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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BackgroundNagasako, C. K., Montes, C. G., Lorena, S. L. S., & Mesquita, M. A. (2015) · Revista Española de Enfermedades Digestivas · doi:10.17235/reed.2015.3979/2015 · Cited by 71
Chang, L. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.02.003 · Cited by 67
Functional Gastrointestinal Disorders: An Update for the Psychiatrist
Jones, M. P., Crowell, M. D., Olden, K. W., & Creed, F. H. (2007) · Psychosomatics · doi:10.1176/appi.psy.48.2.93 · Cited by 67
“tients with FGID frequently report “extra-intestinal” symptoms, and associations exist between IBS, fibromyalgia, chronic headaches, temporomandibular joint dysfunction, dysmenorrhea, asthma, and other non-GI disorders.(40)”
BackgroundEmerging Treatment Options in Mild to Moderate Ulcerative Colitis.
Lichtenstein, G. R., Hanauer, S. B., & Sandborn, W. J. (2015) · Europe PMC (PubMed Central) · Cited by 68
Wright, C. D., Tiani, A. G., Billingsley, A. L., Steinman, S. A., Larkin, K. T., & McNeil, D. W. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02498 · Cited by 76
“Perpetuating factors Many individuals with functional gastrointestinal disorders such as irritable bowel syndrome (IBS) have anxiety and fear about going to restaurants or public places (Whitehead et al., 2002; Labus et al., 2004; Roohafza et al., 2016).”
BackgroundComorbidity and use of health-care services among irritable bowel syndrome sufferers
Hillilä, M. T., Siivola, M., & Färkkilä, M. A. (2007) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365520601113927 · Cited by 66
“Because of these limitations, it has been difficult to make accurate estimations of comorbidity [17].”
BackgroundRajindrajith, S., & Devanarayana, N. (2012) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm.2012.18.3.298 · Cited by 69
Nellesen, D., Chawla, A., Oh, D. L., Weissman, T., Lavins, B. J., & Murray, C. W. (2013) · Postgraduate Medicine · doi:10.3810/pgm.2013.03.2640 · Cited by 67
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“Between one fourth and one third of IBS patients in referral centers meet the Diagnostic and Statistical Manual (DSM) criteria for somatization disorder, and even more have somatization trait by virtue of exhibiting one or more related symptoms including unexplained faintness or dizziness, functional chest pain, gener…”
BackgroundInfluentialImpact of Psychological Comorbidity on the Prognosis of Irritable Bowel Syndrome
Goodoory, V. C., Mikocka‐Walus, A. A., Yiannakou, Y., Houghton, L. A., Black, C. J., & Ford, A. C. (2021) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001247 · Cited by 68
“Patients with IBS often exhibit psychological comorbidity (10), although it remains unclear whether this is a cause or a consequence of the gastrointestinal symptoms experienced (11,12).”
BackgroundAbdominal Pain in Ulcerative Colitis
Coates, M. D., Lahoti, M., Binion, D. G., Szigethy, E., Regueiro, M. D., & Bielefeldt, K. (2013) · Inflammatory Bowel Diseases · doi:10.1097/mib.0b013e31829614c6 · Cited by 65
“Although the retrospective design of our investigation does not allow us to clearly identify the causes of ongoing pain in these patients, the correlations between female gender, mood disorders, chronic pain syndromes, and frequent abdominal pain show significant parallels with functional gastrointestinal disorder.(24…”
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Halder, S. L. S., McBeth, J., Silman, A. J., Thompson, D. G., & Macfarlane, G. J. (2002) · International Journal of Epidemiology · doi:10.1093/ije/31.6.1219 · Cited by 65
Psychological profile of individuals presenting with chronic cough
Hulme, K., Deary, V., Dogan, S., & Parker, S. (2017) · ERJ Open Research · doi:10.1183/23120541.00099-2016 · Cited by 66
Myers, B., & Meerveld, B. G. (2010) · Behavioural Brain Research · doi:10.1016/j.bbr.2010.05.049 · Cited by 67
Irritable bowel syndrome – an evidence‐based approach to diagnosis
Cash, B. D., & Chey, W. D. (2004) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2004.02001.x · Cited by 65
Multiple somatic symptoms predict impaired health status in functional somatic syndromes
Creed, F. H., Tomenson, B., Chew-Graham, C., Macfarlane, G. J., Davies, I., Jackson, J., Littlewood, A., & McBeth, J. (2013) · International Journal of Behavioral Medicine · doi:10.1007/s12529-012-9257-y · Cited by 63
Román, P., Carrillo-Trabalón, F., Sánchez‐Labraca, N., Cañadas, F., Estévez, Á. F., & Cardona, D. (2018) · Beneficial Microbes · doi:10.3920/bm2017.0125 · Cited by 63
Understanding the Connection Between the Gut–Brain Axis and Stress/Anxiety Disorders
Lee, Y.-J., & Kim, Y. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-021-01235-x · Cited by 68
Goodoory, V. C., Guthrie, E., Ng, C. E., Black, C. J., & Ford, A. C. (2022) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17356 · Cited by 68
Winston, J. H., Li, Q., & Sarna, S. K. (2014) · Neurogastroenterology & Motility · doi:10.1111/nmo.12326 · Cited by 66
Sex-related differences in pain behaviors following three early life stress paradigms
Prusator, D. K., & Meerveld, B. G. (2016) · Biology of Sex Differences · doi:10.1186/s13293-016-0082-x · Cited by 65
Psychosocial aspects of functional gastrointestinal disorders
Budavari, A. I., & Olden, K. W. (2003) · Gastroenterology Clinics of North America · doi:10.1016/s0889-8553(03)00030-x · Cited by 63
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“While the majority of patients with FGID have mild to moderate symptoms, on the opposite end are the 20% of patients who suffer from severe FGIDs characterized by higher levels of pain, poorer health-related QOL, more pronounced illness behavior, higher health-care utilization, and more psychosocial (e.g., maladaptive…”
BackgroundClinical update: irritable bowel syndrome
Spiller, R. E. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60726-0 · Cited by 62
Irritable Bowel Syndrome: Current Approach to Symptoms, Evaluation, and Treatment
Videlock, E. J., & Chang, L. (2007) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2007.07.002 · Cited by 60
Fatigue and Comorbidities in Multiple Sclerosis
Fiest, K. M., Fisk, J. D., Patten, S. B., Tremlett, H. L., Wolfson, C. M., Warren, S., McKay, K. A., Berrigan, L. I., Marrie, R. A., & for the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS) (2016) · International Journal of MS Care · doi:10.7224/1537-2073.2015-070 · Cited by 63
Future perspectives: pathogenesis of chronic muscle pain
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Johansson, P. A., Farup, P. G., Bracco, A., & Vandvik, P. O. (2010) · BMC Gastroenterology · doi:10.1186/1471-230x-10-31 · Cited by 60
“Consideration of comorbidity as an explanatory factor for use of health resources is warranted since patients with IBS frequently report other somatic and psychiatric disorders [9,10].”
BackgroundKanuri, N., Cassell, B., Bruce, S. E., White, K. S., Gott, B. M., Gyawali, C. P., & Sayuk, G. S. (2016) · Neurogastroenterology & Motility · doi:10.1111/nmo.12848 · Cited by 59
The interplay between microbiota and brain-gut axis in epilepsy treatment
Zhu, H., Wang, W., & Li, Y. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1276551 · Cited by 62
“Patients with IBS often exhibit stress-induced alterations in gastrointestinal motility, gut sensation, autonomic regulation, and the response of the HPA axis (Whitehead et al., 2002).”
BackgroundGale, J. D., & Houghton, L. A. (2011) · Frontiers in Pharmacology · doi:10.3389/fphar.2011.00028 · Cited by 58
“, 1986; Mayer and Gebhart, 1994), and presence of fibromyalgia in some patients (Whitehead et al., 2002; Almansa et al., 2009) are consistent with a widespread aberrant central processing of pain (central sensitization) in these patients.”
Background
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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