Discussion
comorbidity, IBS-C, alterations in bowel movement, Pain, abdominal pain, IBS, IBS-U, depressive disorder, psychiatric
DISEASE, SECONDARY, CORTEX
Our study suggests that SxD worsens both the general and the specific QOL of female IBS patients. We found that approximately three out of ten women had SxD (IBS and control), which is lower than that previously reported (48%) [IBS women were older than controls. These findings are not consistent with the literature data that show a small protective factor in individuals older than 50 years [Pain related to menses did not differ among the groups. Premenopausal women with IBS report worsening of symptoms during menstruation compared with their follicular phase [IBS is more common in women who have had or are currently in relationships. This is finding is consistent with a study that found that married individuals had an increased odds ratio of IBS compared with nonmarried individuals (OR = 1.19) [Our IBS patients showed a lower weekly frequency of defecation, which is consistent with alterations in bowel movement as a diagnostic feature of IBS [A direct correlation was noted between subjective perception and objective recollection of fecal consistency, which validates its clinical use. This outcome is consistent with previously reported findings [Comparing the general QOL of IBS and SxD women separately, these patient groups share a deterioration in physical function and PCS, suggesting a common pathophysiological characteristic that would explain the poor subjective well-being perception. These findings agree with a recent study of patients with major depressive disorder treated with antidepressant drugs in which symptom responders showed an increase in functional connectivity in the dorsal anterior cingulate cortex (dACC) relative to nonresponders with improvement in physical QOL [QOL is particularly important for IBS not only as a diagnostic or pathophysiological feature but also as a prognostic effectiveness factor. The latest clinical guidelines consider QOL and comorbidity as indicators for healthcare-seeking behavior and consequently as a diagnostic-therapeutic goal [IBS subtype analysis shows a similar prevalence of SxD, but IBS-C patients scored lower on five domains compared with IBS-U patients. Given the small sample size, we are unable to make a definitive conclusion, but this approach will be interesting to investigate in future work.This research is the first step to elucidate the subjective perception of well-being as a diagnostic, therapeutic and prognostic objective. The clinical implications of these results are related to health-seeking behavior [Our study has some limitations to consider. We did not perform an exhaustive evaluation of clinical IBS or SxD. Although the diagnosis of IBS is clinical and the Rome IV criteria are sufficient to diagnose it, the possibility that abdominal pain may be secondary to another disease is latent. If we do not make a general laboratory evaluation, we will not be certain of the presence of IBS. Similarly, SxD requires a thorough psychiatric evaluation to determine which of the possible subtypes is present. Our approach assessed individuals from an open population, so we only trusted what each person reported and used self-administered questionnaires. Another limitation is that the power of prediction in cross-sectional studies is weak; thus, the RR results only serve as an approximation that should be validated in subsequent prospective studies.