Functional gastrointestinal disorders : Co-morbidity and non-somatic aspects

Abstract: Aims of the thesis: The first aim, (Study I) of this thesis was to compare co-morbidity of the reported symptoms and its relation to healthcare seeking behaviour among non-patients who had persistent functional gastro-intestinal disorders (FGID) or who were strictly GI symptom free (SSF). The second aim (study II) was to compare FGID sufferers primary health care consumption, as registered in their medical records. The third aim (study III) was to investigate the occurrence of a history of abuse, and the possible association with consultation rate, and the fourth aim (study IV) was to investigate the possible influence of a negative parental rearing experienced during childhood. Methods: The Abdominal symptom questionnaire (ASQ) was mailed to a random sample of 1537 adults aged 20-87 years from the municipality of Östhammar, Sweden (n= 21,545 in 1995). From the obtained response and by integrating results from previous studies performed in 1988 and 1989, 244 subjects with FGID (e.g. FD and/or IBS) and 219 SSF subjects were invited to their local health centers for completing the ASQ again in addition to a set of other questionnaires. From the results in the ASQ, 141 subjects with persistent FGID and 97 SSF subjects formed the study groups of the studies I,III and IV. A subgroup living in the eastern part of Östhammar constituted the study groups in study II. The used questionnaires were; Complaint score questionnaire (CSQA), Psychological General Well-Being (PGWB), Hospital Anxiety and Depression Scale (HADS), Sexual, physical and emotional abuse (ABQ), Coping strategies questionnaire (CSQ), Social support (ISSI), and the Multidimensional Health locus of control scale (MHLC). Results: In study I: Non-patients with FGID have a higher risk of psychological illness (OR 8.4, CI95: 4.0-17.5) than somatic illness (OR 2.8, CI95: 1.3-5.7) or ache and fatigue symptoms (OR 4.3, CI95:2.1-8.7). Patients with FGID have more severe GI symptoms than healthy controls. In study II: of the FGID patients, 97% had a non-GI diagnosis, compared to 100% of SSF (ns). The mean number of consultations, prescriptions, diagnoses as well as anxiety level and depression were all statistically significantly higher (p<0.05) in FGID compared to SSF, whereas the number of referrals and sick leave were not. Besides a GI diagnosis, there was no significant difference (p>0.05) in the spectrum of morbidity in terms of ICD-9 subgroup classification, except an increased proportion of older SSF subjects with circulatory disorders and hypertension. In study III: Women with FGID had a higher risk of having a history of some kind of abuse, as compared with the SSF controls (45% vs.16%), in contrast to men (29% vs. 24% n.s.). Women with a history of abuse and FGID had reduced HRQoL as compared with women without abuse history. In study IV: Neuroticism and a parental rejective rearing style were identified as risk factors for FGID. FGID consulters reported an increased parental rejection and reduced health-related quality of life. Moreover, consulters had a higher exposure to abuse in childhood, a lower availability of social attachment and less adequacy of social interaction than non-consulters. Conclusions: FGID is related to an increased demand on primary health care due to an increased overall co-morbidity. Women with longstanding FGID often have a history of physical, emotional or sexual abuse which is associated with a poor HRQoL and increased health care seeking. Negative parental upbringing represents an aggravating factor in FGID. The treatment of FGID should involve assessment of psychological distress.