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The more stressful life events an IBS patient experiences, the less predictable the relationship is between changes in symptom severity and quality of life

In their prospective study on the evaluation of symptom evolu‐ tion over a 5‐year follow‐up period in patients with irritable bowel syndrome (IBS), Weerts ZZRM and colleagues1 indicated that the changes in quality of life (QOL) and general well‐being overtime may depend on comorbid psychological symptoms, rather than on the gastrointestinal (GI) symptom severity. A few points deserve attention. The nature of the functional characteristics of IBS, a common chronic functional gastrointestinal disorder,2 has been intention‐ ally or unintentionally ignored. No matter how altered the QOL is, whether positive or negative, the adjustments for acute and chronic psychological confounders3 (eg, acute life stressors, his‐ tory of abuse) will obviously enhance the significance of the study. Recent studies have found that the high loads of daily or emo‐ tional stressors predispose IBS from non‐patient to patient status and exacerbate the severity of symptoms.4,5 The evaluation of the stressful life events in the trial period may be to some extent mod‐ erate the symptom severity and furthermore influence the judg‐ ment of the treatment effects. According to our recent follow‐up study 6, it is found that the more stressful life events an IBS pa‐ tient experiences, the less predictable the relationship is between changes in symptom severity and quality of life. The assessment of stressful life events might help us better clarify and understand the proper management of patients with IBS especially in a fol‐ low‐up study. In conclusion, Weerts ZZRM and colleagues aimed at clarifying the association between quality of life, psychological symptoms, and GI symptom improvement. However, their conclusion ignores the above‐mentioned limitations and tends to over reinforce the im‐ portance of psychological symptoms. Overall, the factors affecting QOL in patients with psychosomatic disorders including IBS remain undetermined.