Non-traumatic stressful events at the time of abdominal pain onset is a marker of current psychological but not GI health in more severe IBS patients

Background and Aim: Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) disorder best understood from a biopsychosocial model. Of psychological factors, significant attention has been paid to the role of traumatic events; IBS patients with an abuse history tend to have poorer health outcomes (e.g., more severe GI symptoms, Drossman, 2011). It is unknown whether traumatic or non-traumatic stressful events are temporally linked to the onset of GI symptoms (e.g., pain). We assessed whether the onset of IBS symptoms occurred at the time of stressful life events, their type and severity. Methods: 353 Rome III diagnosed patients (M age = 41 yrs., F = 79%) underwent baseline assessment of an NIH trial. Assessment included psychological testing and a structured interview (Lackner, Gudleski, et al., 2013) assessing individual IBS symptoms per Rome criteria. For abdominal pain, patients were asked whether a major life event occurred around the time they first experienced the pain of IBS. The types of stressors were then classified into 11 domains (e.g., family, work, financial). Stressor severity was coded using previously reported weights. Results: 80% of patients reported that a stressful life event occurred at the time abdominal pain of IBS began an average of 14 years before evaluation. The 3 most common types of concurrent stressors were health (e.g., illness caused by food poisoning, 19%), school (e.g., starting college, 19%) and family (e.g., conflict, 11%). Patients who experienced a stressful life event around the time abdominal pain began did not differ from those who did not report a concurrent stressor on severity of abdominal pain or global IBS symptoms (p > .05). Patients who first experienced abdominal pain of IBS at the time of a stressful life event reported significantly more emotional distress (Beck Depression Inventory, Perceived Stress Scale, Brief Symptom Inventory, ps < .05). 40% of subjects reported a prior history of physical and/or sexual abuse. Conclusion: While a sizable proportion of IBS patients reported a positive trauma history, it was temporally linked to onset of abdominal pain in a small subset of patients. Pain onset was more frequently associated with non-traumatic stressors (e.g., health, school). The mechanism (e.g. dysregulation in HPA axis activity or ANS tone, intestinal dysbiosis) underlying the temporal relationship between pain and stress onset warrants further study. Patients whose pain began around the time of a stressful life event reported more emotional but not GI problems. Asking patients whether the onset of pain occurred around the time of a stressful life event may help gauge their current psychological, not GI, health. Information regarding prior history of trauma may provide limited information about the complexion of patient's health status.