Real-time abdominal pain - daily life trigger associations in IBS: a multicenter Experience Sampling Method Study.

BACKGROUND AND AIMS: Gastrointestinal symptoms in irritable bowel syndrome (IBS) are influenced by daily life triggers. This study examined real-time associations of abdominal pain with psychosocial and environmental triggers utilizing an Experience Sampling Method (ESM)-based Patient Reported Outcome Measure (PROM), while considering the moderating effects of IBS severity and comorbidities.

METHODS

This prospective multicenter study included 360 Rome IV IBS patients (81% female; mean age 40.5) from seven European countries. Participants completed seven days ESM with ten random daily questionnaires on abdominal pain and potential triggers. Linear mixed-effects models analyzed univariable and multivariable associations between pain and triggers, concurrently and predictively (time-lagged), accounting for severity (IBS-SSS), mental (PHQ-9, GAD-7), and somatic (MFI, PHQ-15) scores.

RESULTS

Significant bidirectional associations were observed between abdominal pain and daily life triggers. Higher positive affect and environmental comfort were associated with lower pain (b=-0.23, p<0.001 and b=-0.18, p<0.01), whereas negative affect and eating were associated with higher pain (b=0.34 and b=0.13; both p<0.001). The associations were consistent across patients, some of which were moderated by IBS and/or comorbid symptom severity (p<0.05). Predictive associations were less frequent and weaker (b=-0.03 to 0.07; p<0.05). Few significant associations persisted in multivariable analyses.

CONCLUSIONS

This international ESM study provides real-time insight into the dynamic interplay between abdominal pain and daily life triggers in IBS. Concurrent and weaker predictive associations highlight the temporal complexity of symptom-trigger dynamics, while multivariable findings suggest that daily-life factors are interrelated rather than isolated triggers. Variation by IBS and comorbid symptom severity underscores the individualized nature of symptom patterns and supports personalized care in IBS.