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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)

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


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).


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).


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.

Corresponding author
*Address for correspondence: Professor P. D. White, Centre for Psychiatry, St Bartholomew's Hospital, LondonEC1A 7BE, UK. (Email:
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OG Cameron (2001). Interoception: the inside story – a model for psychosomatic processes. Psychosomatic Medicine 63, 697710.

AD Craig (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience 3, 655666.

WT Hamilton , AM Gallagher , JM Thomas , PD White (2005). The prognosis of different fatigue diagnostic labels: a longitudinal survey. Family Practice 22, 383388.

SB Harvey , M Wadsworth , S Wessely , M Hotopf (2008). Etiology of chronic fatigue syndrome: testing popular hypotheses using a national birth cohort study. Psychosomatic Medicine 70, 488495.

I Hickie , T Davenport , D Wakefield , U Vollmer-Conna , B Cameron , SD Vernon , WC Reeves , A Lloyd ; 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.

R Jones , R Latinovic , J Charlton , M Gulliford (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.

S Lawrie , D Manders , J Geddes , A Pelosi (1997). A population-based incidence study of chronic fatigue. Psychological Medicine 27, 343353.

R Moss-Morris , M Spence (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.

T Pawlikowska , T Chalder , S Hirsch , P Wallace , D Wright , S Wessley (1995). Population based study of fatigue and psychological distress. British Medical Journal 308, 763766.

I Petersen , JM Thomas , WT Hamilton , PD White (2006). Risk and predictors of fatigue after infectious mononucleosis in a large primary care cohort. Quarterly Journal of Medicine 99, 4955.

ML Phillips , LJ Gregory , S Cullen , S Cohen , V Ng , C Andrew , V Giampietro , E Bullmore , F Zelaya , E Amaro , DG Thompson , AR Hobson , SCR Williams , M Brammer , Q Aziz (2003). The effect of negative emotional context on neural and behavioural responses to oesophageal stimulation. Brain 126, 669684.

R Raine , S Carter , T Sensky , N Black (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.

R Spiller (2007). Irritable bowel syndrome. Lancet 369, 15861588.

U Vollmer-Conna , E Aslakson , PD White (2006). An empirical delineation of the heterogeneity of chronic unexplained fatigue. Pharmacogenetics 7, 355364.

S Wessely , C Nimnuan , MC Sharpe (1999). Functional somatic syndromes: one or many? Lancet 354, 936939.

PD White , JM Thomas , HO Kangro , WD Bruce-Jones , J Amess , DH Crawford , SA Grover , AW Clare (2001). Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis. Lancet 358, 19461954.

S Wiens (2005). Interoception in emotional experience. Current Opinion in Neurology 18, 442447.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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