Alimentary Pharmacology and Therapeutics Letter to the Editors
Letter: irritable bowel syndrome is significantly associated with somatisation C. Dai, M. Jiang & M.-J. Sun Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China. E-mail: [email protected]. doi:10.1111/apt.13114
SIRS, We read with interest the article by Patel and others who evaluated the relationship between IBS subtype, symptoms of IBS and somatisation.1 The authors found that IBS is strongly associated with higher levels of somatization, and bloating may be associated with higher levels of somatisation. Because their findings are important to future research, a question that determinants of IBS symptoms such as bloating or abdominal distension are gastric sensorimotor function, psychosocial factors or somatisation deserve attention. To our knowledge, the relative contribution of gastric sensorimotor function, psychosocial factors and somatisation to IBS symptoms has not been assessed before. Some studies show that gastric sensorimotor function may be more important in normosensitive patients, whereas the effect of somatisation is stronger in hypersensitive patients.2, 3 The concept of somatisation is problematic and ambiguous, although clinically very important. It is important to note that, given the nature of the somatisation measure used in this study, the PHQ-12 somatisation scores can only be seen as indicative of functional somatisation. In other words, the
Letter: irritable bowel syndrome is significantly associated with somatisation – authors’ reply P. Patel*,† & A. C. Ford*,† *Leeds Gastroenterology Institute, St. James’s University Hospital, Leeds, UK. † Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. E-mail: [email protected] doi:10.1111/apt.13116
SIRS, We thank Dr Dai and colleagues for taking the time to read and comment on our paper.1, 2 We agree that Aliment Pharmacol Ther 2015; 41: 789–796 ª 2015 John Wiley & Sons Ltd
somatisation scores in this study only provide a continuous measure of the number and severity of somatic symptoms reported by a patient, without firm implications for the possible biopsychosocial processes underlying this phenomenon. There is growing evidence about the influence of psychosocial factors on central pain processing, and thus on reporting of somatisation. At the same time, the roles of abdomino-phrenic displacement and impaired gas propulsion as causes of bloating and abdominal distension are controversial. Other underlying mechanisms include visceral hypersensitivity, food intolerance, altered gut microflora. However, bloating in IBS still remains incompletely understood and is considered challenging to treat in clinical practice. To gain insight into the pathophysiology of IBS, more studies are needed to evaluate the role of gastric sensorimotor function, psychosocial factors and somatisation in IBS.
ACKNOWLEDGEMENT Declaration of personal and funding interests: None. REFERENCES 1. Patel P, Bercik P, Morgan DG, et al. Irritable bowel syndrome is significantly associated with somatisation in 840 patients, which may drive bloating. Aliment Pharmacol Ther 2015; 41: 449–58. 2. Clauwaert N, Jones MP, Holvoet L, et al. Associations between gastric sensorimotor function, depression, somatization, and symptom-based subgroups in functional gastroduodenal disorders: are all symptoms equal? Neurogastroenterol Motil 2012; 24: 1088–e565. 3. Creed F. Somatisation in functional dyspepsia: integrating gastric physiology with psychological state. Gut 2008; 57: 1642–3.
the somatisation score we used is only a surrogate measure of true somatisation behaviour, as we mentioned in our paper. However, the number of individuals with symptoms compatible with irritable bowel syndrome (IBS) who reported extra-intestinal symptoms was considerable, and emphasises that, although there are treatments that are beneficial for the intestinal symptoms patients with IBS experience,3–6 these may not have any impact on the other symptoms reported. We also concur that further studies are required to better understand the mechanism of bloating and abdominal distension, which can be particularly troublesome and difficult to treat. Such studies may identify pathophysiological processes, towards which therapies can be directed. 791
Letter: irritable bowel syndrome is significantly associated with somatisation C. Dai, M. Jiang & M.-J. Sun Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China. E-mail: [email protected]. doi:10.1111/apt.13114
SIRS, We read with interest the article by Patel and others who evaluated the relationship between IBS subtype, symptoms of IBS and somatisation.1 The authors found that IBS is strongly associated with higher levels of somatization, and bloating may be associated with higher levels of somatisation. Because their findings are important to future research, a question that determinants of IBS symptoms such as bloating or abdominal distension are gastric sensorimotor function, psychosocial factors or somatisation deserve attention. To our knowledge, the relative contribution of gastric sensorimotor function, psychosocial factors and somatisation to IBS symptoms has not been assessed before. Some studies show that gastric sensorimotor function may be more important in normosensitive patients, whereas the effect of somatisation is stronger in hypersensitive patients.2, 3 The concept of somatisation is problematic and ambiguous, although clinically very important. It is important to note that, given the nature of the somatisation measure used in this study, the PHQ-12 somatisation scores can only be seen as indicative of functional somatisation. In other words, the
Letter: irritable bowel syndrome is significantly associated with somatisation – authors’ reply P. Patel*,† & A. C. Ford*,† *Leeds Gastroenterology Institute, St. James’s University Hospital, Leeds, UK. † Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. E-mail: [email protected] doi:10.1111/apt.13116
SIRS, We thank Dr Dai and colleagues for taking the time to read and comment on our paper.1, 2 We agree that Aliment Pharmacol Ther 2015; 41: 789–796 ª 2015 John Wiley & Sons Ltd
somatisation scores in this study only provide a continuous measure of the number and severity of somatic symptoms reported by a patient, without firm implications for the possible biopsychosocial processes underlying this phenomenon. There is growing evidence about the influence of psychosocial factors on central pain processing, and thus on reporting of somatisation. At the same time, the roles of abdomino-phrenic displacement and impaired gas propulsion as causes of bloating and abdominal distension are controversial. Other underlying mechanisms include visceral hypersensitivity, food intolerance, altered gut microflora. However, bloating in IBS still remains incompletely understood and is considered challenging to treat in clinical practice. To gain insight into the pathophysiology of IBS, more studies are needed to evaluate the role of gastric sensorimotor function, psychosocial factors and somatisation in IBS.
ACKNOWLEDGEMENT Declaration of personal and funding interests: None. REFERENCES 1. Patel P, Bercik P, Morgan DG, et al. Irritable bowel syndrome is significantly associated with somatisation in 840 patients, which may drive bloating. Aliment Pharmacol Ther 2015; 41: 449–58. 2. Clauwaert N, Jones MP, Holvoet L, et al. Associations between gastric sensorimotor function, depression, somatization, and symptom-based subgroups in functional gastroduodenal disorders: are all symptoms equal? Neurogastroenterol Motil 2012; 24: 1088–e565. 3. Creed F. Somatisation in functional dyspepsia: integrating gastric physiology with psychological state. Gut 2008; 57: 1642–3.
the somatisation score we used is only a surrogate measure of true somatisation behaviour, as we mentioned in our paper. However, the number of individuals with symptoms compatible with irritable bowel syndrome (IBS) who reported extra-intestinal symptoms was considerable, and emphasises that, although there are treatments that are beneficial for the intestinal symptoms patients with IBS experience,3–6 these may not have any impact on the other symptoms reported. We also concur that further studies are required to better understand the mechanism of bloating and abdominal distension, which can be particularly troublesome and difficult to treat. Such studies may identify pathophysiological processes, towards which therapies can be directed. 791
