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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“In addition to GI problems, patients frequently report such symptoms as headache, fatigue, depression, and anxiety.(5) IBS symptoms frequently have a tremendous impact on work, social activities, quality of life, and health care resource utilization.”
BackgroundAchieving translation in models of visceral pain
Bulmer, D. C., & Grundy, D. (2011) · Current Opinion in Pharmacology · doi:10.1016/j.coph.2011.09.008 · Cited by 20
“In other IBS patients a prevalence of negative early life events has been observed and many patients cite stress as a triggering factor or exacerbate their symptoms [4,5].”
BackgroundClassification of gastrointestinal symptom patterns in young adults
Vivier, H., Ross, E. J., & Cassisi, J. E. (2020) · BMC Gastroenterology · doi:10.1186/s12876-020-01478-7 · Cited by 24
Significance of anti-inflammatory effects of PPARγ agonists?
Rogler, G. (2005) · Gut · doi:10.1136/gut.2005.089946 · Cited by 18
Thiwan, S., & Drossman, D. A. (2006) · Europe PMC (PubMed Central) · Cited by 20
New developments in the diagnosis and treatment of irritable bowel syndrome
Longstreth, G. F., & Drossman, D. A. (2002) · Current Gastroenterology Reports · doi:10.1007/s11894-002-0014-2 · Cited by 20
Towards a Nondualistic Approach to Multisystem Illness
Naliboff, B. D. (2007) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2007.01535.x · Cited by 20
Probiotics in irritable bowel syndrome: an immunomodulatory strategy?
Quigley, E. M. M. (2007) · Journal of the American College of Nutrition · doi:10.1080/07315724.2007.10719648 · Cited by 19
“Given their apparent ability to modulate cytokine balance in the periphery, could probiotics also exert an influence on these processes? In experimental animal models, orally-administered probiotics have been shown to abrogate inflammatory processes far from the bowel, such as in the liver [88] and synovial joints [89…”
BackgroundThe Lifetime Prevalence of Anxiety Disorders Among Patients with Irritable Bowel Syndrome
Grzesiak, M., Beszłej, J. A., Mulak, A., Szechiński, M., Szewczuk-Bogusławska, M., Waszczuk, E., Kantorska-Janiec, M., & Frydecka, D. (2014) · Advances in Clinical and Experimental Medicine · doi:10.17219/acem/37356 · Cited by 19
“Psychiatric disorders are diagnosed among around 40–60% of IBS patients, and according to some sources the rate among IBS patients is as high as 90% [10–13].”
BackgroundMicrobiota and the irritable bowel syndrome
Sabo, C. M., & DUMITRASCU, D. L. (2021) · Minerva Gastroenterology · doi:10.23736/s2724-5985.21.02923-5 · Cited by 21
Sjölund, J., Kull, I., Bergström, A., Ljótsson, B., Törnblom, H., Olén, O., & Simrén, M. (2023) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2023.09.022 · Cited by 20
Valeur, J., Lind, R. A., Berstad, A., & Hatlebakk, J. (2013) · Clinical and Experimental Gastroenterology · doi:10.2147/ceg.s45760 · Cited by 19
Rajagopalan, K., Kleinman, N. L., Brook, R. A., Gardner, H. H., Brizee, T. J., & Smeeding, J. (2006) · Current Medical Research and Opinion · doi:10.1185/030079906x89748 · Cited by 19
Harding, K. A., Simpson, T. L., & Kearney, D. J. (2018) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2018.0135 · Cited by 20
“9 PTSD and IBS are often comorbid, 10 especially among military veterans.”
Ålander, T., Svärdsudd, K., & Agréus, L. (2007) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2007.01549.x · Cited by 19
Association between irritable bowel syndrome and asthma: a meta-analysis and systematic review
Deshmukh, F. (2019) · Annals of Gastroenterology · doi:10.20524/aog.2019.0426 · Cited by 19
New Directions in Brain Imaging Research in Functional Gastrointestinal Disorders
Ringel, Y. (2006) · Digestive Diseases · doi:10.1159/000092881 · Cited by 19
Thakur, E. R., Shapiro, J. M., Chan, J. L., Lumley, M. A., Cully, J. A., Bradford, A. M., & El‐Serag, H. B. (2018) · Digestive Diseases and Sciences · doi:10.1007/s10620-018-5095-3 · Cited by 19
Dess, R. T., Jackson, W., Suy, S., Soni, P., Lee, J., Abugharib, A. E., Zumsteg, Z. S., Feng, F. Y.-C., Hamstra, D. A., Collins, S. P., et al. (2016) · Cancer · doi:10.1002/cncr.30519 · Cited by 18
Gravity and the Gut: A Hypothesis of Irritable Bowel Syndrome
Spiegel, B. M. R. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000002066 · Cited by 19
Tarar, Z. I., Farooq, U., Nawaz, A., Gandhi, M. H., Ghouri, Y. A., Bhatt, A., & Cash, B. D. (2023) · Biomedicines · doi:10.3390/biomedicines11102594 · Cited by 22
“Similar findings were shown in a study by Whitehead et al. [26].”
BackgroundResultInfluentialCampanale, A., Inserra, A., & Comai, S. (2024) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2024.111058 · Cited by 19
“The incidence of IBS is significantly greater in individuals with BD compared to those without (Tseng et al., 2016).”
BackgroundInfluentialDevelopment and validation of new disease-specific measures of somatization and comorbidity in IBS
MacLean, E. W., Palsson, O. S., Turner, M. J., & Whitehead, W. E. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.08.007 · Cited by 18
“This resulted in the identification of 41 studies showing excess overlap of IBS with psychiatric disorders, 38 studies reporting excess overlap with other (non-psychiatric) medical conditions, and 20 studies reporting an excess of one or more non-gastrointestinal symptom in IBS (7;8).”
BackgroundSelf-citationSensory neuromodulators in functional nausea and vomiting: predictors of response
Patel, A. C., Sayuk, G. S., Kushnir, V. M., & Gyawali, C. P. (2012) · Postgraduate Medical Journal · doi:10.1136/postgradmedj-2012-131284 · Cited by 18
Hanevik, K., Kristoffersen, E. K., Sørnes, S., Mørch, K., Næss, H., Rivenes, A. C., Bødtker, J. E., Hausken, T., & Langeland, N. (2012) · BMC Infectious Diseases · doi:10.1186/1471-2334-12-258 · Cited by 18
“One study has found that 14% of IBS patients also have chronic fatigue syndrome (CFS), while six studies report that 35-92% of CFS patients also have IBS [7].”
BackgroundKosako, M., Akiho, H., Miwa, H., Kanazawa, M., & Fukudo, S. (2018) · BioPsychoSocial Medicine · doi:10.1186/s13030-018-0137-9 · Cited by 20
“Furthermore, we did not investigate whether there were subjects with an organic GI disease and/or an other comorbidity, although it has been reported that IBS patients have more somatic/psychiatric comorbidities which may affect their daily lives than non-IBS subjects [31].”
BackgroundCojocariu, R. O., Balmuș, I.-M., Lefter, R. M., Ababei, D. C., Ciobica, A. S., Hrițcu, L. D., Kamal, F. Z., & Doroftei, B. (2020) · Brain Sciences · doi:10.3390/brainsci10110865 · Cited by 18
Lin, W.-T., Liao, Y., Peng, Y., Chang, C., Lin, C., Yeh, H., & Chang, C. (2017) · World Journal of Gastroenterology · doi:10.3748/wjg.v23.i19.3513 · Cited by 20
Evaluating depression- and anxiety-like behaviors in non-human primates
Ausderau, K., Colman, R. J., Kabakov, S. A., SCHULTZ‐DARKEN, N. J., & Emborg, M. E. (2023) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2022.1006065 · Cited by 17
Endotoxemia coupled with heightened inflammation predicts future depressive symptoms
Madison, A. A., Andridge, R., Padin, A. C., Wilson, S. J., Bailey, M. T., Alfano, C. M., Povoski, S. P., Lipari, A. M., Agnese, D. M., Carson, W. E., et al. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104864 · Cited by 19
“Gastrointestinal and psychiatric disorders are commonly comorbid (Whitehead et al., 2002).”
BackgroundZheng, H., Jin, S., Shen, Y., Peng, W.-Y., Ye, K., Tang, T., Zhao, J., Chen, M., & Li, Z. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.694741 · Cited by 17
“, anxiety, depression, and other functional gastrointestinal disorders) and sex since the comorbidity of IBS with other disorders is common (Whitehead et al., 2002) and there is no evidence suggesting a difference in the effect of CHM caused by sex.”
BackgroundPsychogastroenterology: The brain-gut axis and its psychological applications
van Tilburg, M. A. L., Drossman, D. A., & Knowles, S. R. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110684 · Cited by 17
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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