Veterans With IBS Experience Psychological Comorbidities, High Health Care Use

Irritable bowel syndrome is prevalent among US veterans and is associated with high health care use and psychological comorbidities, such as anxiety, depression, and PTSD.

Irritable bowel syndrome (IBS) is prevalent among US veterans and is associated with significant psychological comorbidities, worse quality of life (QOL), and higher health care use, according to study findings published in Clinical Gastroenterology and Hepatology.

Researchers at Indiana University School of Medicine conducted a cross-sectional survey study between June 2018 and April 2020 at the Indianapolis Veterans Affairs Medical Center. The objective was to investigate the prevalence of IBS among US veterans; to explore the associated psychosocial, environmental, and phenotypic factors; and to analyze the effect of IBS on health-related QOL and health care use.

Researchers mailed 36,449 surveys to veterans, which included the Rome IV IBS questionnaire, Short Form-12, Post-Traumatic Stress Disorder (PTSD) checklist, Hospital Anxiety and Depression Scale, and questionnaires regarding general health, antibiotic use, infective enteritis (IE), and use of health care services.

Of 1286 respondents, 858 (66.7%) veterans (mean age, 53.6±10.7 years; women, 19.8%; White, 87.3%; Hispanic, 2.9%; and body mass index [BMI], 31.2±6.5 kg/m2) completed the survey. Of these 858 veterans, 244 (28.4%) met the Rome IV criteria for IBS. Veterans had IBS with diarrhea (47.5%), IBS with constipation (16.8%), and mixed IBS (33.6%). The remaining 2% were unsubtyped.

Increased IBS awareness and identification of IBS risk factors, including IE [infective enteritis] and PTSD, is required.

IBS was significantly associated with anxiety (odds ratio [OR], 3.47; 95% CI, 2.55-4.72; P <.001), depression (OR, 2.88; 95% CI, 2.13-3.89; P <.001), and PTSD (OR, 3.09; 95% CI, 2.19-4.37, P <.001).

Veterans with IBS were more likely to have a history of IE (P <.001), new bowel problems following IE (P =.008), and new bowel problems following antibiotic use (P <.001).

Among the subtypes, veterans with mixed IBS were more likely to have a medical history of IE (P <.001) and experience bowel problems after antibiotics (P =.005), while those with IBS with constipation experienced new bowel problems more frequently after IE (P =.03).

Regardless of subtype, veterans with IBS were more likely to report IE than veterans without IBS. Both IE and PTSD increased the risk for IBS in this patient population.

Additionally, veterans with IBS scored lower on the physical and mental QOL questionnaires (both P <.001). Veterans with IBS also experienced a higher frequency of doctor visits (P =.005) and hospitalizations (P =.044) over a 10-year period, especially among those with the IBS constipation subtype (multiple doctor visits, P =.003; hospitalizations, P =.027).

“We demonstrate that IBS is prevalent among Veterans survey respondents and IBS in Veterans is associated with psychological symptoms and places a measurable burden on health and healthcare utilization,” the study authors wrote. “Effects may differ by subtype. Increased IBS awareness and identification of IBS risk factors including IE and PTSD is required.”

Study limitations include the single-center design, so findings may not be generalizable to veterans nationwide; a lack of civilian comparators; and possible selection, recall, or responder bias.


Shin A, Xu H, Imperiale TF. The prevalence, humanistic burden, and health care impact of irritable bowel syndrome among United States veterans. Clin Gastroenterol Hepatol. Published online August 11, 2022. doi:10.1016/j.cgh.2022.08.005