Vol.:(0123456789) 1 3 Digestive Diseases and Sciences https://doi.org/10.1007/s10620-018-5352-5 ORIGINAL ARTICLE Bloating in Irritable Bowel Syndrome Is Associated with Symptoms Severity, Psychological Factors, and Comorbidities Keren Hod 1,2  · Yehuda Ringel 3,4  · Miranda A. L. van Tilburg 4,5,6  · Tamar Ringel‑Kulka 7 Received: 23 May 2018 / Accepted: 24 October 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Background Bloating is one of the most bothersome symptoms of irritable bowel syndrome (IBS), but its association with other symptoms is not well described. Aims We investigated the association between symptoms of abdominal bloating, other IBS symptoms, psychological dis- tress, and comorbid pain conditions. Methods We conducted a cross-sectional study on a large cohort of IBS patients with and without symptoms of abdominal bloating and healthy controls. Subjects were assessed for IBS and its subtypes, pain severity, symptoms severity, psychologi- cal disturbances, comorbidities, and dietary restrictions of three fluid groups. Results A total of 484 subjects were investigated. Compared with IBS − B, IBS + B subjects had higher rates of constipation (30% vs. 15%, p = 0.191) and lower rates of diarrhea, (70% vs. 85%, p = 0.191) although these were not statistically significant. Bloating severity correlated with IBS symptoms severity (r = 0.397, p = 0.000), pain severity (r = 0.364, p = 0.000), and both anxiety and somatization scores (r = 0.167, p = 0.015 and r = 0.219, p = 0.001, respectively). Prevalence of fibromyalgia and depression and somatization scores was significantly higher in IBS with bloating than in IBS without bloating. IBS patients with bloating reported more dietary restriction of three fluid groups to control their symptoms compared with healthy con- trols and IBS patients without bloating. Conclusions Abdominal bloating in IBS is associated with increased symptoms and pain severity, somatization, depression, fibromyalgia, and altered dietary fluids composition. Recognizing and addressing these factors in the diagnosis and manage- ment of patients with IBS may improve clinical outcome. Keywords Irritable bowel syndrome · Bloating · Comorbidity · Somatization disorder * Yehuda Ringel ringel@med.unc.edu; yehuda_ringel@med.unc.edu Keren Hod hodkeren@gmail.com Miranda A. L. van Tilburg miranda_van_tilburg@med.unc.edu Tamar Ringel-Kulka ringelta@email.unc.edu 1 Research Division, Epidemiology Service, Assuta Medical Centers, Tel Aviv, Israel 2 Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, 6997801 Ramat Aviv, Tel Aviv, Israel 3 Division of Gastroenterology and Hepatology, Meir Medical Center, Tel Aviv University, 59 Tchernichovsky Street, 4428164 Kfar Saba, Israel 4 Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, 4107 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599-7080, USA 5 College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA 6 School of Social Work, University of Washington, Seattle, WA, USA 7 Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 404A Rosenau, CB#7445, Chapel Hill, NC 27599, USA