Midenfjord, Irina, Khadija, Mahrukh, Sundelin, Elias et al. · United European gastroenterology journal · 2026 · DOI
This study looked at 607 patients with irritable bowel syndrome (IBS) across nine European centers to understand how other conditions—like anxiety, depression, fibromyalgia, and chronic fatigue syndrome—affect their symptoms and overall health. Patients who had IBS along with one or more of these comorbid conditions experienced more severe digestive symptoms, mood problems, and fatigue than those with IBS alone. The more comorbidities someone had, the worse their symptoms became.
This study is significant for ME/CFS patients because it rigorously demonstrates that comorbid conditions substantially worsen symptom severity and disease burden, validating the clinical experience of patients with multiple overlapping conditions. The inclusion of chronic fatigue syndrome as a comorbidity and the large multinational cohort design strengthen the evidence base for understanding how ME/CFS co-occurring with other conditions affects patient outcomes and care needs.
This study does not establish whether comorbidities cause worsening of IBS symptoms or whether underlying shared biological mechanisms link these conditions. The cross-sectional design cannot determine temporal relationships or directionality—it only shows that these conditions co-occur and are associated with greater severity. The study also does not identify specific mechanisms explaining why comorbidities increase symptom burden.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Midenfjord, Irina, Khadija, Mahrukh, Sundelin, Elias, Trindade, Inês A, Törnblom, Hans, Santos, Javier, et al. (2026). Increased Disease Burden in Irritable Bowel Syndrome With Comorbid Conditions and Psychiatric Diagnoses in a Multinational European Cohort: Results From the DISCOvERIE Project.. United European gastroenterology journal. https://doi.org/10.1002/ueg2.70157
BibTeX
@article{mecfsatlas-midenfjord-2026-increased-disease,
author = {Midenfjord, Irina and Khadija, Mahrukh and Sundelin, Elias and Trindade, Inês A and Törnblom, Hans and Santos, Javier and Lobo, Beatriz and Mulder, Danique and Vasquez, Alejandro Arias and Ruesing, Georgy and Reif, Andreas and Aichholzer, Mareike and Van Den Houte, Maaike and Van Oudenhove, Lukas and Matteucci, Maria Chiara and Barbara, Giovanni and Bosman, Michelle and Jonkers, Daisy and Ramos-Quiroga, Josep Antoni and Jekkel, Eva and Bitter, István and Pop, Andrei-Vasile and Dumitrascu, Dan Lucian and Alonso-Cotoner, Carmen and Rodríguez-Urrutia, Amanda and Simrén, Magnus},
title = {Increased Disease Burden in Irritable Bowel Syndrome With Comorbid Conditions and Psychiatric Diagnoses in a Multinational European Cohort: Results From the DISCOvERIE Project.},
journal = {United European gastroenterology journal},
year = {2026},
doi = {10.1002/ueg2.70157},
note = {PubMed: 41442222},
url = {https://www.mecfsatlas.com/evidence/midenfjord-2026-increased-disease},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/midenfjord-2026-increased-disease
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