Skip to main content

Advertisement

SpringerLink
Log in

Bloating in Irritable Bowel Syndrome Is Associated with Symptoms Severity, Psychological Factors, and Comorbidities

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Bloating is one of the most bothersome symptoms of irritable bowel syndrome (IBS), but its association with other symptoms is not well described.

Aims

We investigated the association between symptoms of abdominal bloating, other IBS symptoms, psychological distress, and comorbid pain conditions.

Methods

We conducted a cross-sectional study on a large cohort of IBS patients with and without symptoms of abdominal bloating and healthy controls. Subjects were assessed for IBS and its subtypes, pain severity, symptoms severity, psychological disturbances, comorbidities, and dietary restrictions of three fluid groups.

Results

A total of 484 subjects were investigated. Compared with IBS − B, IBS + B subjects had higher rates of constipation (30% vs. 15%, p = 0.191) and lower rates of diarrhea, (70% vs. 85%, p = 0.191) although these were not statistically significant. Bloating severity correlated with IBS symptoms severity (r = 0.397, p = 0.000), pain severity (r = 0.364, p = 0.000), and both anxiety and somatization scores (r = 0.167, p = 0.015 and r = 0.219, p = 0.001, respectively). Prevalence of fibromyalgia and depression and somatization scores was significantly higher in IBS with bloating than in IBS without bloating. IBS patients with bloating reported more dietary restriction of three fluid groups to control their symptoms compared with healthy controls and IBS patients without bloating.

Conclusions

Abdominal bloating in IBS is associated with increased symptoms and pain severity, somatization, depression, fibromyalgia, and altered dietary fluids composition. Recognizing and addressing these factors in the diagnosis and management of patients with IBS may improve clinical outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

GI:

Gastrointestinal

HC:

Healthy controls

IBS:

Irritable bowel syndrome

IBS − B:

Irritable bowel syndrome without bloating

IBS + B:

Irritable bowel syndrome with bloating

IBS-C:

Constipation-predominant irritable bowel syndrome

IBS-D:

Diarrhea-predominant irritable bowel syndrome

TMJ:

Temporomandibular joint

References

  1. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J. 1978;2:653–654.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology. 2016;150:1393–1407.

    Article  Google Scholar 

  3. Palsson OS, Whitehead WE, van Tilburg MA, et al. Rome IV diagnostic questionnaires and tables for investigators and clinicians. Gastroenterology. 2016. https://doi.org/10.1053/j.gastro.2016.02.014.

  4. Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gastroenterology. 2006;130:1480–1491.

    Article  PubMed  Google Scholar 

  5. Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17:643–650.

    Article  CAS  PubMed  Google Scholar 

  6. Ringel Y, Williams RE, Kalilani L, Cook SF. Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009;7:68–72. (quiz 3).

    Article  PubMed  Google Scholar 

  7. Kanazawa M, Miwa H, Nakagawa A, Kosako M, Akiho H, Fukudo S. Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan. Biopsychosoc Med. 2016;10:19.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Houghton LA, Whorwell PJ. Towards a better understanding of abdominal bloating and distension in functional gastrointestinal disorders. Neurogastroenterol Motil. 2005;17:500–511.

    Article  CAS  PubMed  Google Scholar 

  9. Seo AY, Kim N, Oh DH. Abdominal bloating: pathophysiology and treatment. J Neurogastroenterol Motil. 2013;19:433–453.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ringel-Kulka T, Palsson OS, Maier D, et al. Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study. J Clin Gastroenterol. 2011;45:518–525.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Malagelada JR, Accarino A, Azpiroz F. Bloating and abdominal distension: old misconceptions and current knowledge. Am J Gastroenterol. 2017;112:1221–1231.

    Article  PubMed  Google Scholar 

  12. Ghoshal U, Shukla R, Srivastava D, Ghoshal UC. Irritable bowel syndrome, particularly the constipation-predominant form, involves an increase in Methanobrevibacter smithii, which is associated with higher methane production. Gut Liver. 2016;10:932–938.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Azpiroz F, Malagelada JR. Abdominal bloating. Gastroenterology. 2005;129:1060–1078.

    Article  PubMed  Google Scholar 

  14. Lee HJ, Park KS. Bloating. Korean J Gastroenterol. 2017;70:288–295.

    Article  PubMed  Google Scholar 

  15. Major G, Pritchard S, Murray K, et al. Colon hypersensitivity to distension, rather than excessive gas production, produces carbohydrate-related symptoms in individuals with irritable bowel syndrome. Gastroenterology. 2017;152:124–133e2.

    Article  PubMed  Google Scholar 

  16. Niec AM, Frankum B, Talley NJ. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol. 1998;93:2184–2190.

    Article  CAS  PubMed  Google Scholar 

  17. Ragnarsson G, Bodemar G. Pain is temporally related to eating but not to defaecation in the irritable bowel syndrome (IBS). Patients’ description of diarrhea, constipation and symptom variation during a prospective 6-week study. Eur J Gastroenterol Hepatol. 1998;10:415–421.

    Article  CAS  PubMed  Google Scholar 

  18. Simren M, Månsson A, Langkilde AM, et al. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion. 2001;63:108–115.

    Article  CAS  PubMed  Google Scholar 

  19. Locke GR III, Zinsmeister AR, Talley NJ, Fett SL, Melton LJ. Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities. Am J Gastroenterol. 2000;95:157–165.

    Article  PubMed  Google Scholar 

  20. Neri L, Iovino P, Laxative Inadequate Relief Survey (LIRS) Group. Bloating is associated with worse quality of life, treatment satisfaction, and treatment responsiveness among patients with constipation-predominant irritable bowel syndrome and functional constipation. Neurogastroenterol Motil. 2016;28:581–591.

    Article  CAS  PubMed  Google Scholar 

  21. Ryu MS, Jung HK, Ryu JI, Kim JS, Kong KA. Clinical dimensions of bloating in functional gastrointestinal disorders. J Neurogastroenterol Motil. 2016;22:509–516.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Dorn SD, Morris CB, Hu Y, et al. Irritable bowel syndrome subtypes defined by Rome II and Rome III criteria are similar. J Clin Gastroenterol. 2009;43:214–220.

    Article  PubMed  Google Scholar 

  23. Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997;11:395–402.

    Article  CAS  PubMed  Google Scholar 

  24. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64:258–266.

    Article  PubMed  Google Scholar 

  25. Hartono JL, Mahadeva S, Goh KL. Anxiety and depression in various functional gastrointestinal disorders: do differences exist? J Dig Dis. 2012;13:252–257.

    Article  PubMed  Google Scholar 

  26. Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhea in the United States: prevalence and impact. Dig Dis Sci. 2000;45:1166–1171.

    Article  CAS  PubMed  Google Scholar 

  27. Chang L, Lee OY, Naliboff B, Schmulson M, Mayer EA. Sensation of bloating and visible abdominal distension in patients with irritable bowel syndrome. Am J Gastroenterol. 2001;96:3341–3347.

    Article  CAS  PubMed  Google Scholar 

  28. Heaton KW, Ghosh S, Braddon FE. How bad are the symptoms and bowel dysfunction of patients with the irritable bowel syndrome? A prospective, controlled study with emphasis on stool form. Gut. 1991;32:73–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Song JY, Merskey H, Sullivan S, Noh S. Anxiety and depression in patients with abdominal bloating. Can J Psychiatry. 1993;38:475–479.

    Article  CAS  PubMed  Google Scholar 

  30. Van Oudenhove L, Törnblom H, Störsrud S, Tack J, Simrén M. Depression and somatization are associated with increased postprandial symptoms in patients with irritable bowel syndrome. Gastroenterology. 2016;150:866–874.

    Article  PubMed  Google Scholar 

  31. Park HJ, Jarrett M, Cain K, Heitkemper M. Psychological distress and GI symptoms are related to severity of bloating in women with irritable bowel syndrome. Res Nurs Health. 2008;31:98–107.

    Article  PubMed  Google Scholar 

  32. Sperber AD, Atzmon Y, Neumann L, et al. Fibromyalgia in the irritable bowel syndrome: studies of prevalence and clinical implications. Am J Gastroenterol. 1999;94:3541–3546.

    Article  CAS  PubMed  Google Scholar 

  33. Bohn L, Storsrud S, Simren M. Nutrient intake in patients with irritable bowel syndrome compared with the general population. Neurogastroenterol Motil. 2013;25:23–30e1.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was performed in partial fulfillment of the requirements for a PhD degree of Keren Hod, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Funding

None for the design, funding, conduction, analysis, interpretation, and writing of this study. The collection of the dataset used in this study was supported by GSK.

Author information

Authors and Affiliations

  1. Research Division, Epidemiology Service, Assuta Medical Centers, Tel Aviv, Israel

    Keren Hod

  2. Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, 6997801, Ramat Aviv, Tel Aviv, Israel

    Keren Hod

  3. Division of Gastroenterology and Hepatology, Meir Medical Center, Tel Aviv University, 59 Tchernichovsky Street, 4428164, Kfar Saba, Israel

    Yehuda Ringel

  4. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, 4107 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, 27599-7080, USA

    Yehuda Ringel & Miranda A. L. van Tilburg

  5. College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA

    Miranda A. L. van Tilburg

  6. School of Social Work, University of Washington, Seattle, WA, USA

    Miranda A. L. van Tilburg

  7. Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 404A Rosenau, CB#7445, Chapel Hill, NC, 27599, USA

    Tamar Ringel-Kulka

Authors
  1. Keren Hod
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yehuda Ringel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miranda A. L. van Tilburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tamar Ringel-Kulka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yehuda Ringel.

Ethics declarations

Conflict of interest

No competing interests declared.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hod, K., Ringel, Y., van Tilburg, M.A.L. et al. Bloating in Irritable Bowel Syndrome Is Associated with Symptoms Severity, Psychological Factors, and Comorbidities. Dig Dis Sci 64, 1288–1295 (2019). https://doi.org/10.1007/s10620-018-5352-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-018-5352-5

Keywords

Search

Navigation