Psychological factors influence the overlap syndrome in functional gastrointestinal disorders (FGIDs) among middle-aged women in South Korea

Overlap of disorders of gut-brain interaction: a systematic review and meta-analysis

BACKGROUND

Rome criteria differentiate distinct types of disorders of gut-brain interaction (DGBI); also known as functional gastrointestinal disorders. Overlap of symptom categories frequently occurs. This systematic review and meta-analysis aimed to define the prevalence of DGBI overlap and compare overlap in population-based, primary care or tertiary care health settings. Furthermore, we aimed to compare symptom severity of psychological comorbidities in DGBI with and without overlap.

METHODS

For this systematic review and meta-analysis we searched MEDLINE (PubMed) and Embase electronic databases from inception until March 1, 2022, for original articles and conference abstracts of observational cross-sectional, case-controlled, or cohort design studies that reported the prevalence of DGBI overlap in adult participants (aged ≥18 years). We included only those studies where the diagnosis of DGBI was based on clinical assessment, questionnaire data, or specific symptom-based criteria. Studies were excluded if reporting on mixed populations of DGBI and organic diseases. Aggregate patient data were extracted from eligible published studies. The prevalence of DGBI overlap in all studies was pooled using the DerSimonian and Laird random effects model, and further analysis stratified by subgroups (care setting, diagnostic criteria, geographic region, and gross domestic product per capita). We also assessed the relationship between DGBI overlap with anxiety, depression, and quality of life symptom scores. This study was registered with PROSPERO (CRD42022311101).

FINDINGS

46 of 1268 screened studies, reporting on 75 682 adult DGBI participants, were eligible for inclusion in this systematic review and meta-analysis. Overall, 24 424 (pooled prevalence 36·5% [95% CI 30·7 to 42·6]) participants had a DGBI overlap, with considerable between-study heterogeneity (I2=99·51, p=0·0001). In the tertiary health-care setting, overlap among participants with DGBI was more prevalent (8373 of 22 617, pooled prevalence 47·3% [95% CI 33·2 to 61·7]) compared with population-based cohorts (11 332 of 39 749, pooled prevalence 26·5% [95% CI 20·5 to 33·4]; odds ratio 2·50 [95% CI 1·28 to 4·87]; p=0·0084). Quality of life physical component scores were significantly lower in participants with DGBI overlap compared with participants without overlap (standardised mean difference -0·47 [95% CI -0·80 to -0·14]; p=0·025). Participants with DGBI overlap had both increased symptom scores for anxiety (0·39 [95% CI 0·24 to 0·54]; p=0·0001) and depression (0·41 [0·30 to 0·51]; p=0·0001).

INTERPRETATION

Overlap of DGBI subtypes is frequent, and is more prevalent in tertiary care settings and associated with more severe symptom manifestations or psychological comorbidities. Despite the large sample size, the comparative analyses revealed substantial heterogeneity, and the results should be interpreted with caution.

FUNDING

National Health and Medical Research Council and Centre for Research Excellence.

Cluster Analysis on Gastrointestinal Symptoms during Menopausal Transition

The purpose of this secondary analysis was to determine the clusters of midlife women by gastrointestinal (GI) symptoms and to explore differences in the clusters by race/ethnicity. This analysis used the data from two internet-based studies among 1,054 midlife women. The analysis was conducted with the data on background characteristics, health and menopausal status, and GI symptoms (collected using the GI Symptom Index for Midlife Women). The data were analyzed using factor analyses, hierarchical cluster analyses, chi-square tests, multinomial logistic regression analyses, and analyses of covariance. Three clusters were adopted: Cluster 1 (with low total numbers and severity scores of symptoms; 46.0%), Cluster 2 (with moderate total numbers and severity scores of symptoms; 44.0%), and Cluster 3 (with high total numbers and severity scores of symptoms; 10.0%). Only in Cluster 2, there were significant racial/ethnic differences in individual GI symptoms. These results provide directions for future GI symptom management among midlife women.

Incongruent Views of Functioning between Patients and Gastroenterologists: A Mixed Methods Study

Gastrointestinal patients, especially those diagnosed with functional digestive disorders (FGIDs), usually present a complex clinical picture that poses a challenge for their management in primary care. The main objective of the current research was to examine the relationship of the congruence of the perception of severity and quality of life between gastroenterologists and their patients with psychological distress and the helping attitude experienced by the latter attended in primary care centres. Additionally, we wanted to explore patients' and practitioners' perceptions. We performed a cross-sectional study with a total of 2261 patients (1562 analysed) that attended three primary care centres. Patients completed questionnaires that measured physical functioning, distress, and perception of helping attitude. Gastroenterologists registered the functional status of each participating patient. Patients were then invited to take part in the qualitative part of the study if they were considered to have incongruent views on their functioning with their gastroenterologist. In total, 52 patients took part in one of eight focus groups. Additionally, four individual interviews were carried out with three gastroenterologists and one consultation-liaison psychiatrist specialised in FGIDs. Both incongruence and functional diagnosis correlated with distress. However, incongruent views between patients and gastroenterologists explained more variance. Statistically significant differences in patients' helping attitude perception were detected between diagnostic but no incongruence groups. In the second stage of the study, a total of five themes were identified from the patient focus groups and the gastroenterologist interviews: illness-emotional and personal problems, disease-health system interaction, health system, intervention, and patients. The current research allowed us to confirm that incongruence in the perception of severity and quality of life between gastroenterologists and patients is related to psychological distress and that this occurs in a multifactorial context where the characteristics of the disorder interact with those of the health system.

Gastrointestinal symptoms in four major racial/ethnic groups of midlife women: race/ethnicity and menopausal status

OBJECTIVE

The purpose of this study was to explore the associations of race/ethnicity and menopausal status to gastrointestinal (GI) symptoms experienced during the menopausal transition while considering multiple factors that could influence the symptoms.

METHODS

This secondary analysis was conducted with the data from 1,051 women from 2 Internet-based studies on midlife women's health issues. In the original studies, the data were collected using a dozen questions on sociodemographic and health/menopausal factors and the GI Index for Midlife Women. The data were analyzed utilizing ANOVA, multiple logistic regression, and hierarchical linear regression analyses.

RESULTS

When covariates were controlled, being Non-Hispanic (N-H) Asian was a significant factor that influenced the total numbers of GI symptoms (β = -0.26) and total severity scores of GI symptoms (β = -0.26). When covariates were controlled, premenopausal status was the strongest factor that influenced the total numbers of GI symptoms in all participants, Hispanics, N-H Whites, N-H African Americans, and N-H Asians (β = 53, -0.40, -0.77, -0.76, -0.26, respectively) and the total severity scores of GI symptoms in all participants, Hispanics, N-H Whites, N-H African Americans, and N-H Asians (β = -0.50, -0.38, -0.72, -0.75, -0.25, respectively).

CONCLUSIONS

This study supports the association of race/ethnicity and menopausal status to GI symptoms experienced during the menopausal transition.

Patients with Multiple Functional Gastrointestinal Disorders (FGIDs) Show Increased Illness Severity: A Cross-Sectional Study in a Tertiary Care FGID Specialty Clinic

OBJECTIVES

Overlaps between different functional gastrointestinal disorders (FGIDs) are common. However, little is known about the impact of this overlap on patients' health status. This study is aimed at analyzing the differences between patients with multiple as compared to one single FGID.

METHODS

A retrospective, cross-sectional study was conducted with patients presenting to a tertiary care FGID specialty clinic between 06/2012 and 01/2015 (n = 294). They were characterized primarily according to their GI symptom severity (IBS-SSS) and secondarily to their physical as well as psychosocial symptom burden, quality of life, health care utilization, and work-related impairment. Differences between patients with >1 vs. 1 FGID were analyzed.

RESULTS

Of the 294 patients, 92.2% fulfilled the Rome III criteria for any FGID, and 48.0% had >1 FGIDs. FGID patients had a median age of 38 [23.0] years; 72.0% were female. Median GI symptom severity (IBS-SSS) scores were 339 [126] and 232 [163] in patients with >1 and 1 FGID, respectively (p < .001). Furthermore, patients with >1 FGIDs had higher general somatic symptom severity, higher illness anxiety, lower quality of life, and more work-related impairment. Almost no differences were found regarding their somatic as well as mental comorbidities.

CONCLUSIONS

Multiple FGIDs are associated with an increased risk for complicated courses of illness as reflected in higher GI and somatic symptom severity, as well as stronger psychosocial and diet- and work-related impairment. Stepped and interdisciplinary models of care including psychosocial expertise and dietary advice are needed, especially for patients with multiple FGIDs.