The Impact Factors On Quality Of Life For Patients With Irritable Bowel Syndrome With Diarrhea

Background and Objective Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which is characterized by abdominal pain or discomfort with altered bowel habits and stool forms. The chronic persistent or recurrent symptoms might significantly impaire the quality of life(QOL) for patients. QOL has been became one of measures to evaluate the severity of IBS and the response to treatment. The aims of this study are to investigate the gastrointestinal symptoms, and psychological status and QOL in patients of IBS with diarrhea (IBS-D), and to analyze the possible factors which impact on the QOL.Methods Patients met Rome III criteria of IBS-D were consecutively enrolled. The IBS symptom questionnaire, IBS-specific QOL(IBS-QOL) questionnaire, and Hamilton Rating Scale for Depression/Anxiety (HAMD/HAMA) were completed in face-to-face manner by well trained investigators. X2test, the Mantel-Haenszel test, analysis of variance (ANOVA), the two-sample independent t-test or the Mann-Whitney test, Spearman rank analysis and multiple linear regressions were used for the data analysis. Statistical significance was set as a two sided P<0.05.Results A total of155IBS-D patients (97males and58females) were included in this study, with the average age43.55±11.12years. The mean overall score of IBS-QOL was71.61±19.22. Among eight domains of QOL, the greatest impairment was in food avoidance (53.23±26.82), followed by anxious factor (67.52±24.39), body image domain was with the highest score (85.28±16.75). The score of food avoidance for female was lower than male (P=0.012). There are negative correlations between the bowel predominant symptoms score, defecation-related symptoms score, global bowel symptoms score and IBS-QOL (r1=-0.215, Pi=0.007. r2=-0.357, P2=0.000. r3=-0.304, P3=0.000). Patients with persistent IBS had lower QOL score than those with episode symptoms (65.62±22.47vs80.26±12.63, P=0.003). The frequency of passing mucus and intensity of urgency to defecation were the independent risk factors to predict lower IBS-QOL score. Overlapping with gastroesophageal reflux disease (GERD) and/or functional dyspepsia (FD) did not impair the IBS-QOL score. IBS-D patients with history of abuse and/or psychological distress have lower IBS-QOL score(P=0.016, P=0.011). The IBS-QOL score had negative correlation with HAMD/HAMA(r1=-0.268, r2=-0.262, P=0.001). The obvious depression and anxiety worsen patients’ feeling to abdominal pain and urgency to defecation. Sleep disorders had minor effects on the quality of life for IBS-D patients. Considering under the equal circumstances, the increase of global bowel symptoms score bring more obvious decrease of QOL score than the change of HAMD/HAMA score. Diet avoidance is very common in IBS-D patients, and impare IBS-QOL(P<0.05).Conclusions:Lower quality of life for IBS-D patients was impacted by their bowel predominant symptoms, defecation-related symptoms, psychological factors and diet avoidance. When patients had recurrent or persistent IBS, the global bowel symptoms play a determinant role for their quality of life, co-existed psychological disorders worsen patients’ feeling to bowel symptoms and quality of life.