Singh P¹, Lee HN¹, Rangan V¹, Ballou S¹, Lembo J¹, Katon J¹, McMahon C¹, Friedlander D¹, Iturrino J¹, Nee J¹, Lembo A². Clin Gastroenterol Hepatol. 2019 Aug 20. pii: S1542-3565(19)30895-X. doi: 10.1016/j.cgh.2019.08.020. [Epub ahead of print]

Author information

1 Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

2 Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: alembo@bidmc.harvard.edu.

Abstract

BACKGROUND & AIMS: There have been few published studies of clinical and psychological characteristics of patients with functional diarrhea (FDr). We studied the clinical and psychological characteristics of patients with FDr presenting to a tertiary care clinic, and compared symptom profiles of FDr with those of IBS-diarrhea (IBS-D).

METHODS: Consecutive patients with a diagnosis of FDr (n=48) or IBS-D (n=49), per Rome IV criteria, completed a detailed symptom survey from October 2017 through July 2018. Abdominal pain and diarrhea severity were assessed using patient-reported outcomes measurement information system (PROMIS) questionnaires. Patients with anxiety, depression, or sleep disturbances were identified based on PROMIS T-score of 60 or more. Mean and proportions were compared using the Student t test and χ2 analyses, respectively.

RESULTS: A significantly lower proportion of patients with FDr reported abdominal pain (77.1%) than patients with IBS-D (100%, P<.001). The proportion of patients reporting abdominal bloating and level of severity did not differ significantly between groups. Proportions of bowel movements with diarrhea did not differ significantly between groups (P=.54), but the mean diarrhea PROMIS T-score was significantly higher among patients with IBS-D (P=.03). This difference resulted from the significantly higher levels of fecal urgency-related distress reported by patients with IBS-D (P=.007). Proportions of patients with anxiety, depression, or sleep disturbance, and their severities, did not differ significantly between groups.

CONCLUSIONS: In an analysis of about 100 patients with FDr or IBS-D, we found overlap in gastrointestinal and psychosomatic symptoms. These 2 entities appear to be a continuum.