Background Up to 70% of fibromyalgia patients have functional bowel disorders as irritable bowel syndrome (IBS), constipation and diarrhea. Patients with chronic constipation may feature changes in microflora of large bowel, which are characterized by a relative decrease in obligate bacteria and a parallel increase in potentially pathogenic microorganisms and fungi. This condition causes chronic low-grade inflammation. It has been reported that as a result of chronic constipation, altered microbiota and intestinal permeability may be related to neurological diseases such as autism and Parkinson’s disease.

Objectives As you know, the etiology of fibromyalgia is related to both central nervous system and peripheral causes. So the aim of this study was to evaluate the relationship between chronic constipation and duration and severity of the disease in fibromyalgia.

Methods The cross-sectional study was designed as two groups: fibromyalgia patients, who is diagnosed according to the ACR 2016 revised classification criteria, and healthy population. All study participants were 18 years and older. Subjects were excluded if they had systemic disease, neurological disease, cognitive problems and secondary fibromyalgia. The Fibromyalgia Impact Questionnaire (FIQ) was applied to fibromyalgia patient. All subjects were questioned in terms of IBS, functional constipation and functional diarrhea according to Roma IV criteria. The Patient Assessment of Constipation Quality of Life questionnaire (PACQLQ) and the Constipation Severity Instrument (CSI) were applied to patients with constipation.

Results The study was completed with 40 patients in both groups. No difference was found between the fibromyalgia group and the control group in terms of age, body mass index and educational status (p> 0.05). While 10% constipation (n = 4), 0% IBS (n = 0) and 25% gastritis (n = 10) were observed in the control group; 45% constipation (n = 18), 22.5% IBS (n = 9), 67.5% gastritis (n = 27) were found in fibromyalgia group (p <0.01). In fibromyalgia patients with constipation, the mean duration of constipation was 20.1 ± 8.9 and the mean duration of fibromyalgia symptoms was 16.0 ± 10.2 years. Fibromyalgia symptoms started in 16 of 18 patients after constipation (Mean year: 4.1 ± 5.3). Compared with constipated and non-constipated fibromyalgia patients, symptom duration and FIQ were significantly higher in constipated fibromyalgia patients (p <0.01). The duration of constipation was correlated with duration of fibromyalgia symptom (r² = 0.85, p = 0.000), PACQLQ (r² = 0.71, p = 0.001) and CSI (r² = 0.59, p = 0.01). There was a correlation between FIQ and CSI (r² = 0.96, p = 0.00) and PACQLQ (r² = 0.62, p = 0.006).

Conclusion The frequency of gastrointestinal symptoms increased in patients with fibromyalgia. As the severity of constipation increases, the symptoms of fibromyalgia are exacerbated. The presence of constipation findings before fibromyalgia suggests that low-grade chronic inflammation caused by constipation may have an effect on the onset of fibromyalgia. There is a need for a prospective cohort study to clarify this cause and effect relationship.

References [1] Nair AT, Ramachandran V, Joghee NM, Antony S, Ramalingam G. Gut Microbiota Dysfunction as Reliable Non-invasive Early Diagnostic Biomarkers in the Pathophysiology of Parkinson’s Disease: A Critical Review. J Neurogastroenterol Motil. 2018Jan30;24(1):30-42.

[2] Goebel A, Buhner S, Schedel R, Lochs H, Sprotte G. Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology (Oxford). 2008Aug;47(8):1223-7.

Disclosure of Interests None declared