Am J Gastroenterol. 2023 May 8. doi: 10.14309/ajg.0000000000002280. Online ahead of print.

Pei-Lin Yang ¹, Kendra J Kamp ², Robert L Burr ², Hsin-Yi Jean Tang ², Adrian Dobra ^2 3, Robert J Shulman ^4 5, Margaret M Heitkemper ²

Author information

¹School of Nursing, National Defense Medical Center, Taipei, Taiwan.

²Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA.

³Department of Statistics, University of Washington, Seattle, Washington, USA.

⁴Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.

⁵Children's Nutrition Research Center, Houston, Texas, USA.

Abstract

Introduction: Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction, characterized by symptoms of abdominal pain and changes in bowel habits. It often co-occurs with extraintestinal somatic and psychological symptoms. However, the nature of the interrelationships among these symptoms is unclear. Although previous studies have noted age differences in IBS prevalence and specific symptom severity, it remains unknown whether specific symptoms and symptom relationships may differ by age.

Methods: Symptom data were collected in 355 adults with IBS (mean age 41.4 years, 86.2% female). Network analysis was used to examine the interrelationships among 28 symptoms and to identify the core symptoms driving the symptom structure between young (≤45 years) vs older (>45 years) adults with IBS. We evaluated 3 network properties between the 2 age groups: network structure, edge (connection) strength, and global strength.

Results: In both age groups, fatigue was the top core symptom. Anxiety was a second core symptom in the younger age group, but not the older age group. Intestinal gas and/or bloating symptoms also exerted considerable influences in both age groups. The overall symptom structure and connectivity were found to be similar regardless of age.

Discussion: Network analysis suggests fatigue is a critical target for symptom management in adults with IBS, regardless of age. Comorbid anxiety is likely an important treatment focus for young adults with IBS. Rome V criteria update could consider the importance of intestinal gas and bloating symptoms. Additional replication with larger diverse IBS cohorts is warranted to verify our results.