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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Anxiety Disorders and Comorbid Medical Illness
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“Several comorbidities that occur more often in IBS patients than in the general population have been identified, including Fibromyalgia Syndrome (FMS), Chronic Fatigue Syndrome (CFS), Gastroesophageal Reflux Disease (GERD), Temporo-Mandibular Joint (TMJ) disorder, headache, backache, genito-urinary symptoms, anxiety a…”
BackgroundLahmann, C., Röhricht, F., Sauer, N., Noll‐Hussong, M., Ronel, J., Henrich, G., von Arnim, A., & Loew, T. H. (2010) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2009.0084 · Cited by 46
“of patients with IBS are described as suffering from comorbid depressive, anxiety, or hypochondriacal symptoms.(9,10) Regarding the pathophysiology of IBS, abnormalities of gastrointestinal sensation, motility, autonomic function, bacterial flora, the mucosal immune system, and serotonin pathways have been advocated a…”
Epidemiology: prevalence, causes and consequences
Creed, F. H., BARSKY, A. J., & Leiknes, K. A. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9780511977862.002 · Cited by 48
Dietary Fatty Acids and Microbiota-Brain Communication in Neuropsychiatric Diseases
Marrone, M. C., & Coccurello, R. (2019) · Biomolecules · doi:10.3390/biom10010012 · Cited by 48
Rutter, C. L., & Rutter, D. R. (2007) · Journal of Health Psychology · doi:10.1177/1359105307071748 · Cited by 59
“…those who seek medical care do so because of the severity of their symptoms, because of psychiatric or other co-morbidity or because they fear they may be seriously ill (Drossman et al., 1988; Heaton et al., 1992; Henningsen, Zimmermann, & Sattel, 2003; Talley et al., 1990; Whitehead et al., 2002).”
BackgroundChang, F. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i10.2499 · Cited by 46
Grodzinsky, E., Walter, S., Viktorsson, L., Carlsson, A.-K., Jones, M. P., & Faresjö, Å. (2015) · BMC Family Practice · doi:10.1186/s12875-015-0225-x · Cited by 46
“IBS has been reported to be associated with altered psychological and cognitive functioning [15] such as mood disturbances [16], somatization, catastrophizing [17] or altered visceral interoception by negative emotions and stress [18].”
BackgroundLee, V., Guthrie, E., Robinson, A., Kennedy, A. P., Tomenson, B., Rogers, A. E., & Thompson, D. G. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.09.004 · Cited by 45
“In secondary care, investigators have consistently shown that 40–50% of patients with functional bowel disorders have diagnosable psychiatric disorder [4–7] and have higher rates of psychological distress than normal controls [8].”
BackgroundNam, S. Y., Kim, B. C., Ryu, K. H., & Park, B. J. (2010) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm.2010.16.1.47 · Cited by 44
Lydiard, R. B. (2005) · CNS Spectrums · doi:10.1017/s1092852900019878 · Cited by 45
Wasim, S., Suddaby, J. S., Parikh, M., Leylachian, S., Ho, B., Guerin, A., & So, J. (2019) · Rheumatology International · doi:10.1007/s00296-019-04293-w · Cited by 44
Mullin, G. E., Shepherd, S. J., Roland, B. C., Ireton-Jones, C. S., & Matarese, L. E. (2014) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607114545329 · Cited by 47
Anderson, J. L., Acra, S. A., Bruehl, S. P., & Walker, L. S. (2008) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0b013e3181653a6f · Cited by 44
“For example, stress, depression, and dysfunctional coping strategies have been associated with maintenance of abdominal complaints and disability (19,20).”
BackgroundHyland, N. P., O’Mahony, S. M., O’Malley, D., O'Mahony, C. M., Dinan, T. G., & Cryan, J. F. (2014) · Neurogastroenterology & Motility · doi:10.1111/nmo.12486 · Cited by 45
Sense of Coherence and Quality of Life in Women With and Without Irritable Bowel Syndrome
Motzer, S., Hertig, V., Jarrett, M. E., & Heitkemper, M. (2003) · Nursing Research · doi:10.1097/00006199-200309000-00007 · Cited by 40
Lackner, J. M., Jaccard, J. J., Baum, C., Smith, A., Krasner, S. S., Katz, L., Firth, R. S., Raby, T., & Powell, C. (2011) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2011.06.014 · Cited by 45
Gastritis and mental disorders
Goodwin, R. D., Cowles, R. A., Galea, S., & Jacobi, F. (2012) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2012.09.016 · Cited by 44
Trott, N., Aziz, I., Rej, A., & Sanders, D. S. (2019) · Nutrients · doi:10.3390/nu11061313 · Cited by 46
Bourke, S. L., Schlag, A. K., O’Sullivan, S. E., Nutt, D., & Finn, D. P. (2022) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2022.108216 · Cited by 46
An international study of irritable bowel syndrome: Family relationships and mind-body attributions
Gerson, M., Gerson, C. D., Awad, R. A., Dancey, C. P., Poitras, P., Porcelli, P., & Sperber, A. D. (2005) · Social Science & Medicine · doi:10.1016/j.socscimed.2005.10.019 · Cited by 44
Palomba, S., Orio, F., Manguso, F., Russo, T., Falbo, A. I., Lombardi, G., Doldo, P., & Zullo, F. (2005) · Fertility and Sterility · doi:10.1016/j.fertnstert.2004.12.007 · Cited by 44
Traub, R. J., Cao, D., Karpowicz, J., Pandya, S., Ji, Y., Dorsey, S. G., & Dessem, D. (2014) · Journal of Pain · doi:10.1016/j.jpain.2014.06.008 · Cited by 44
“Although this study was initially designed to model comorbidity between TMD and IBS, fibromyalgia is also comorbid with IBS.52,63,67 Although biceps brachii inflammation is not a model of fibromyalgia, it suggests that a more generalized mechanism of injury plus stress inducing chronic visceral pain must be considered.”
BackgroundInfluentialGastrointestinal pain in functional bowel disorders: sensory neurons as novel drug targets
Holzer, P. D. (2004) · Expert Opinion on Therapeutic Targets · doi:10.1517/14728222.8.2.107 · Cited by 44
“1 Advantages and disadvantages of sensory neuron-targeting drugs Although the comorbidity of FBDs with depression, anxiety and related disorders [1,2,7,48,49] suggests that GI hyperalgesia involves many disturbances in the gut–brain (Figure 1) and brain–gut axis, sensory neurons serve as the first element at which to…”
BackgroundCo-morbidity and physician use in fibromyalgia
Bernatsky, S., Dobkin, P. L., Penrod, J. R., & De, C. (2005) · Swiss Medical Weekly · doi:10.4414/smw.2005.10774 · Cited by 44
Is there a causal link between psychological disorders and functional gastrointestinal disorders?
Wouters, M. M., & Boeckxstaens, G. E. (2015) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/17474124.2016.1109446 · Cited by 44
“Comorbid psychiatric disorders such as major depression, anxiety and somatoform disorders are highly prevalent in FGID patients, and can affect up to 50– 94% of irritable bowel syndrome (IBS) patients.[2] In addition, psychosocial difficulties, such as a history of physical or sexual abuse, maladaptive coping and “cat…”
BackgroundSherwin, L. B., Leary, E. V., & Henderson, W. A. (2017) · Quality of Life Research · doi:10.1007/s11136-017-1554-0 · Cited by 43
Balmuș, I.-M., Ciobica, A. S., Cojocariu, R. O., Luca, A.-C., & Gorgan, L. (2020) · Medicina · doi:10.3390/medicina56040175 · Cited by 43
Ryan, M., & Gevirtz, R. (2004) · Applied Psychophysiology and Biofeedback · doi:10.1023/b:apbi.0000026635.03016.ef · Cited by 43
“Although many current researchers have focused on the high comorbidity rates that these functional disorders have with each other, and with Axis I-DSM diagnoses, it has been pointed out that most of the patients with these diagnoses do not meet any DSM diagnostic criteria (Epstein et al., 1999; Whitehead, Palsson, & J…”
BackgroundDo psychotherapies produce neurobiological effects?
Kumari, V. (2006) · Acta Neuropsychiatrica · doi:10.1111/j.1601-5215.2006.00127.x · Cited by 45
Managing functional bowel disorders from the top down: lessons from a well-designed treatment trial
Clouse, R. E. (2003) · Gastroenterology · doi:10.1016/s0016-5085(03)00808-4 · Cited by 43
Genetics of irritable bowel syndrome: shifting gear via biobank-scale studies
Camilleri, M., Zhernakova, A., Bozzarelli, I., & D’Amato, M. (2022) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-022-00662-2 · Cited by 49
Alexithymia and gastrointestinal-specific anxiety in moderate to severe irritable bowel syndrome
Porcelli, P., Carne, M. D., & Leandro, G. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.05.022 · Cited by 44
Tanaka, Y., Kanazawa, M., Kano, M., Morishita, J., Hamaguchi, T., Oudenhove, L. V., Ly, H. G., Dupont, P. J., Tack, J. F., Yamaguchi, T., et al. (2016) · PLoS ONE · doi:10.1371/journal.pone.0157347 · Cited by 42
Walker, L. S., Stone, A. L., Smith, C. A., Bruehl, S. P., Garber, J., Puzanovova, M., & Diedrich, A. (2017) · Pain · doi:10.1097/j.pain.0000000000000942 · Cited by 42
Prospero, L., Riezzo, G., Linsalata, M., Orlando, A., D’Attoma, B., & Russo, F. (2021) · Nutrients · doi:10.3390/nu13072469 · Cited by 47
Karling, P., Danielsson, A., Adolfsson, R., & Norrback, K. (2007) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2007.00967.x · Cited by 42
Irritable Bowel Syndrome: A Co-Twin Control Analysis
Wojczynski, M. K., North, K. E., Pedersen, N. L., & Sullivan, P. F. (2007) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2007.01479.x · Cited by 42
“Additionally, among IBS patients seeking specialist care, 54–94% met DSM-III-R criteria for a primary psychological disorder (29); however, in a population-based study, only 13% of IBS patients met DSM-III criteria for a primary psychiatric disorder (31).”
BackgroundNot All Side Effects Associated With Tricyclic Antidepressant Therapy Are True Side Effects
Thiwan, S., Drossman, D. A., Morris, C. B., Dalton, C. B., Toner, B. B., Diamant, N. E., Hu, J. B., Whitehead, W. E., Leserman, J., & Bangdiwala, S. I. (2008) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2008.11.014 · Cited by 42
Self-citation
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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