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Psychological Factors: The Defining Features of Quality of Life in Disorders of Gut-Brain Interaction: A Comparative
Sylvester R Groen1, Daniel Keszthelyi1, Zsa Zsa R M Weerts1
1Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands; NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
Background & Aims:
Delineating key determinants of health-related quality of life (HrQoL) in patients with disorders of the gut-brain-interaction (DGBI) remains challenging due to complex interplay of socioeconomic, psychological, and clinical factors. This exploratory comparative study aimed to identify factors and latent patient-profiles associated with generic and condition-specific HrQoL across different DGBI.
Methods:
Data from 4 clinical patient-cohorts were analyzed, including patients with functional dyspepsia ([FD]; n = 73), fecal incontinence ([FI]; n = 72), and irritable bowel syndrome ([IBS]; n = 419; 2 cohorts). Participants completed questionnaires on gastrointestinal (GI) symptoms, psychological factors, generic HrQoL (EQ-5D-5L), and condition-specific HrQoL. Finite mixture modeling identified latent clusters, and multivariate regression assessed factors associated with HrQoL outcomes.
Results:
In patients with IBS and FD, higher depression scores and GI symptom severity were significantly associated with lower generic and condition-specific HrQoL (P < .001). In both FI and IBS cohorts, higher anxiety scores were associated with reduced HrQoL. Finite mixture modeling identified distinct latent clusters-2 in FD and FI cohorts, and 3 in IBS cohort-primarily defined by psychological comorbidity. Latent clusters with higher anxiety and depression scores showed markedly lower HrQoL outcomes. In contrast, socioeconomic and lifestyle factors appeared less relevant. There were no significant associations between GI symptom severity and HrQoL in FI.
Conclusions:
Psychological comorbidity appears the most salient factor associated with HrQoL, which was uniformly seen across different DGBI, whereas GI symptom severity was only associated with HrQoL in patients with FD and patients with IBS, but not in patients with FI. Although causality between psychological factors and HrQoL cannot be ascertained, our findings underscore the importance of holistic DGBI management that extends beyond symptom control to encompass the full spectrum of patient experience.
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