Natural History of Psychological Symptoms in Individuals With Rome IV Irritable Bowel Syndrome and Association With Gastrointestinal Symptom Severity

Background and Aims

Psychological symptoms are common in irritable bowel syndrome (IBS) and are associated with more severe gastrointestinal symptoms. However, data describing the relationship between psychological symptoms and IBS symptom severity, and how this changes over time, are limited. We aimed to characterize the longitudinal course of psychological symptoms in individuals with Rome IV IBS and examine their association with gastrointestinal symptom severity over the same time period.

Methods

We recruited individuals with self-reported IBS from three UK community-based organizations who completed validated questionnaires assessing gastrointestinal symptoms and psychological symptoms at baseline and after 12 months. IBS symptom severity was measured using the IBS Severity Scoring System, and psychological symptoms were assessed using the Hospital Anxiety and Depression Scale, Patient Health Questionnaire-12, Visceral Sensitivity Index, and Perceived Stress Scale. Analyses included participants meeting Rome IV criteria at both time points.

Results

Among 1375 individuals recruited, 811 (59.0%) met Rome IV criteria at baseline. Of these 811 individuals who met Rome IV criteria at baseline, 452 (55.7%) provided follow-up data at 12 months and were the population of interest for this study. All psychological symptoms demonstrated moderate stability over 12 months (κ = 0.43–0.50, % agreement 61.7%–69.5%). Higher levels of anxiety, depression, extraintestinal symptom reporting, gastrointestinal symptom-specific anxiety, and perceived stress were consistently observed among individuals with persistently moderate-to-severe IBS symptoms, while those with worsening IBS symptoms also showed increased psychological symptom burden over time.

Conclusions

Psychological symptoms are moderately stable and closely associated with gastrointestinal symptom severity in Rome IV IBS. These findings support integrated gut–brain behavioral approaches to treatment and longitudinal assessment of psychological symptoms as part of the routine clinical management of IBS.