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Characterization of the Alternating Bowel Habit Subtype in Patients with Irritable Bowel Syndrome

Tillisch, Kirsten, M.D.; Labus, Jennifer S., Ph.D.; Naliboff, Bruce D., Ph.D.; Bolus, Roger, Ph.D.; Shetzline, Michael, M.D.; Mayer, Emeran A., M.D.; Chang, Lin, M.D.

American Journal of Gastroenterology: April 2005 - Volume 100 - Issue 4 - p 896–904

BACKGROUND Due to a wide range of symptom patterns, patients with irritable bowel syndrome (IBS) are often subgrouped by bowel habit. However, the IBS subgroup with alternating bowel habits (IBS-A) has been poorly characterized.

OBJECTIVES (i) To determine a set of bowel habit symptom criteria, which most specifically identifies IBS patients with an alternating bowel habit, (ii) to describe IBS-A bowel symptom patterns, and (iii) to compare clinical characteristics among IBS-A, constipation-predominant (IBS-C), and diarrhea-predominant IBS (IBS-D).

METHODS One thousand one hundred and two Rome I positive IBS patients were analyzed. Three sets of potential criteria for IBS-A were developed and compared by multirater Kappa test. Gastrointestinal, psychological, extraintestinal symptoms, and health-related quality of life were compared in IBS-A, IBS-C, and IBS-D using χ2 test and analysis of variance (ANOVA).

RESULTS Stool consistency was determined to be the most specific criteria for alternating bowel habits. IBS-A patients reported rapid fluctuations in bowel habits with short symptom flares and remissions. There was a greater prevalence of psychological and extraintestinal symptoms in the IBS-A subgroup compared to IBS-C and IBS-D. No differences were seen between bowel habit subtypes in health-related quality of life.

CONCLUSIONS IBS-A patients have rapidly fluctuating symptoms and increased psychological comorbidity, which should be taken into account for clinical practice and clinical trials.

CNS/WH: Center for Neurovisceral Sciences & Women's Health, Departments of Medicine, Physiology, Psychiatry & Biobehavioral Sciences, UCLA, and the VA Greater Los Angeles Healthcare System, Los Angeles, California; and Novartis Pharmaceuticals, East Hanover, New Jersey

Reprint requests and correspondence: Kirsten Tillisch, M.D., CNS/WH: Center for Neurovisceral Sciences & Women's Health, CURE Building 115, Room 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073.

Received July 20, 2004; accepted December 13, 2004.

© The American College of Gastroenterology 2005. All Rights Reserved.
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