Skip to main content
×
Home

Risk markers for both chronic fatigue and irritable bowel syndromes: a prospective case-control study in primary care

  • W. T. Hamilton (a1), A. M. Gallagher (a2), J. M. Thomas (a2) and P. D. White (a2)
Abstract
Background

Fatigue syndromes and irritable bowel syndrome (IBS) often occur together. Explanations include being different manifestations of the same condition and simply sharing some symptoms.

Method

A matched case-control study in UK primary care, using data collected prospectively in the General Practice Research Database (GPRD). The main outcome measures were: health-care utilization, specific symptoms and diagnoses. Risk markers were divided into distant (from 3 years to 1 year before diagnosis) and recent (1 year before diagnosis).

Results

A total of 4388 patients with any fatigue syndrome were matched to two groups of patients: those attending for IBS and those attending for another reason. Infections were specific risk markers for both syndromes, with viral infections being a risk marker for a fatigue syndrome [odds ratios (ORs) 2.3–6.3], with a higher risk closer to onset, and gastroenteritis a risk for IBS (OR 1.47, compared to a fatigue syndrome). Chronic fatigue syndrome (CFS) shared more distant risk markers with IBS than other fatigue syndromes, particularly other symptom-based disorders (OR 3.8) and depressive disorders (OR 2.3), but depressive disorders were a greater risk for CFS than IBS (OR 2.4). Viral infections were more of a recent risk marker for CFS compared to IBS (OR 2.8), with gastroenteritis a greater risk for IBS (OR 2.4).

Conclusions

Both fatigue and irritable bowel syndromes share predisposing risk markers, but triggering risk markers differ. Fatigue syndromes are heterogeneous, with CFS sharing predisposing risks with IBS, suggesting a common predisposing pathophysiology.

Copyright
Corresponding author
*Address for correspondence: Professor P. D. White, Centre for Psychiatry, St Bartholomew's Hospital, London EC1A 7BE, UK. (Email: p.d.white@qmul.ac.uk)
References
Hide All
Afari N, Buchwald D (2001). A review of the evidence for overlap among unexplained medical conditions. Annals of Internal Medicine 134, 868881.
Aggarwal VR, McBeth J, Zakrzewska JM, Lunt M, Macfarlane GJ (2006). The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? International Journal of Epidemiology 35, 468476.
Buchwald DS, Rea TD, Katon WJ, Russo JE, Ashley RL (2000). Acute infectious mononucleosis: characteristics of patients who report failure to recover. American Journal of Medicine 101, 531537.
Cameron OG (2001). Interoception: the inside story – a model for psychosomatic processes. Psychosomatic Medicine 63, 697710.
CFS/ME Working Group (2002). A Report of the CFS/ME Working Group: Report to the Chief Medical Officer of an independent working group. Department of Health: London.
Craig AD (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience 3, 655666.
Euba R, Chalder T, Deale A, Wessely S (1996). A comparison of the characteristics of chronic fatigue syndrome in primary and tertiary care. British Journal of Psychiatry 168, 121126.
Gallagher A, Thomas J, Hamilton W, White PD (2004). The incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001. Journal of the Royal Society of Medicine 97, 571575.
Hall GH, Hamilton WT, Round AP (1998). Increased illness experience preceding chronic fatigue syndrome: a case control study. Journal of the Royal College of Physicians of London 32, 4448.
Hamilton W, Hall GH, Round AP (2001). Frequency of attendance in general practice and symptoms before development of chronic fatigue syndrome: a case control study. British Journal of General Practice 51, 553558.
Hamilton WT, Gallagher AM, Thomas JM, White PD (2005). The prognosis of different fatigue diagnostic labels: a longitudinal survey. Family Practice 22, 383388.
Harvey SB, Wadsworth M, Wessely S, Hotopf M (2008). Etiology of chronic fatigue syndrome: testing popular hypotheses using a national birth cohort study. Psychosomatic Medicine 70, 488495.
Heim C, Wagner D, Maloney E, Papanicolaou DA, Solomon L, Jones JF, Unger ER, Reeves WC (2006). Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study. Archives of General Psychiatry 63, 12581266.
Hickie I, Davenport T, Wakefield D, Vollmer-Conna U, Cameron B, Vernon SD, Reeves WC, Lloyd A; Dubbo Infection Outcomes Study Group (2006). Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. British Medical Journal 333, 575580.
Jones R, Latinovic R, Charlton J, Gulliford M (2006). Physical and psychological co-morbidity in irritable bowel syndrome: a matched cohort study using the General Practice Research Database. Alimentary Pharmacology and Therapeutics 24, 879886.
Kato K, Sullivan P, Evengård B, Pedersen NL (2009). A population-based twin study of functional somatic syndromes. Psychological Medicine 39, 497505.
Lawrie S, Manders D, Geddes J, Pelosi A (1997). A population-based incidence study of chronic fatigue. Psychological Medicine 27, 343353.
Moss-Morris R, Spence M (2006). To ‘Lump’ or to ‘Split’ the functional somatic syndromes: can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome? Psychosomatic Medicine 68, 463469.
Pawlikowska T, Chalder T, Hirsch S, Wallace P, Wright D, Wessley S (1995). Population based study of fatigue and psychological distress. British Medical Journal 308, 763766.
Petersen I, Thomas JM, Hamilton WT, White PD (2006). Risk and predictors of fatigue after infectious mononucleosis in a large primary care cohort. Quarterly Journal of Medicine 99, 4955.
Phillips ML, Gregory LJ, Cullen S, Cohen S, Ng V, Andrew C, Giampietro V, Bullmore E, Zelaya F, Amaro E, Thompson DG, Hobson AR, Williams SCR, Brammer M, Aziz Q (2003). The effect of negative emotional context on neural and behavioural responses to oesophageal stimulation. Brain 126, 669684.
Raine R, Carter S, Sensky T, Black N (2004). General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study. British Medical Journal 328, 13541357.
Spiller R (2007). Irritable bowel syndrome. Lancet 369, 15861588.
Thabane M, Kottachchi DT, Marshall JK (2007). Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Alimentary Pharmacology and Therapeutics 26, 535544.
Vollmer-Conna U, Aslakson E, White PD (2006). An empirical delineation of the heterogeneity of chronic unexplained fatigue. Pharmacogenetics 7, 355364.
Wessely S (1997). Chronic fatigue syndrome: a 20th century illness? Scandinavian Journal of Work, Environment and Health 23, 1734.
Wessely S, Chalder T, Hirsch S, Pawlikoska T, Wallace P, Wright D (1995). Postinfectious fatigue: prospective cohort study in primary care. Lancet 345, 13331338.
Wessely S, Nimnuan C, Sharpe MC (1999). Functional somatic syndromes: one or many? Lancet 354, 936939.
Wessely S, White PD (2004). There is only one functional somatic syndrome. British Journal of Psychiatry 185, 9596.
White PD, Thomas JM, Kangro HO, Bruce-Jones WD, Amess J, Crawford DH, Grover SA, Clare AW (2001). Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis. Lancet 358, 19461954.
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders; Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.
Wiens S (2005). Interoception in emotional experience. Current Opinion in Neurology 18, 442447.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 4
Total number of PDF views: 21 *
Loading metrics...

Abstract views

Total abstract views: 140 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th November 2017. This data will be updated every 24 hours.