# Overlapping Upper and Lower Gastrointestinal Symptoms



## eric (Jul 8, 1999)

FYIGastroenterology, November 2003 Journal ScanFromThe American Journal of GastroenterologyNovember (Volume 98, Number 11)Overlapping Upper and Lower Gastrointestinal Symptoms in Irritable Bowel Syndrome Patients With Constipation or DiarrheaTalley NJ, Dennis EH, Schettler-Duncan VA, Lacy BE, Olden KW, Crowell MDThe American Journal of Gastroenterology. 2003;98(11):2454-2459Findings from a number of studies have suggested that patients with irritable bowel syndrome (IBS) may have motor dysfunction that extends beyond the colon to include other parts of the gastrointestinal tract, such as the stomach, esophagus, and small intestine.Indeed, the functional gastrointestinal disorders, including IBS and functional dyspepsia, are currently defined by symptom groupings that seem to cluster together in both clinical practice and population-based studies. However, these symptoms commonly overlap, leading some investigators to question the validity of subdividing the disorders based exclusively on symptom presentation.In this setting, it is recognized that distinguishing between IBS and functional dyspepsia can be diagnostically challenging because of the variations in symptom patterns, which frequently overlap. But this symptom overlap is poorly quantified and defined, and it remains unclear whether symptom patterns differ in subgroups of IBS that have been arbitrarily defined by primary bowel patterns of constipation and diarrhea (Note: The Rome committee has not endorsed subdividing IBS patients according to primary alteration in bowel function because of significant overlap in primary bowel symptoms). Therefore, Talley and colleagues set out to investigate the distribution of upper and lower gastrointestinal symptoms among patients with IBS with constipation and IBS with diarrhea. They hypothesized that IBS with constipation would be associated with more upper gastrointestinal complaints, and would therefore more often overlap with functional dyspepsia.The study involved 121 consecutive patients who presented with a diagnosis of IBS. Patients were grouped according to primary bowel symptoms as either IBS with constipation (58 women and 18 men, mean age 47 ï¿½ 17 years) or IBS with diarrhea (26 women and 19 men, mean age 47 ï¿½ 15 years). All patients completed the Hopkins Bowel Symptom Questionnaire (which includes a brief quality-of-life assessment) and the Hopkins Symptom Checklist. Patients with alternating bowel habits (between constipation and diarrhea) were excluded so as to more accurately assess the overlap between upper and lower gastrointestinal complaints.Overall, results showed that IBS with constipation was associated with more bloating and early satiety; this likely reflects underlying pathophysiologic mechanisms that are distinct from those in IBS with diarrhea. In fact, patients with IBS with constipation reported significantly more overall gastrointestinal symptoms when compared with patients with IBS with diarrhea (6.67 vs 4.62, respectively, P .001). Abdominal pain patterns differed in patients with IBS with constipation vs in patients with IBS with diarrhea (lower abdominal pain: 40.8% vs 24.4%, and upper abdominal pain: 36.8% vs 24.4%, respectively). However, there were no significant differences in personality subscales by IBS subgroup -- but somatization was positively associated with multiple symptom reports and was negatively correlated with quality of life.These findings demonstrated that upper gastrointestinal symptoms consistent with functional dyspepsia were more common among patients with IBS with constipation. Despite considerable overlap of upper and lower gastrointestinal symptoms among patients with IBS with constipation and patients with IBS with diarrhea, the former had more frequent lower abdominal pain and bloating. A better elucidation of the overlap between symptoms in patients with IBS may help guide clinical management of this disorder, which should be targeted at the multiple symptoms in these patients. http://www.medscape.com/viewarticle/465193_4


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