The DOI matches its Crossref record; 181 of the 181 references it cites were found in a registry or an index.
Systematic review of the comorbidity of irritable bowel syndrome with other disorders: What are the causes and implications?
Abstract
Background & aims Comorbid or extraintestinal symptoms occur frequently with irritable bowel syndrome and account for up to three fourths of excess health care visits. This challenges the assumption that irritable bowel is a distinct disorder. The aims of this study were to (1) assess comorbidity in 3 areas: gastrointestinal disorders, psychiatric disorders, and nongastrointestinal somatic disorders; and (2) evaluate explanatory hypotheses.Methods The scientific literature since 1966 in all languages cited in Medline was systematically reviewed.Results Comorbidity with other functional gastrointestinal disorders is high and may be caused by shared pathophysiological mechanisms such as visceral hypersensitivity. Psychiatric disorders, especially major depression, anxiety, and somatoform disorders, occur in up to 94%. The nongastrointestinal nonpsychiatric disorders with the best-documented association are fibromyalgia (median of 49% have IBS), chronic fatigue syndrome (51%), temporomandibular joint disorder (64%), and chronic pelvic pain (50%).Conclusions Multivariate statistical analyses suggest that these are distinct disorders and not manifestations of a common somatization disorder, but their strong comorbidity suggests a common feature important to their expression, which is most likely psychological. Some models explain the comorbidity of irritable bowel with other disorders by suggesting that each disorder is the manifestation of varying combinations of interacting physiological and psychological factors. An alternative hypothesis is that the irritable bowel diagnosis is applied to a heterogeneous group of patients, some of whom have a predominantly psychological etiology, whereas others have a predominantly biological etiology, and that the presence of multiple comorbid disorders is a marker for psychological influences on etiology.
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In the citing paper
“it is becoming increasingly understood how psychological co-morbidity may have an impact on gastrointestinal function, [30, 31, 32, 33] and vice versa, [34, 35]”
From Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis (2020) · cites this paper as [32]
In the citing paper
“Many IBS patients have at least one co-morbid somatic complaint and many meet diagnostic criteria for other functional disorders.”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [4]
In the citing paper
“Studies of IBS among patients with chronic fatigue syndrome have reported a prevalence ranging from 35-92%.”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [4]
In the citing paper
“Many IBS patients have at least one co-morbid somatic complaint and many meet diagnostic criteria for other functional disorders.”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [4]
In the citing paper
“The studies are consistent in their finding that the overlap among these disorders is greater than expected based on their separate prevalence rates.”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [4]
In the citing paper
“In addition, patients with more than 1 disorder have greater disease severity, higher rates of psychopathology, and more severely impaired health-related quality of life than those with only 1 disorder.4”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [4]
In the citing paper
“There is substantial overlap between IBS and other FGID, such as functional dyspepsia.”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [4]
In the citing paper
“Studies of IBS among CFS patients have reported a prevalence ranging from 35-92%34-38 with a median of 51%.4”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [4]
In the citing paper
“In summary, many IBS patients have at least 1 co-morbid somatic complaint and many of them meet diagnostic criteria for other gastrointestinal and extraintestinal functional disorders.”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [4]
In the citing paper
“Furthermore, in the systemic review, Whitehead et al. (20) reported that between a quarter and a third of patients with IBS meet the criteria for somatization disorder, which is much higher than in the normal population.”
From Psychosocial Distress and Somatic Symptoms in Community Subjects With Irritable Bowel Syndrome: A Psychological Component Is the Rule (2009) · cites this paper as [20]
In the citing paper
“It is well known that psychological and psychiatric comorbidity is common among patients with IBS (17,20,40).”
From Psychosocial Distress and Somatic Symptoms in Community Subjects With Irritable Bowel Syndrome: A Psychological Component Is the Rule (2009) · cites this paper as [20]
In the citing paper
“The definition of PPPD paralleled work in other areas of medicine where functional disorders (e.g., the functional gastrointestinal disorders [25, 91] and fibromyalgia [93, 94]) were defined by their core physical symptoms and not associated psychological features.”
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Nellesen, D., Yee, K., Chawla, A., Lewis, B. E., & Carson, R. T. (2013) · Journal of Managed Care Pharmacy · doi:10.18553/jmcp.2013.19.9.755 · Cited by 248
Catassi, C., Alaedini, A., Bojarski, C., Bonaz, B. L., Bouma, G., Carroccio, A., Castillejo, G., de Magistris, L., Dieterich, W., Liberto, D. D., et al. (2017) · Nutrients · doi:10.3390/nu9111268 · Cited by 249
“Patients with IBS report a reduced quality of life and there is an associated economic and societal cost [60,61].”
BackgroundImpact of Functional Gastrointestinal Disorders on Survival in the Community
CHANG, J. Y., Locke, R. G., McNally, M. A., Halder, S. L. S., Schleck, C. D., Zinsmeister, A. R., & Talley, N. J. (2010) · The American Journal of Gastroenterology · doi:10.1038/ajg.2010.40 · Cited by 235
“19 ); depression (and suicidal ideation) is also associated (”
BackgroundSpiller, R. E., Humes, D. J., Campbell, E., Hastings, M. C., Neal, K. R., Dukes, G. E., & Whorwell, P. J. (2010) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2010.04402.x · Cited by 241
An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome
Brandt, L. J., Chey, W. D., Foxx-Orenstein, A. E., Quigley, E. M. M., Schiller, L. R., Schoenfeld, P. S., Spiegel, B. M., Talley, N. J., & Moayyedi, P. (2009) · American Journal of Gastroenterology · doi:10.14309/00000434-200901001-00002 · Cited by 225
Walker, L. S., Sherman, A. L., Bruehl, S. P., Garber, J., & Smith, C. A. (2012) · Pain · doi:10.1016/j.pain.2012.03.026 · Cited by 232
Levy, R. L., Whitehead, W. E., Walker, L. S., Korff, M. V., Feld, A. D., Garner, M. D., & Christie, D. L. (2004) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2004.40478.x · Cited by 223
“This last observation may contribute to the development of multiple, extraintestinal symptoms that are frequently seen in association with IBS (2) and that account for two-third of their excess health-care costs in IBS patients (31).”
BackgroundResultSelf-citationEdwards, R. R., Ness, T. J., Weigent, D. A., & Fillingim, R. B. (2003) · Pain · doi:10.1016/j.pain.2003.09.005 · Cited by 220
“Relative to controls, patients with fibromyalgia (FM; Hurtig et al., 2001), whiplash (Kasch et al., 2001), headache (Bendtsen, 2000), temporomandibular disorder (TMD; Svensson et al., 2001), and irritable bowel syndrome (Whitehead et al., 2002) show enhanced pain sensitivity.”
BackgroundSomatic comorbidities of irritable bowel syndrome: A systematic analysis
Riedl, A., Schmidtmann, M., Stengel, A., Goebel, M., Wisser, A.-S., Klapp, B. F., & Mönnikes, H. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.02.021 · Cited by 274
Matricon, J., Méleine, M., Gelot, A., Piche, T., Dapoigny, M. C., Muller, E., & Ardid, D. (2012) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12080 · Cited by 216
The Burden of Illness of Irritable Bowel Syndrome: Current Challenges and Hope for the Future
Hulisz, D. (2004) · Journal of Managed Care Pharmacy · doi:10.18553/jmcp.2004.10.4.299 · Cited by 215
“5% of IBS patients also suffered from GERD.(4,5) About 50% of IBS sufferers experience at least 1 comorbid non–GI-related symptom, such as headache, back pain, poor sleep, and fatigue.”
BackgroundInfluentialCremonini, F., & Talley, N. J. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.02.008 · Cited by 215
Wu, Y., Murray, G. K., Byrne, E. M., Sidorenko, J., Visscher, P. M., & Wray, N. R. (2021) · Nature Communications · doi:10.1038/s41467-021-21280-7 · Cited by 220
Comorbidity in Irritable Bowel Syndrome
Whitehead, W. E., Palsson, O. S., Levy, R. R., Feld, A. D., Turner, M., & Von Korff, M. (2007) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2007.01540.x · Cited by 210
“We have previously shown that excess comorbitity is the primary determinant of excess health-care costs associated with IBS (5), and we suggested that understanding the causes of comorbidity is critical both to improving the care of IBS patients and to reducing the burden on the health-care system which these patients…”
BackgroundResultInfluentialSelf-citationStress and visceral pain: From animal models to clinical therapies
Larauche, M. H., Mulak, A., & Taché, Y. (2011) · Experimental Neurology · doi:10.1016/j.expneurol.2011.04.020 · Cited by 219
Irritable bowel syndrome: Diagnosis and pathogenesis
El‐Salhy, M. (2012) · World Journal of Gastroenterology · doi:10.3748/wjg.v18.i37.5151 · Cited by 222
Comorbid Subjective Health Complaints in Low Back Pain
Hagen, E. M., Svensen, E., Eriksen, H. R., Ihlebæk, C., & Ursin, H. (2006) · Spine · doi:10.1097/01.brs.0000219947.71168.08 · Cited by 210
“to all somatic complaints as seen in patients with irritable bowel syndrome.(22,23) These patients have high scores on most other subjective health complaints,(22) including musculoskeletal pain, while our LBP patients did not report any higher levels of gastrointestinal complaints than the general population.”
BackgroundGastrointestinal issues in autism spectrum disorder
Hsiao, E. Y. (2014) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000029 · Cited by 209
“In fact, it is estimated that 60% of patients suffering from functional GI disorders exhibit comorbid major affective disorders.(79)”
BackgroundThe cost of treating anxiety: the medical and demographic correlates that impact total medical costs
Marciniak, M. D., Lage, M. J., Dunayevich, E., Russell, J. M., Bowman, L., Landbloom, R. P., & Levine, L. R. (2005) · Depression and Anxiety · doi:10.1002/da.20074 · Cited by 204
“…of psychiatric [Dinardo and Barlow, 1990; Pini et al., 1997; Roy et al., 1995] as well as medical comorbidities [Carr 1999; Lloyd et al., 2000; Whitehead et al., 2002] among individuals diagnosed with anxiety as well as research which has shown increased hospitalizations, emergency room…”
BackgroundGrundmann, O., & Yoon, S. L. (2010) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2009.06120.x · Cited by 210
Is Irritable Bowel Syndrome a Low-Grade Inflammatory Bowel Disease?
Berčík, P., Verdu, E. F., & Collins, S. M. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.02.007 · Cited by 207
“Comorbidity of psychiatric conditions is high and occurs in up to 94% of patients [48].”
BackgroundEvidence-based clinical practice guidelines for irritable bowel syndrome
Fukudo, S., Kaneko, H., Akiho, H., Inamori, M., Endo, Y., Okumura, T., Kanazawa, M., Kamiya, T., Sato, K., Chiba, T., et al. (2014) · Journal of Gastroenterology · doi:10.1007/s00535-014-1017-0 · Cited by 208
“have at least one psychological disturbance [167].”
Spiegel, B. M. R., Farid, M., Esrailian, E., Talley, J., & Chang, L. (2010) · The American Journal of Gastroenterology · doi:10.1038/ajg.2010.47 · Cited by 206
Kuiken, S. D., Tytgat, G. N. J., & Boeckxstaens, G. E. (2003) · Clinical Gastroenterology and Hepatology · doi:10.1016/s1542-3565(03)70039-1 · Cited by 206
“The severity of IBS symptoms of abdominal bloating, flatulence, urgency, and the feeling of incomplete evacuation was scored before, at 2 weeks, and after 6 weeks of treatment on a self-rated scale, derived from the validated Gastrointestinal Symptom Rating Scale (GSRS), in which symptoms are rated on a 7-graded Liker…”
MethodKleykamp, B. A., Ferguson, M. C., McNicol, E., Bixho, I., Arnold, L. M., Edwards, R. R., Fillingim, R., Grol-Prokopczyk, H., Turk, D. C., & Dworkin, R. H. (2021) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2020.10.006 · Cited by 202
Fadgyas-Stanculete, M., Buga, A.-M., Popa-Wagner, A., & Dumitrascu, D. L. (2014) · Journal of Molecular Psychiatry · doi:10.1186/2049-9256-2-4 · Cited by 197
“Rates of co-morbidity with psychiatric disorders range from 54 to 94% in treatment-seeking patient with IBS [15-17].”
BackgroundMigraine, fibromyalgia, and depression among people with IBS: a prevalence study
Cole, J. A., Rothman, K. J., Cabral, H., Zhang, Y., & Farraye, F. A. (2006) · BMC Gastroenterology · doi:10.1186/1471-230x-6-26 · Cited by 196
The economic impact of irritable bowel syndrome
Inadomi, J. M., Fennerty, M. B., & Bjorkman, D. (2003) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.2003.t01-1-01736.x · Cited by 190
Intestinal Barrier Dysfunction in Irritable Bowel Syndrome: A Systematic Review
Hanning, N., Edwinson, A. L., Ceuleers, H., Peters, S. A., De Man, J. G., Hassett, L. C., De Winter, B. Y., & Grover, M. (2021) · Therapeutic Advances in Gastroenterology · doi:10.1177/1756284821993586 · Cited by 197
Gut memories: Towards a cognitive neurobiology of irritable bowel syndrome
Kennedy, P. J., Clarke, G., Quigley, E. M. M., Groeger, J. A., Dinan, T. G., & Cryan, J. F. (2012) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2011.07.001 · Cited by 193
There is only one functional somatic syndrome
Wessely, S. C., & White, P. D. (2004) · The British Journal of Psychiatry · doi:10.1192/bjp.185.2.95 · Cited by 193
Microbiome, Metabolome and Inflammatory Bowel Disease
Ahmed, I., Roy, B. C., Khan, S., Septer, S. S., & Umar, S. (2016) · Microorganisms · doi:10.3390/microorganisms4020020 · Cited by 199
Evidence-based clinical practice guidelines for irritable bowel syndrome 2020
Fukudo, S., Okumura, T., Inamori, M., Okuyama, Y., Kanazawa, M., Kamiya, T., Sato, K., Shiotani, A., Naito, Y., Fujikawa, Y., et al. (2021) · Journal of Gastroenterology · doi:10.1007/s00535-020-01746-z · Cited by 201
“Comment: IBS shows high co-morbidity with extraintestinal disorders such as fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, temporomandibular joint disease, interstitial cystitis, premenstrual syndrome, bronchial asthma, dementia [218], Parkinson’s disease [219], and psychological disturbance especially a…”
BackgroundGebhart, G. F., & Bielefeldt, K. (2016) · Comprehensive physiology · doi:10.1002/cphy.c150049 · Cited by 238
Psychosocial determinants of irritable bowel syndrome
Blaga, T. S. (2012) · World Journal of Gastroenterology · doi:10.3748/wjg.v18.i7.616 · Cited by 198
Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study
Wensaas, K., Langeland, N., Hanevik, K., Mørch, K., Eide, G. E., & Rørtveit, G. (2011) · Gut · doi:10.1136/gutjnl-2011-300220 · Cited by 184
A psychology of the human brain-gut-microbiome axis
Allen, A. P., Dinan, T. G., Clarke, G., & Cryan, J. F. (2017) · Social and Personality Psychology Compass · doi:10.1111/spc3.12309 · Cited by 174
Metadata
- Authors
- Whitehead, W. E., Palsson, O., & Jones, K. R.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2002-04
- Volume
- 122
- Issue
- 4
- Pages
- 1140-1156
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2145558296
- Cited by
- 1,116
- References
- 180
- Citations by year
- 2026: 26 · 2025: 16 · 2024: 29 · 2023: 27 · 2022: 63 · 2021: 53 · 2020: 53 · 2019: 49 · 2018: 50 · 2017: 51 · 2016: 63 · 2015: 51 · 2014: 64 · 2013: 55 · 2012: 54
- FWCI
- 6.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK031369, R01 DK31369)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- irritable bowel syndrome, comorbidities, extraintestinal manifestations, functional gastrointestinal disorders, mental illness, depression, anxiety, somatoform disorders, fibromyalgia, chronic fatigue syndrome, temporomandibular disorders, chronic pelvic pain, visceral hypersensitivity, somatization, psychological etiology
- MeSH terms
- Mental Disorders, Colonic Diseases, Functional, Gastrointestinal Diseases, Humans, Psychophysiologic Disorders, Comorbidity
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