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Cumulative Effects of Psychologic Distress, Visceral Hypersensitivity, and Abnormal Transit on Patient-reported Outcomes in Irritable Bowel Syndrome
Open accessAbstract
Background & aims Little is known about the link between pathophysiologic factors and symptoms of irritable bowel syndrome (IBS), or whether these factors have cumulative effects on patient-reported outcomes (PROs). We investigated whether pathophysiologic alterations associated with IBS have cumulative or independent effects on PROs.Methods We performed a retrospective analysis of data from 3 cohorts of patients with IBS (n = 407; 74% female; mean age, 36 ± 12 years), based on Rome II or Rome III criteria, seen at a specialized unit for functional gastrointestinal disorders in Sweden from 2002 through 2014. All patients underwent assessments of colonic transit time (radiopaque markers); compliance, allodynia, and hyperalgesia (rectal barostat); anxiety and depression (Hospital Anxiety and Depression scale), as pathophysiologic factors. Dysfunction was defined by available normal values. PROs included IBS symptom severity, somatic symptom severity, and disease-specific quality of life.Results Allodynia was observed in 36% of patients, hyperalgesia in 22%, accelerated colonic transit in 18%, delayed transit in 7%, anxiety in 52%, and depression in 24%: each of these factors was associated with severity of at least 1 symptom of IBS. Rectal compliance was not associated with more severe symptoms of IBS. At least 3 pathophysiologic factors were present in 20% of patients, 2 in 30%, 1 in 31%, and none in 18%. With increasing number of pathophysiologic abnormalities, there was a gradual increase in IBS symptom severity (P < .0001) and somatic symptom severity (P < .0001), and a gradual reduction in quality of life (P < .0001).Conclusion Visceral hypersensitivity, including allodynia and hyperalgesia, abnormal colonic transit, and psychologic factors are all associated with IBS symptoms. These factors have a cumulative effect on gastrointestinal and nongastrointestinal symptoms, as well as on quality of life, in patients with IBS and are therefore relevant treatment targets.
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Bajaj, J. S., Brenner, D. M., Cai, Q., Cash, B. D., Crowell, M. D., DiBaise, J. K., Gallegos-Orozco, J. F., Gardner, T. B., Gyawali, C. P., Ha, C. Y., et al. (2020) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000000709 · Cited by 6
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“These two mental disorders may exacerbate gastrointestinal and related symptoms by influencing visceral sensitivity and altering the gut microbiome, thereby further diminishing quality of life and complicating the management of IBS [11, 12].”
Gastrointestinal transit abnormalities in irritable bowel syndrome and their relation to symptoms
Aliyu, A. I., Katsumata, R., Törnblom, H., & Simrén, M. (2025) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2025.2493867 · Cited by 5
“Despite this, it is to be noted that most patients with IBS, regardless of subtype, have a normal CTT [47,49,55].”
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Pathophysiology of irritable bowel syndrome
Nasser, Y., Shin, A., Ford, A. C., Camilleri, M., & Black, C. J. (2026) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(26)00148-2 · Cited by 12
Guanylyl cyclase C ameliorates visceral pain: an unsuspected link
Liddle, R. A. (2023) · Journal of Clinical Investigation · doi:10.1172/jci166703 · Cited by 4
“The pathophysiological basis of IBS is unknown, but heightened visceral nociception has been demonstrated in clinical investigations (4).”
BackgroundElevated Fecal Biomarkers of Colo‐Rectal Epithelial Cell Activity in Irritable Bowel Syndrome
Venge, P., Tejera, V. C., Petersson, C., Xu, S., Larsson, A. O., Simrén, M., Öhman, L., & Törnblom, H. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14984 · Cited by 4
“Furthermore, there are indications that IBS symptom severity is affected by the number of pathophysiologic mechanisms present [6].”
Self-citationJosefsson, A., Törnblom, H., & Simrén, M. (2022) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm21214 · Cited by 4
“6,13,26 The Regional Ethical Review Board at the University of Gothenburg approved the studies included in this manuscript prior to the start of patient inclusion (Approval No. 489-02 and 731-09).”
InfluentialSelf-citationThe pathological involvement of spinal cord EphB2 in visceral sensitization in male rats
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“Studies have shown that PTSD-like stress is a trigger for the initial onset, exacerbation, or recurrence of irritable bowel syndromes (IBS), characterized by hyperalgesia and allodynia (Iorio et al., 2014; Keszthelyi et al., 2012; Simren et al., 2019).”
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Role of antispasmodics in the treatment of irritable bowel syndrome
Drozdov, V., Arefev, K. I., Serebrova, S., Komissarenko, I., Shikh, E., & Starodubtsev, A. K. (2021) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2021-5-155-164 · Cited by 1
Primer consenso centroamericano y del Caribe del síndrome de intestino irritable
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La grossesse invisible : caractéristiques cliniques et perspectives autour du déni de grossesse
Ballerini, M., Raimbaud, M., Joly, L., & Bottemanne, H. (2022) · Gynécologie Obstétrique Fertilité & Sénologie · doi:10.1016/j.gofs.2022.02.079 · Cited by 3
Katsumata, R., Hosokawa, T., Manabe, N., Mori, H., Wani, K., Kimura, M., Oda, S., Ishii, K., Tanikawa, T., Urata, N., et al. (2025) · Journal of Gastroenterology · doi:10.1007/s00535-025-02228-w · Cited by 2
“…be challenging, as symptoms and subjective distress can result from a multitude of factors, including both central and peripheral components, such as dysfunction of motility, hypersensitivity, gut microbiome, psychological stress [48], intestinal immune dysfunction [49], and central processing [1].”
Liu, H., Cheng, K., Lu, Y., Cabral, H., & Weber, H. C. (2025) · Diseases · doi:10.3390/diseases13050161 · Cited by 3
Modern aspects of the pathogenesis and treatment of dyspepsia
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The Role of the Nurse in the Management of Irritable Bowel Syndrome: a narrative review
Ruggiero, L., Andretta, V., Soldaini, C., Fricano, I., Mancusi, M., Sellitti, A., Vastarella, J., & Santonicola, A. (2023) · Translational Medicine UniSa · doi:10.37825/2239-9747.1043 · Cited by 2
“Psychological distress may also result in lowering the threshold of afferent signals to reach conscious awareness leading to greater symptom intensity [30] or may also be a risk factor for the evolution of an acute peripheral insult in the gut in the context of chronic pain [31].”
Journal of Clinical Gastroenterology Lectureship Dubai 2022
Marasco, G., Cremon, C., Barbaro, M., Stanghellini, V., & Barbara, G. (2024) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001964 · Cited by 2
Wu, H., Li, J., Li, F., & Lun, W. (2024) · Frontiers in Genetics · doi:10.3389/fgene.2024.1328327 · Cited by 2
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Study of dynamic brain function in irritable bowel syndrome via Hidden Markov Modeling
Jing, C., Liu, T., Li, Q., Zhang, C., Sun, B., Yang, X., You, Y., Liu, J., & Yang, H. (2025) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1515540 · Cited by 2
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Unnisa, M., Faghih, M., Drewes, A. M., Singh, V. K., Yadav, D. K., Talukdar, R., Olesen, S. S., & Phillips, A. E. (2025) · Gastro Hep Advances · doi:10.1016/j.gastha.2025.100720 · Cited by 1
Metadata
- Authors
- Simrén, M., Törnblom, H., Palsson, O. S., Van Oudenhove, L., Whitehead, W. E., & Tack, J.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Gothenburg (SE)
- KU Leuven (BE)
- Corresponding author
- Simrén, Magnus
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2019-08
- Volume
- 157
- Issue
- 2
- Pages
- 391-402.e2
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2936108149
- Cited by
- 131
- References
- 58
- Citations by year
- 2026: 14 · 2025: 21 · 2024: 10 · 2023: 15 · 2022: 23 · 2021: 23 · 2020: 24
- FWCI
- 15.94
- Type
- journal article
- Language
- en
- Open access
- green
- lirias.kuleuven.be
- Licence
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion, other-oa)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- Medicinska Forskningsrådet (13409, 21691, 21692)
- AFA Försäkring
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Health and Development
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- irritable bowel syndrome, visceral hypersensitivity, allodynia, hyperalgesia, colonic transit, rectal compliance, psychological distress, anxiety, depression, somatic symptom severity, quality of life, IBS symptom severity
- MeSH terms
- Patient Reported Outcome Measures, Adult, Aged, Colon, Female, Gastrointestinal Transit, Humans, Hyperalgesia, Male, Middle Aged, Quality of Life, Retrospective Studies, Severity of Illness Index, Stress, Psychological, Irritable Bowel Syndrome, Young Adult, Visceral Pain
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