Original article—alimentary tract
Prevalence of Functional Gastrointestinal Disorders in Patients With Fibromyalgia and the Role of Psychologic Distress

https://doi.org/10.1016/j.cgh.2008.12.005Get rights and content

Background & Aims

Fibromyalgia is a rheumatologic disorder associated with somatic and psychologic conditions. Although fibromyalgia is associated with irritable bowel syndrome, its relationship with other functional gastrointestinal disorders (FGID) is unclear. We evaluated the prevalence of FGID in patients with fibromyalgia and the role of psychologic factors in this relationship.

Methods

From a Spanish population, 100 patients with fibromyalgia and 100 matched controls completed the Rome II Integrative Questionnaire to assess the prevalence of FGID and the Symptom Checklist-90 Revised (SCL-90R) to evaluate psychologic distress. Patients completed the Fibromyalgia Impact Questionnaire to evaluate the overall impact of fibromyalgia and controls filled out the Chronic Widespread Pain Questionnaire to detect potential cases of fibromyalgia.

Results

Ninety-three percent of the total study population was female, with a mean age of 50 years. We identified 6 cases of widespread pain among controls. The average Fibromyalgia Impact Questionnaire score for patients was 67.28 ± 14.25. All gastrointestinal symptoms except for vomiting were more frequent in patients. Ninety-eight percent of patients with fibromyalgia had at least one FGID, compared with only 39% of controls. Fibromyalgia was correlated most highly with irritable bowel syndrome. Patients presented with significantly higher scores of psychologic distress than controls, especially those with fecal incontinence.

Conclusions

There is a prevalence of FGID in patients with fibromyalgia and a wider distribution of such symptoms along the gastrointestinal tract compared with controls. We propose that an increased degree of psychologic distress in these patients predisposes them to FGID, especially significant for anorectal syndromes.

Section snippets

Population

Patients were selected randomly from the Madrilian Association of Patients with Fibromyalgia, which requires a medical diagnosis of FM performed by a rheumatologist according to the American College of Rheumatology (ACR) criteria4 to be enrolled. Controls were selected randomly from a list of the Madrid electoral census and matched by age and sex with patients.

All controls selected were first contacted by telephone and those who agreed to participate completed the questionnaires over the

Results

We included 100 patients and 100 controls matched by age and sex. Controls showed a slightly higher educational level than cases, but no significant differences on other characteristics (Table 1). We identified 6 cases of widespread musculoskeletal pain among controls (6%; 95% confidence interval, 1.5–10.6). Exclusion of these subjects from the analysis did not modify results. The overall impact of FM in a patient's life as assessed by the FIQ was 67.28 ± 14.25 among patients.

Discussion

Our study was designed with the purpose of better understanding the prevalence of FGIDs in Spanish patients with FM, as well as assessing whether certain psychologic abnormalities were related to the presence of FGID in patients with FM.

In addition, we found a 6% prevalence of widespread pain among controls that reinforced the concept that this is a prevalent condition in the general population.1, 2, 3

Our case-control study confirms the high prevalence of FGID in patients with FM and shows that

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    Conflicts of Interest The authors disclose no conflicts.

    Funding This study was supported by an unrestricted grant from the Mutua Madrileña Foundation for Medical Research.

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