Among patients with Rome IV-defined irritable bowel syndrome (IBS), nearly 70% of patients may exhibit at least 1 psychological comorbidity, with IBS symptom severity increasing with the presence of more psychological comorbidities, according to study results published in The American Journal of Gastroenterology.

Previous studies have found that psychological comorbidities are linked to IBS. However, their cumulative effect on IBS prognosis is not well understood. To address this knowledge gap, a team of investigators conducted a 12-month longitudinal follow-up study to determine whether a higher number of psychological comorbidities at baseline would exacerbate IBS prognosis in patients with Rome IV-defined IBS.

At baseline, the investigators obtained demographic, symptom, and psychological comorbidity data from 807 patients who met the criteria for Rome IV-defined IBS. At 12 months following study initiation, they collected patient data for severity of IBS symptoms, impact of symptoms, consultation behavior, and treatments.

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A total of 807 participants were included at baseline; 177 patients had 1 psychological comorbidity, 139 patients had 2 psychological comorbidities, 103 had 3 psychological comorbidities, 89 patients had 4 psychological comorbidities, and 54 patients had 5 psychological comorbidities.

There was a significant association between IBS symptom severity and increasing number of psychological comorbidities at baseline. Severe symptoms were reported among 72.2% of patients with 5 psychological comorbidities compared with 29.1% of patients who reported no psychological comorbidities (P <.001).

At follow-up, 452 (56.0%) patients were still enrolled in the study. Of the remaining participants, those who had a higher number of psychological comorbidities at baseline were significantly more likely to have seen a gastroenterologist (33.3% of patients with 5 psychological comorbidities vs 21.4% of patients with 0 psychological comorbidities; P <.001).

In addition, patients who had a higher number of psychological comorbidities at baseline were also more likely to cycle through multiple treatments (P <.0001), reported having more severe IBS symptoms (P <.001), and were more likely to have continuous abdominal pain (P <.001). Patients with more psychological comorbidities at baseline were also more likely to report that IBS symptoms affected their daily activities 50% or more of the time (P <.001).

“Although there is an association between psychological comorbidity and severity of IBS symptoms, as well as prognosis, it remains unclear which psychological comorbidity has the greatest effect on the prognosis of IBS, although anxiety was the most common in this study, and whether one of these psychological comorbidities is driving others,” the investigators wrote.

“In addition, although we have assessed the cumulative effects of psychological comorbidities on the prognosis of IBS during 12 months of follow-up, the longer-term effects are unknown. Future studies should address these issues,” the researchers noted.


Goodoory VC, Mikocka-Walus A, Yiannakou Y, Houghton LA, Black CJ, Ford AC. Impact of psychological comorbidity on the prognosis of irritable bowel syndrome. Am J Gastroenterol. 2021;116(7):1485-1494. doi:10.14309/ajg.0000000000001247