Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain?

doi:10.3748/wjg.v28.i33.4861

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Sep 7, 2022 (publication date) through Nov 26, 2024

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Sep 7, 2022; 28(33): 4861-4874
Published online Sep 7, 2022. doi: 10.3748/wjg.v28.i33.4861

Table 1 Demographic data for irritable bowel syndrome patients with abdominal pain alone, abdominal discomfort alone, and abdominal pain & discomfort

Variable	Pain group (n = 233)	Discomfort group (n = 83)	Pain & discomfort group (n = 51)	P value
Male, %	117 (50.2)	56 (67.5)	32 (62.7)	0.01²
Age in yr	43.7 ± 11.7	42.3 ± 10.6	40.8 ± 11.0	0.23
BMI in kg/m²	23.0 ± 4.0	22.8 ± 4.0	22.3 ± 3.8	0.56
Education level, college and above, %	71 (30.5)	29 (34.9)	13 (25.5)	0.51
Physical labor, %	135 (57.9)	42 (50.6)	34 (66.7)	0.18
Family economic status, well-off & above, %	105 (45.1)	44 (53.0)	18 (35.3)	0.13
Marriage status, married, %	201 (86.3)	71 (85.5)	41 (80.4)	0.56
IBS disease course in yr¹	6.0 (7.5)	5.3 (7.0)	6.0 (7.0)	0.38
IBS type				0.06
IBS-D, %	95.7	96.4	86.3
IBS-C, %	3.0	2.4	7.8
IBS-M, %	1.3	1.2	5.9

¹Data presented as median (interquartile range), Kruskal-Wallis test. Note: P value is the difference among pain group, discomfort group, and pain & discomfort group, superscript letter is significantly different at a P < 0.05.

²The difference is between the pain group and discomfort group.

Data presented as number (%) or mean ± SD. Analysis of variance and χ²tests. IBS-D: Irritable bowel syndrome with diarrhea; BMI: Body mass index; IBS-C: Irritable bowel syndrome with constipation; IBS-M: Mixed irritable bowel syndrome.

Table 2 Characteristics of bowel symptoms in irritable bowel syndrome patients with abdominal pain alone, abdominal discomfort alone, and abdominal pain & discomfort

Variable	Pain group (n = 233)	Discomfort group (n = 83)	Pain & discomfort group (n = 51)	P value
Location¹, %				0.213
Left lower quadrant	67 (28.8)	14 (16.9)	12 (23.5)
Umbilical	79 (33.9)	27 (32.5)	20 (39.2)
Lower abdomen	65 (27.9)	23 (27.7)	15 (29.4)
Epigastric	11 (4.7)	2 (2.4)	2 (3.9)
Whole abdomen	12 (4.0)	8 (9.6)	5 (9.8)
Others	24 (10.3)	18 (21.7)	7 (13.7)
Severity, %				0.007
Mild	21 (9.0)	19 (22.9)	6 (11.7)
Moderate	160 (68.7)	55 (66.3)	37 (72.6)
Severe	52 (22.3)	9 (10.8)	8 (15.7)
Frequency, %				0.290
3 d/mo	37 (15.9)	11 (13.3)	4 (7.84)
1 d/wk	25 (10.7)	5 (6.0)	2 (3.9)
>1 d/wk	108 (46.4)	38 (45.8)	27 (52.94)
Every day	63 (27.0)	29 (34.9)	18 (35.3)
Ordinary pain/discomfort, %				< 0.001
Pain alone	84 (36.1)	6 (7.2)	6 (11.8)
Discomfort alone	21 (9.0)	43 (51.8)	3 (5.9)
Pain & discomfort	7 (3.0)	2 (2.4)	28 (54.9)
No pain or discomfort	121 (51.9)	32 (38.6)	14 (27.4)
Defecation-related symptoms, %
Abdominal bloating	93 (39.9)	43 (51.8)	35 (68.6)	0.001³
Abdominal distension	21 (9.0)	13(15.7)	12 (23.5)	0.01³
Urgency	197 (84.6)	80 (96.4)	42 (82.4)	0.01²^,⁴
Defecation straining	70 (30.0)	25 (30.1)	23 (45.1)	0.10
Sensation of anorectal obstruction	62 (26.6)	30 (36.1)	19 (37.3)	0.13
Anorectal pain	28 (12.0)	15 (18.1)	17 (33.3)	0.001³
Sensation of incomplete evacuation	164 (70.4)	74 (89.2)	39 (76.5)	0.003²
Passing mucus	141 (60.5)	66 (79.5)	39 (76.5)	0.002²

¹Some patients reported more than one location. χ² test, data presented as number (%).

²The difference is between pain group and discomfort group.

³The difference is between pain group and pain & discomfort group.

⁴The difference is between discomfort group and pain & discomfort group.

P value is the difference among pain group, discomfort group, and pain & discomfort group, and superscript letters are significantly different at a P < 0.05.

Table 3 Coexisting extraintestinal symptoms of irritable bowel syndrome patients with abdominal pain alone, abdominal discomfort alone, and abdominal pain & discomfort

Variable	Pain group (n = 233)	Discomfort group (n = 83)	Pain & discomfort group (n = 51)	P value
GERD, %	60 (25.8)	14 (16.9)	10 (19.6)	0.20
Heartburn	35 (15.0)	6 (7.2)	6 (11.8)	0.18
Acid reflux	44 (18.9)	10 (12.1)	5 (9.8)	0.15
Food regurgitation	14 (6.0)	4 (4.8)	3 (5.9)	0.92
Retrosternal chest pain	10 (4.3)	3 (3.6)	2 (3.9)	0.96
Functional dyspepsia, %	86 (36.9)	23 (27.7)	18 (35.3)	0.32
Epigastric pain syndrome	49 (21.0)	6 (7.2)	7 (13.7)	0.01²
Epigastric pain	43 (18.5)	5 (6.0)	7 (13.7)	0.02²
Epigastric burning	12 (5.2)	2 (2.4)	3 (5.9)	0.54
Postprandial distress syndrome	64 (27.5)	22 (26.5)	15 (29.4)	0.94
Postprandial fullness	57 (24.5)	20 (24.1)	9 (17.7)	0.57
Early satiation	14 (6.0)	6 (7.2)	9 (17.7)	0.02³
Somatic pain, %
Headache	17 (45.9)	37 (44.6)	26 (51.0)	0.76
Neck pain	21 (9.0)	7 (8.4)	3 (5.9)	0.77
Backache	41 (17.6)	8 (9.6)	7 (13.7)	0.21
Dyspareunia	12 (5.2)	6 (7.2)	11 (21.6)	< 0.001³^,⁴
Menstrual pain¹	30 (25.9)	10 (37.0)	11 (57.9)	0.016³

¹The number of female patients in the abdominal pain, abdominal discomfort, and pain & discomfort groups was 116, 27, and 19, respectively. χ²test. Data presented as number (%).

²P value is difference between the pain group and the discomfort group.

³The difference is between the pain group and the pain & discomfort group.

⁴The difference is between the discomfort group and the pain & discomfort group.

P value is the difference among the pain group, discomfort group, and pain & discomfort group, and superscript letters are significantly different at P < 0.05. GERD: Gastroesophageal reflux disease.

Table 4 Comorbid anxiety and depression among irritable bowel syndrome patients with abdominal pain alone, abdominal discomfort alone, and abdominal pain & discomfort

Variable	Pain group (n = 233)	Discomfort group (n = 83)		Pain & discomfort group (n = 51)	P value
HAMA score	16.1 ± 7.3		15.5 ± 7.3	17.3 ± 7.4	0.36
Comorbid anxiety, %	141 (60.5)		49 (59.0)	38 (74.5)	0.14
Mild	69 (29.6)		25 (30.1)	21 (41.2)	0.26
Moderate-severe	72 (30.9)		24 (28.9)	17 (33.3)	0.86
HAMD score	13.2 ± 6.2		12.3 ± 6.1	14.3 ± 5.5	0.18
Comorbid depression, %	66 (28.3)		22 (26.5)	18 (35.3)	0.53
Mild	54 (23.2)		20 (24.1)	17 (33.3)	0.31
Moderate-severe	12 (5.2)		2 (2.4)	1 (2.0)	0.40
Comorbid anxiety & depression, %	62 (26.6)		20 (24.1)	18 (35.3)	0.35

Data presented as mean ± SD or number (%). Student’s t test and χ²tests. P value is difference among the pain group, discomfort group, and pain & discomfort group. HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale.

Table 5 Consultations and medications of irritable bowel syndrome patients with abdominal pain alone, abdominal discomfort alone, and abdominal pain & discomfort

Variable	Pain group (n = 233)	Discomfort group (n = 83)	Pain & discomfort group (n = 51)	P value
In the whole disease course
Consultation times per year¹	4.6 ± 6.7	5.7 ± 6.2	4.2 ± 4.1	0.54
Colonoscopies²	1.9 ± 1.4	1.5 ± 0.8	1.6 ± 0.9	0.22
In the last year
Consultation times¹	4.0 ± 5.7	4.5 ± 4.5	4.9 ± 4.7	0.54
Medications, intermittent and long-term use, %	164 (70.4)	56 (67.5)	43 (84.3)	0.09
Antispasmodics use
Use rate	29 (12.4)	24 (28.9)	12 (23.5)	0.002³
Response rate	22 (75.9)	13 (54.2)	10 (83.3)	0.12
Overall satisfaction to medical care, %	125 (53.7)	39 (47.0)	21 (41.2)	0.21

¹Consultation times were average consultation times of consulters.

²Colonoscopies were average colonoscopies of patients who performed colonoscopies.

³The difference is between the pain group and the discomfort group.

Data presented as mean ± SD or number (%). Analysis of variance and χ²test. P value is difference among pain group, discomfort group, and pain & discomfort group, and superscript letter is significantly different at a P < 0.05.

Table 6 Risk factors for irritable bowel syndrome patients describing symptoms as abdominal pain alone, abdominal discomfort alone, and abdominal pain & discomfort

	Partial regression coefficient	Standard error	Wald χ²	95%CI	P value
Abdominal discomfort alone vs abdominal pain alone
Male sex	0.671	0.291	5.293	1.955 (1.104-3.462)	0.021^a
Severity (mild defecatory pain or discomfort)	1.391	0.525	7.018	4.020 (1.436-11.253)	0.008^a
Abdominal pain alone vs abdominal pain & discomfort
Abdominal bloating	0.805	0.372	4.692	2.238 (1.080-4.638)	0.030^a
Anorectal pain	1.091	0.405	7.272	2.979 (1.347-6.585)	0.007^a

^aP < 0.05. Multiple logistic regression analysis. Superscript letter is significantly different at a P < 0.05.

CI: Confidence interval.

Citation: Fang XC, Fan WJ, Drossman DD, Han SM, Ke MY. Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain? World J Gastroenterol 2022; 28(33): 4861-4874
URL: https://www.wjgnet.com/1007-9327/full/v28/i33/4861.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i33.4861