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From the School of Psychology, University of Southampton, Highfield, Southampton, United Kingdom (R.M-M.); Psychological Medicine, Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand (M.S.).
Address correspondence and reprint requests to Dr. Rona Moss-Morris, School of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ, United Kingdom. E-mail: R.E.Moss-Morris{at}soton.ac.uk
Objectives: Recent academic debate has centered on whether functional somatic syndromes should be defined as separate entities or as one syndrome. The aim of this study was to investigate whether there may be significant differences in the etiology or precipitating factors associated with two common functional syndromes, irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS).
Methods: We prospectively studied 592 patients with an acute episode of Campylobacter gastroenteritis and 243 with an acute episode of infectious mononucleosis who had no previous history of CFS or IBS. At the time of infection, patients completed a baseline questionnaire that measured their levels of distress using the Hospital Anxiety and Depression scale. At 3- and 6-month follow-up, they completed questionnaires to determine whether they met published diagnostic criteria for chronic fatigue (CF), CFS, and/or IBS.
Results: The odds of developing IBS were significantly greater post-Campylobacter than post–infectious mononucleosis at both 3- (odds ratio, 3.45 [95% confidence interval (CI), 1.75–6.67]) and 6- (2.22 [95% CI, 1.11–6.67]) month follow-up. In contrast, the odds for developing CF/CFS were significantly greater after infectious mononucleosis than after Campylobacter at 3 (2.77 [95% CI, 1.08–7.11]) but not 6 (1.48 [95% CI, 0.62–3.55]) months postinfection. Anxiety and depression were the strongest predictors of CF/CFS, whereas the nature of the infection was the strongest predictor of IBS.
Conclusions: These results support the argument to distinguish between postinfectious IBS and CFS. The nature of the precipitating infection appears to be important, and premorbid levels of distress appear to be more strongly associated with CFS than IBS, particularly levels of depression.
Key Words: chronic fatigue syndrome • irritable bowel syndrome • Campylobacter gastroenteritis • infectious mononucleosis • functional somatic syndromes • psychological distress
Abbreviations: CDC = Centers for Disease Control and Prevention; CFS = chronic fatigue syndrome; CF = chronic fatigue; CI = confidence interval; IBS = irritable bowel syndrome; IM = infectious mononucleosis; HADS = Hospital Anxiety and Depression Scale.
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