Anxiety about IBS

Summarized by Robert W. Griffith, MD
March 11, 2005

Introduction

The irritable bowel syndrome (IBS) is the most common of the so-called functional gastrointestinal disorders, which includes chronic heartburn, GERD, and motility upsets such as diarrhea or constipation. IBS is reported in up to 3% of the adult US population. It used to be labeled as a condition that was "all in the mind". In recent decades, however, it's become clear that it has distinct diagnostic features, and responds to treatments aimed at the likely underlying functional disorder, whether it's constipation- or diarrhea-predominant.

Although the characterization of IBS today is much more exact, and new drugs are proving extremely helpful, there remains an area where more needs to be done to help patients - IBS-associated anxiety. As many as 40% of IBS sufferers have general forms of anxiety, but even more may have symptoms of anxiety directly related to the gastrointestinal tract (GI). To this end, a group of Californian scientists have developed a test - the Visceral Sensitivity Index, or VSI - to measure the degree of specific GI anxiety, in order to allow the effectiveness of treatments to be accurately assessed. Their report in the Alimentary Pharmacology and Therapeutics journal is summarized below.

What was done

The specific GI test - called the VSI - was planned to consist of a short series of yes/no questions about symptoms associated with the subjects IBS. To begin with a large number of such items were collected from previous general anxiety and IBS diagnostic questionnaires; these sources were used because the items had been fully tested and found to be unambiguous, understandable, and user-friendly.

There were 86 items, from which the scientists were to select the most suitable. An external panel, consisting of seven physicians and two psychologists, evaluated the items for relevance, conciseness, and clarity, using a 5-point scale; they were also asked to add any items they felt would be useful. A second panel, consisting of three of the authors of the report, repeated the work of the first panel. And finally a 'focus group' consisting of 11 patients with established IBS reviewed the items and proposed a questionnaire format consisting of a statement for each item, followed by a 6-point choice ranging from 'strongly agree' to 'strongly disagree'.

To test the accuracy of the 90 final items in questionnaire format they were administered to 96 patients with a documented history of IBS. The patients were also asked to complete a bowel-symptom questionnaire and two tests of general anxiety systems.

Paring down the 90 items to a manageable number was done using such criteria as overlap of content, coverage of all relevant areas, and so on. A final set of 15 items were analyzed statistically for internal consistency, reliability, and validity.

What the VSI contains

Here are the 15 questions used in the VSI, which allows a score of 1 through 6 for each question 'strongly agree' (1), 'moderately agree' (2), 'mildly agree' (3), 'mildly disagree' (4), 'moderately disagree' (5), and 'strongly disagree' (6). The term 'discomfort' in some questions should cover pain, diarrhea, constipation, bloating, or a sense of urgency.

1. I worry that whenever I eat during the day, bloating and distension in my belly will get worse
2. I get anxious when I go to a new restaurant
3. I often worry about problems in my belly
4. I have a difficult time enjoying myself because I cannot get my mind off of discomfort in my belly
5. I often fear that I won't be able to have a normal bowel movement
6. Because of fear of developing abdominal discomfort, I seldom try new foods
7. No matter what I eat, I will probably feel uncomfortable
8. As soon as I feel abdominal discomfort I begin to worry and feel anxious
9. When I enter a place I haven't been before, one of the first things I do is to look for a bathroom
10. I am constantly aware of the feelings I have in my belly
11. I often feel discomfort in my belly could be a sign of serious illness
12. As soon as I awake, I worry that I will have discomfort in my belly during the day
13. When I feel discomfort in my belly, it frightens me
14. In stressful situations, my belly bothers me a lot
15. I constantly think about what is happening inside by belly

This 15-item index passed all statistical tests for reliability and validity. The scores were not influenced by age, sex, or duration of IBS. However, general anxiety symptoms (assessed using the other tests mentioned above) did appear to influence, or be linked with, the VSI scores.

Comment

The main use of this test (or others like it) will be in evaluating new treatments for the anxiety that IBS sufferers experience that's directly related to their disorder. It's likely that the VSI will produce high scores in patients with other functional GI disorders such as GERD or chronic indigestion. It will be interesting to see if people with both IBS and general anxiety disorders, who are treated with anxiolytic drugs (e.g. minor tranquilizers such as Valium^®) have a reduction in their VSI scores along with improvement in their general anxiety symptoms. On the other hand, how would people treated specifically to reduce their VSI score fare with regard to their general anxiety symptoms? Obviously there's plenty of room for useful clinical studies to help us learn more about IBS, and this new tool - the VSI - will be most helpful.

Source

• The Visceral Sensitivity Index: Development and validation of a gastrointestinal symptom-specific anxiety scale. JS. Labus, R. Bolus, L. Chang,  et al., Aliment Pharmacol Ther, 2004, vol. 20, pp. 89--97

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A Psychologist has Irritable Bowel Syndrome - Part 1: Understanding the Problem

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