 million.
IBS negatively affects quality of life and
social function. Patients may experience
increased anxiety, depression, pain and
discomfort. 8 Patients in whom constipation
predominates among IBS symptoms
have significantly lower quality-of-life
scores on physical and mental components
Epidemiology
IBS is diagnosed in 1 in 5 Americans
each year. 1 Among adults, IBS incidence
peaks between ages 30 and 50. 2 Women
are affected twice as often as men at
younger ages, but men and women are
at equal risk later in life. 2 The estimated
prevalence of IBS in Western countries
varies widely, from 5% to 15%. 3-5 Italy has
the highest prevalence among developed
countries. 3-5
tom whalen
Susan Anderson is a family nurse practitioner
who is an associate professor in the
School of Nursing at Texas Tech University
Health Sciences Center in Lubbock, Texas.
She has completed a disclosure statement and
reports no relationships related to this article.
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