Psychological characteristics of patients with irritable bowel syndrome and their dynamics against the background of cytoprotective therapy

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional bowel disorder caused by disruption of the bidirectional brain-gut signaling pathways. While psychological disorders are considered a predisposing factor for the development of IBS, its clinical manifestations significantly contribute to the development and exacerbation of existing psychopathological symptoms. Another significant factor in the pathogenesis of the disease is increased epithelial permeability of the intestinal mucosa. Including the cytoprotector rebamipide in the complex therapy of patients with IBS is promising, as its pharmacological effects are aimed at correcting increased epithelial permeability. Presumably, rebamipide will not only reduce gastrointestinal complaints but also improve the psychological state of IBS patients through its positive impact on their well-being.

AIM: Study the clinical and psychological status of IBS patients, the dynamics of gastrointestinal complaints and psychopathological symptoms during therapy with the cytoprotector rebamipide.

METHODS: This article presents an excerpt from a single-center, open-label, comparative, randomized, prospective study titled “Mucosal Leakage Syndrome in Functional and Organic Diseases of the Colon (SOCRAT)” that included 120 patients with irritable bowel syndrome. This article describes only a subset of patients from the SOCRAT study, divided into two groups. The main group received rebamipide in addition to antispasmodic therapy, while the comparison group received bismuth tripotassium dicitrate. Gastroenterological complaints were assessed before and after treatment using the Gastrointestinal Symptom Rating Scale (GSRS) and the 7x7 questionnaire (V.T. Ivashkina). All patients also underwent an experimental psychological examination before and after treatment, including an assessment of anxiety, depression, and asthenia using questionnaires. The Hospital Anxiety and Depression Scale (HADS), the Asthenic State Scale (L.D. Malkova, adapted by T.G. Chertova), and the Self-Assessment Anxiety Scale (C.D. Spielberger, Yu.L. Khanina) were used. All patients were consulted by a psychotherapist.

RESULTS: To achieve this objective, 52 patients with IBS were recruited from the SOCRAT study. Along with gastrointestinal complaints, anxiety disorders were observed in almost half of the patients, depressive disorders in more than a third, and asthenia in two-thirds of patients. Moreover, patients with constipation-predominant IBS and the mixed type of irritable bowel syndrome demonstrated higher levels of general anxiety than patients with diarrhea-predominant IBS. No significant differences were found in the levels of depression, reactive and trait anxiety, or asthenia across the different clinical types of irritable bowel syndrome. The study patients were divided into two groups: the main group (n = 25) and the comparison group (n = 27), matched by gender, age, and IBS type. During therapy, a decrease in the severity of gastrointestinal complaints was observed in both groups of IBS patients. Patients receiving rebamipide demonstrated more significant positive dynamics. Along with an improvement in the clinical course of irritable bowel syndrome, the rebamipide group also showed a reduction in anxiety, depression, and asthenia. No significant improvement in psychological status was observed in the comparison group.

CONCLUSION: Most of the studied patients with IBS were found to have various psychological disorders of varying severity, including increased anxiety, depression, and asthenia. Including the cytoprotector rebamipide in the complex therapy of patients with irritable bowel syndrome not only improves the clinical course of the disease and regresses gastrointestinal complaints, but also indirectly helps reduce these psychopathological symptoms.