Fibromyalgia Significantly Linked to Benign Gastrointestinal Disorders

Results of a retrospective cross-sectional study demonstrated that a fibromyalgia diagnosis was positively associated with a variety of benign, but not malignant, gastrointestinal disorders, according to data published in Clinical and Experimental Rheumatology.¹

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Many patients with fibromyalgia report gastrointestinal symptoms, as proven in a previous study that reported 73% of patients experienced bowel dysfunction and 63% had alternating periods of constipation and diarrhea, compared with none in a cohort of healthy controls.²

“Several studies have shown a higher prevalence of irritable bowel syndrome (IBS) among patients with fibromyalgia yet, data regarding association between fibromyalgia and other gastrointestinal disorders have been relatively overlooked,” wrote Einat Savin, MD, Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel, and colleagues. “Our aim was to investigate the association between fibromyalgia and gastrointestinal disorders including both benign and malignant conditions.”

Investigators performed a study utilizing the comprehensive electronic database of the largest health maintenance organization in Israel. Eligible patients with fibromyalgia were age- and sex-matched with controls. The link between fibromyalgia and benign gastrointestinal disorders, including IBS, peptic ulcer disease (PUD), celiac disease, gastroesophageal reflux disease (GERD), ulcerative colitis, and Crohn’s disease, as well as gastrointestinal malignancies such as stomach, liver, pancreatic, colorectal, and bile duct cancers, was evaluated.

Demographic information such as age, sex, smoking status, socioeconomic status (SES), and body mass index (BMI) were collected from the electronic database Clalit Health Services (CHS).

Ultimately, 18,598 patients with fibromyalgia and 36,985 controls were included in the analysis. The mean age was 56.6 years and most (91%) were female. Patients with fibromyalgia were more likely to be smokers when compared with controls (37% vs 30%, respectively) and have a higher BMI (29.07 vs 28.14, respectively). Most patients in both groups were categorized as low (45%) or medium (39%) SES.

A fibromyalgia diagnosis was significantly associated with GERD (odds ratio [OR] 2.62, 95% confidence interval [CI] 2.5-2.75, P <.001), PUD (OR 2.13, 95% CI 1.98-2.3, P <.001), IBS (OR 4.61, 95% CI 4.09-5.2, P <.001), Crohn’s disease (OR 1.85, 95% CI 1.408-2.32, P <.001), ulcerative colitis (OR 1.81, 95%CI 1.4-2.33, P <.001), and celiac disease (OR 2.08, 95% CI 1.63-2.65, P <.001).

Compared with controls, patients with fibromyalgia had a higher prevalence of IBS (4.8% vs 1.1%, respectively), celiac disease (.7 vs .4%, respectively), Crohn’s disease (.8% vs .4%, respectively), and ulcerative colitis (.6% vs .4%, respectively).

However, no significant differences were observed regarding gastrointestinal malignancies between patients with fibromyalgia compared with the controls. Univariate and multivariate adjusted logistic regression did not show statistical differences between both groups.

Investigators noted that the study had several strengths, including being one of the largest studies to analyze gastrointestinal comorbidities in patients with fibromyalgia. Further, the population-based design coupled with the matched controls reduced the risk of bias.

In contrast, limitations included the retrospective, cross-sectional nature of the study, which may have hindered any conclusions based on the relative risk of developing gastrointestinal disorders in this patient population. Additionally, the study lacked information regarding temporality and data concerning the diagnosis criteria for various diseases was unavailable. However, CHS data are systematically verified and were proven to have high validity in other studies.

“Our findings suggest that fibromyalgia is positively associated with various benign but not malignant gastrointestinal disorders, further prospective studied are required to explore this association and validate our results,” investigators concluded.

References

1. ^{Savin E, Tsur AM, Watad A, et al. Association of fibromyalgia with cancerous and non-cancerous gastrointestinal comorbidities: a cross-sectional study [published online ahead of print, 2023 Apr 3]. Clin Exp Rheumatol. 2023;10.55563/clinexprheumatol/rp5lkn. doi:10.55563/clinexprheumatol/rp5lkn}
2. ^{Triadafilopoulos G, Simms RW, Goldenberg DL. Bowel dysfunction in fibromyalgia syndrome. Dig Dis Sci. 1991;36(1):59-64. doi:10.1007/BF01300088}