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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Edwards, R. R., Doleys, D. M., Lowery, D., & Fillingim, R. B. (2003) · Pain · doi:10.1016/j.pain.2003.09.004 · Cited by 111
“In support of this notion, fibromyalgia (Hurtig et al., 2001), headache (Bendtsen, 2000), TMD (Sarlani and Greenspan, 2003), and IBS (Whitehead et al., 2002) patients show greater sensitivity to laboratory-induced pain relative to healthy controls.”
BackgroundPain management in patients with inflammatory bowel disease: insights for the clinician
Srinath, A. I., Walter, C., Newara, M. C., & Szigethy, E. M. (2012) · Therapeutic Advances in Gastroenterology · doi:10.1177/1756283x12446158 · Cited by 111
Alterations in intestinal microbial flora and human disease
Othman, M. O., Agüero, R., & Lin, H. C. (2008) · Current Opinion in Gastroenterology · doi:10.1097/mog.0b013e3282f2b0d7 · Cited by 112
“Between 30 and 75% of patients with fibromyalgia also have symptoms meeting the criteria for IBS [ 63 ].”
BackgroundWingenfeld, K., Heim, C. C., Schmidt, I., Wagner, D., Meinlschmidt, G., & Hellhammer, D. H. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31815ff3ce · Cited by 112
Convergence of sensory pathways in the development of somatic and visceral hypersensitivity
Bielefeldt, K., Lamb, K. R., & Gebhart, G. F. (2006) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00585.2005 · Cited by 107
Experimental colitis in mice and sensitization of converging visceral and somatic afferent pathways
Lamb, K. R., Zhong, F., Gebhart, G. F., & Bielefeldt, K. (2005) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00353.2005 · Cited by 107
van Tilburg, M. A. L., Runyan, D. K., Zolotor, A. J., Graham, J. C., Dubowitz, H., Litrownik, A. J., Flaherty, E. G., Chitkara, D. K., & Whitehead, W. E. (2010) · The Annals of Family Medicine · doi:10.1370/afm.1053 · Cited by 106
Self-citationAntidepressants and Cognitive-Behavioral Therapy for Symptom Syndromes
Jackson, J. L., O’Malley, P. G., & Kroenke, K. (2006) · CNS Spectrums · doi:10.1017/s1092852900014383 · Cited by 107
Effect of Yoga in the Therapy of Irritable Bowel Syndrome: A Systematic Review
Schumann, D., Anheyer, D., Lauche, R., Dobos, G. J., Langhorst, J., & Cramer, H. (2016) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2016.04.026 · Cited by 108
The presentation of irritable bowel syndrome in the context of somatization disorder
North, C. S., Downs, D., Clouse, R. E., Alrakawi, A., Dokucu, M. E., Cox, J., Spitznagel, E. L., & Alpers, D. H. (2004) · Clinical Gastroenterology and Hepatology · doi:10.1016/s1542-3565(04)00350-7 · Cited by 102
Symptom overlap and comorbidity of irritable bowel syndrome with other conditions
Frissora, C. L., & Koch, K. L. (2005) · Current Gastroenterology Reports · doi:10.1007/s11894-005-0018-9 · Cited by 100
Palsson, O. S., & Drossman, D. A. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.02.004 · Cited by 99
“a quarter and a third of IBS patients to meet criteria for somatization disorder [5], which is much higher than in the normal population.”
BackgroundInfluentialSelf-citationChang, L., Berman, S., Mayer, E. A., Suyenobu, B., Derbyshire, S., Naliboff, B., Vogt, B., FitzGerald, L., & Mandelkern, M. A. (2003) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2003.07478.x · Cited by 122
“This explanation is supported by Whitehead et al. in their extensive review of the comorbidity of IBS with other disorders, including FM ( 1 ).”
BackgroundResultInfluentialA Microbial Signature of Psychological Distress in Irritable Bowel Syndrome
Peter, J., Fournier, C., Durdević, M., Knoblich, L., Keip, B., Dejaco, C., Trauner, M., & Moser, G. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000630 · Cited by 100
From the Bottom-Up: Chemotherapy and Gut-Brain Axis Dysregulation
Bajic, J. E., Johnston, I. N., Howarth, G. S., & Hutchinson, M. R. (2018) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2018.00104 · Cited by 100
Medical and productivity costs of anxiety disorders: Case control study
Marciniak, M., Lage, M. J., Landbloom, R. P., Dunayevich, E., & Bowman, L. (2004) · Depression and Anxiety · doi:10.1002/da.10131 · Cited by 99
“Whereas these finding suggest that anxiety disorders may exacerbate the medical conditions, and hence lead to increased diagnoses [Carr, 1999; Whitehead et al., 2002], this analysis is unable to determine issues of causation.”
BackgroundBerrill, J., Green, J. T., Hood, K., & Campbell, A. K. (2013) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12335 · Cited by 99
“92 (chi-square) CD 13 (42%) 27 (41%) Disease Location UC (n = 57) Proctitis 6 (33%) 7 (18%) N/A‡ Left-Sided 7 (39%) 21 (54%) Pan-Colitis 5 (28%) 11 (28%) CD (n = 40) Ileal 5 (38%) 7 (26%) N/A‡ Colonic 3 (23%) 10 (37%) Ileo-colonic 5 (38%) 10 (37%) Median disease duration, years (range) 9 (1-36) 8 (1-47) 0.”
The Effects of Inflammation, Infection and Antibiotics on the Microbiota-Gut-Brain Axis
Berčík, P., & Collins, S. M. (2014) · Advances in experimental medicine and biology · doi:10.1007/978-1-4939-0897-4_13 · Cited by 98
Boyd, C., Abraham, S., & Kellow, J. (2005) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520510015836 · Cited by 113
“Our finding of a high prevalence of several FGIDs in a large sample of individuals suffering from an eating disorder complements previous research concerning the comorbidity of disorders of gastrointestinal function with psychiatric disorders [27,28].”
ResultSex‐based differences in gastrointestinal pain
Mayer, E. A., Berman, S. M., Chang, L., & Naliboff, B. D. (2004) · European Journal of Pain · doi:10.1016/j.ejpain.2004.01.006 · Cited by 98
“An important feature of the epidemiology of IBS is the high co-occurrence with other gastrointestinal disorders and other non-gastrointestinal pain disorders and affective disorders (Veale et al., 1991; Walker et al., 1992; Whitehead et al., 2002; Hazlett-Stevens et al., 2003).”
BackgroundSpiegel, B. M. R., Schoenfeld, P., & Naliboff, B. D. (2007) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2007.03357.x · Cited by 103
The Place of Stress and Emotions in the Irritable Bowel Syndrome
Sonia Pellissier, A., & Bonaz, B. L. (2016) · Vitamins and hormones · doi:10.1016/bs.vh.2016.09.005 · Cited by 102
Tricyclic Antidepressants for Management of Residual Symptoms in Inflammatory Bowel Disease
Iskandar, H. N., Cassell, B., Kanuri, N., Gyawali, C. P., Gutierrez, A., Dassopoulos, T., Ciorba, M. A., & Sayuk, G. S. (2014) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000000049 · Cited by 96
“27,28 In our IBD and IBS cohorts, functional and psychiatric disorders were equally common, perhaps because of our center's experience in treating GI patients with these comorbid diagnoses.”
BackgroundDefinition and Classification of Irritable Bowel Syndrome: Current Consensus and Controversies
Longstreth, G. F. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.02.011 · Cited by 95
Anxiety disorders and medical comorbidity: Treatment implications
Meuret, A. E., Tunnell, N., & Roque, A. (2020) · Advances in Experimental Medicine and Biology · doi:10.1007/978-981-32-9705-0_15 · Cited by 96
Citalopram Provides Little or No Benefit in Nondepressed Patients With Irritable Bowel Syndrome
Ladabaum, U., Sharabidze, A., Levin, T. R., Zhao, W. K., Chung, E. H., Bacchetti, P., Jin, C., Grimes, B. A., & Pepin, C. J. (2009) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2009.09.008 · Cited by 95
Kolacz, J., Kovacic, K. K., & Porges, S. W. (2019) · Developmental Psychobiology · doi:10.1002/dev.21852 · Cited by 94
Pain/Depression Dyad: A Key to a Better Understanding and Treatment of Functional Somatic Syndromes
Goldenberg, D. L. (2010) · The American Journal of Medicine · doi:10.1016/j.amjmed.2010.01.014 · Cited by 94
Schiller, L. R., Pardi, D. S., Spiller, R. E., Semrad, C. E., Surawicz, C. M., Giannella, R. A., Krejs, G. J., Farthing, M. J. G., & Sellin, J. H. (2013) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.12392 · Cited by 95
Does past pain influence current pain: biological and psychosocial models of sex differences
Rollman, G. B., Abdel‐Shaheed, J., Gillespie, J. M., & Jones, K. S. (2004) · European Journal of Pain · doi:10.1016/j.ejpain.2004.03.002 · Cited by 99
“…1997; Mountz et al., 1995; Staud et al., 2001; Staud et al., 2003b), irritable bowel syndrome (Naliboff et al., 1997; Verne and Price, 2002; Whitehead et al., 2002), temporomandibular disorder (Fillingim et al., 1998; Maixner et al., 1998; Svensson et al., 2001; Svensson and…”
Self-citationPsychological disorders in gastrointestinal disease: epiphenomenon, cause or consequence?
Shah, E. D., Rezaie, A. R., Riddle, M. S., & Pimentel, M. (2014) · PubMed Central · Cited by 93
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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