Impact of somatization on health resource usage in patients with irritable bowel syndrome

Doctors may drive unnecessary procedures

Patients with irritable bowel syndrome (IBS) use over 50 percent more health resources than people without the disorder. Even though there are definitive guidelines to diagnose IBS through simple blood tests, many IBS patients have additional procedures and surgeries that rarely result in relief or any additional diagnostic findings.

“It is difficult to know why patients with IBS have such a high use of healthcare resources, and whether the high use is driven by the patients themselves or by the physicians taking care of them,” said Dr. Brennan M.R. Spiegel, study author and director, UCLA/VA Center for Outcomes Research and Education (CORE).

UCLA researchers tried to tease this out by analyzing the effect of somatization on the amount of health care resources utilized by patients with IBS. Somatization is a condition where emotional stressors trigger physical pain without the presence of disease. The new study is published in the October 2005 issue of the American Journal of Gastroenterology.

According to Spiegel, IBS patients often suffer from somatization. Since patients with somatization are sometimes perceived as “complainers” by their doctors, the researchers hypothesized that physicians might respond to these complaints by ordering excessive tests instead of treating the somatization itself.

Researchers found that patients with high levels of somatization were not more likely to seek gastrointestinal care than those with low levels of the condition. Once evaluated for care by the doctors however, the patients with more severe somatization were significantly more likely to utilize more health care services.

“This finding suggests that the doctors and not the patients may be driving the need for procedures and surgeries that may not be necessary,” said Dr. Brennan M.R. Spiegel, assistant professor of medicine, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System. “We need to educate and train doctors to recognize somatization and treat this condition appropriately, rather than order a number of diagnostic tests as a reaction in the face of symptoms that are otherwise difficult to explain.”

Spiegel noted that doctors should work closely with patients to diagnose and treat IBS, while also addressing the influence of stress and somatization, which is most often treated through cognitive behavioral training. More severe levels can be helped with anxiety and anti-depression medications.

An entirely new field has emerged called neurogastroenterology to scientifically study how the nervous and digestive systems interact in health and disease. One important question is how emotional stressors may alter the way patients with irritable bowel syndrome perceive and respond to gut stimuli.

“In many IBS patients the brain interprets and responds to sensations arising from the digestive system differently, causing abdominal discomfort and pain on the one side, and altered bowel habits on the other — generally without evidence of more serious disease, such as colitis or cancer,” said Dr. Emeran Mayer, study author and professor of medicine, physiology and psychiatry and director of The Center for Neurovisceral Sciences & Women’s Health where the study was performed. “We are just beginning to understand the mind-body connection in these conditions.”

Researchers analyzed questionnaires completed by 1,410 IBS patients seen at the Integrative Medicine and Women’s Digestive Health Clinic at UCLA. The questionnaires included information on health care services utilized, psychological symptoms, and a health survey. Investigators then measured one year of direct gastrointestinal health care costs used by the patients including physician visits, procedures and surgeries, as well as examined the number of visits to a gastrointestinal specialist in a year’s time.