An encounter with the frustrated husband of a patient with irritable bowel syndrome (IBS) led Dr Reuben Wong to wonder about the burden borne by spouses because of the chronic gut condition.
The patient had just left his consultation room when there was a knock on the door. Her husband came inside alone and pleaded with Dr Wong to help his wife get better.
"He told me her symptoms were affecting their marital life negatively, that they no longer had a social life and that he was suffering too," said Dr Wong.
It left a deep impression on the consultant at the department of gastroenterology and hepatology at National University Hospital about the far-reaching impact of IBS.
"When a family member is unwell, we know it affects everyone else in the family too, especially if it's a severe chronic illness," he said.
The phenomenon of partner burden has been described in cancer and dementia, but never explored in gastrointestinal diseases or functional disorders, said Dr Wong.
Not long after, in 2008, Dr Wong left for a postgraduate fellowship at the University of North Carolina at Chapel Hill in the United States.
There, he embarked on a study comparing the partners of 152 IBS patients against the partners of 39 healthy individuals.
The study found that the partners of IBS patients suffered significantly more burden than partners of healthy people.
The patients' partners completed questionnaires including the Zarit Burden Interview (ZBI), Relationship Satisfaction Scale and questions on sexual relationships.
The ZBI is a previously validated scale which has also been used to measure the burden suffered by the partners or caregivers of people with dementia, cancer and other conditions.
Partners of those with IBS scored 22.1 on the ZBI total score, compared with 11.5 for the control group and 18.5 for partners of cancer patients.
One in three partners also said they believed that IBS interfered in their sex lives either quite frequently or nearly all the time.
The study also showed that the more severe the IBS, the worse the burden reported by the partner or spouse, said Dr Wong.
But if the couple's relationship was stronger, the perceived burden was less.
The study was published in the Journal Of Clinical Gastroenterology & Hepatology earlier this year.
Its authors were doctors from the Center for Functional GI and Motility Disorders and department of biostatistics at the University of North Carolina at Chapel Hill and the department of gastroenterology and hepatology of the University Medical Cluster of the National University Health System in Singapore.
Dr Wong, who returned here in 2009, is now hoping to carry his research further.
"In the pipeline is a study to be conducted here, which not only looks at partner burden in Singapore IBS patients, but also evaluates the intervention that will help alleviate this burden," he said.
IBS patients' symptoms are due to an interaction of multiple factors, such as micro-inflammation, stress, previous infections and hypersensitivity of the nerves. These all interact to give the symptoms which are the hallmarks of the condition, said Dr Wong.
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