Factors associated with symptom relief in patients with irritable bowel syndrome

The study identifies several demographic, lifestyle, psychological, and physiological factors associated with symptom relief in patients with irritable bowel syndrome (IBS). Here’s a detailed breakdown of the findings:

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### **1. Demographic Factors**

• **Age**: The average age of the cohort was 45 years, but specific age-related differences in symptom relief were not highlighted.
• **Gender**: Females had a slightly higher likelihood of symptom relief (54.5%) compared to males (45.9%). This could be due to gender differences in stress response, hormonal influences, or healthcare-seeking behavior.
• **IBS Subtype**:
• Patients with mixed-type IBS (IBS-M) showed the highest likelihood of symptom relief (55%) compared to diarrhea-predominant IBS (IBS-D, 39.9%) and constipation-predominant IBS (IBS-C, 40.5%).
• The variability in symptoms in IBS-M may allow for greater responsiveness to interventions.

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### **2. Lifestyle Factors**

• **Exercise**:
• Daily exercise (≥30 minutes of moderate-intensity activity) was a strong predictor of symptom relief, with a 65.5% relief rate compared to 35% in those who did not exercise.
• A dose-response relationship was observed, with patients exercising 3–5 times per week also showing significant benefit (53% relief rate).
• **Smoking and Alcohol Consumption**:
• While these were associated with worse baseline symptom severity, they were not directly linked to symptom relief rates. However, lifestyle counseling may help reduce the overall symptom burden.

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### **3. Psychological Factors**

• **Depression**:
• Lower depression scores were significantly associated with better symptom outcomes (OR = 0.93). Depression worsens gut-brain axis function, contributing to IBS severity, so addressing mental health is critical.
• **Stress**:
• High stress levels were associated with lower symptom relief rates (39%) compared to those with low stress (58%). Stress likely exacerbates IBS through hormonal and autonomic dysregulation.
• **Anxiety**:
• Anxiety showed some association with symptom relief in univariate analysis but lost significance in multivariate analysis, suggesting that depression and stress play stronger roles in symptom outcomes.

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### **4. Social and Family Support**

• **Family Support**:
• Strong family support was associated with a higher relief rate (60.5%) compared to those with poor support (35%). Family involvement likely enhances treatment adherence, coping, and psychological well-being.

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### **5. Baseline Symptom Severity**

• **Symptom Severity**:
• Patients with higher baseline symptom severity were more likely to report symptom relief (OR = 1.20). This may reflect greater motivation to adhere to treatment and lifestyle changes, or possibly a regression-to-the-mean effect.

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### **6. Physiological and Biological Markers**

• **CRP Levels and Gut Microbiota Diversity**:
• Neither C-reactive protein (CRP) levels nor gut microbiota diversity were independent predictors of symptom relief. While these markers are relevant to IBS pathophysiology, their role in predicting symptom improvement appears limited.

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### **7. Medication Adherence**

• **Adherence**:
• Higher medication adherence showed a trend toward better outcomes, though it was not statistically significant. This indicates that lifestyle and psychological factors may have a stronger influence on symptom relief than medication alone.

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### **8. Financial and Economic Factors**

• **Financial Stress**:
• Financial burden did not significantly impact symptom relief outcomes. This suggests that psychosocial support and coping mechanisms may outweigh economic factors in determining IBS symptom improvement.

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### **9. Predictive Model Performance**

• The predictive model, which included factors like symptom severity, exercise, depression, stress, and family support, had an area under the curve (AUC) of 0.76, indicating good reliability in predicting symptom relief.

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### **Clinical Implications**

• IBS management should take a **holistic approach** that integrates:
• **Lifestyle interventions**: Regular physical activity (e.g., daily or 3–5 times/week).
• **Mental health support**: Addressing depression and stress through therapy or stress management techniques.
• **Social support**: Encouraging family involvement to improve adherence and coping.
• These low-cost, non-pharmacological strategies can complement pharmacological or dietary therapies to enhance patient outcomes.

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### **Summary of Key Predictors of Symptom Relief**

1. **Positive Predictors**:

• Daily exercise (≥30 minutes of moderate-intensity activity).
• Strong family support.
• Lower depression and stress levels.
• Higher baseline symptom severity.

2. **Negative Predictors**:

• High stress levels.
• Poor family support.
• Lack of regular physical activity.

3. **Non-Significant Predictors**:

• CRP levels and gut microbiota diversity.
• Financial stress.
• Anxiety (in multivariate analysis).

By focusing on these factors, healthcare providers can develop more personalized and effective IBS management plans.