Severity of abdominal pain and depression are significant predictors of health care use among patients with irritable bowel syndrome (IBS), functional constipation (FC), and functional diarrhea (FDr), researchers reported in the American Journal of Gastroenterology.

Disorders of the gut-brain interaction are estimated to affect over 40% of patients worldwide. Given this prevalence, patients presenting with these disorders are often among the highest users of healthcare resources. Thus, investigators aimed to identify predictors of health care utilization in patients with IBS, FC, and FDr.

The study included consecutive new patients who presented to an outpatient center for functional bowel disorders and gastrointestinal motility from October 2017 to April 2020. The investigators used Rome IV questionnaires to identify patients with IBS, FC, and FDr. The patients completed a 13-item, self-reported questionnaire regarding their health care use in the 6 months prior to their initial presentation. The Patient-Reported Outcomes Measurement Information System was used to assess participants’ severity of abdominal pain, constipation, diarrhea, anxiety, depression, and sleep disturbance.

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A total of 434 patients were included in the analysis; 79.5% were women, the mean age was 44±16.7 years, 73.5% had IBS, 17.1% had FC, and 9.4% had FDr.

After controlling for the other independent variables, the study authors found that older age (P =.005), abdominal pain (P =.022), constipation (P =.049), and depression (P <.001) were independently positively associated with increased use of outpatient services. Abdominal pain (P =.024), depression (P =.001), and sleep (P =.037) were independently positively associated with increased use of gastrointestinal outpatient services.

Increased abdominal pain was the only significant variable that was predictive of increased medication use for gastrointestinal symptoms (P =.002). Univariate analysis showed that female sex, abdominal pain, constipation, diarrhea, depression, anxiety, and sleep difficulties were associated with increased odds of an emergency department visit for gastrointestinal symptoms, but only abdominal pain was significant, according to the multivariable model (P =.002).

Patients who had both abdominal pain and depression 1 SD greater than the mean scores were more likely to be high users of health care resources. Specific bowel habits were not strong predictors of health care use.

Among several study limitations, participants were from a single, tertiary care center, and most had IBS. Additionally, the data were retrospective and based on a questionnaire that has not been validated using 6-month recall, and there is a possibility of selection bias.

“Specific attention to treatment of abdominal pain and depression in patients with [disorders of gut-brain interaction] may result in decreased health care utilization in this patient population,” the researchers commented. “Evidence-based therapies for pain and depression include both pharmacologic and nonpharmacologic approaches, and future research should seek to clarify whether different approaches result in different health care utilization,” they concluded.

Disclosure: One of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.


Yu V, Ballou S, Hassan R, et al. Abdominal pain and depression, not bowel habits, predict health care utilization in patients with functional bowel disorders. Am J Gastroenterol. 2021;116(8):1720-1726. doi: 10.14309/ajg.0000000000001306