High-Dimensional Clustering of 4000 Irritable Bowel Syndrome Patients Reveals Seven Distinct Disease Subsets

Clin Gastroenterol Hepatol. 2024 Jan;22(1):173-184.e12. doi: 10.1016/j.cgh.2022.09.019.Epub 2022 Sep 27.


Anjali Byale 1Ryan J Lennon 2Siddharth Byale 3Margaret Breen-Lyles 1Adam L Edwinson 1Ruchi Gupta 2Brian E Lacy 4Janet E Olson 2Lesley A Houghton 5Madhusudan Grover 6


Author information

1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

2Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.

3Viterbi School of Engineering, University of Southern California, Los Angeles, California.

4Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida.

5Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida; Division of Gastroenterology and Surgical Sciences, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom.

6Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: grover.madhusudan@mayo.edu.


Background and aims: Irritable bowel syndrome (IBS) is a pain disorder classified by bowel habits, disregarding other factors that may influence the clinical course. The aim of this study was to determine if IBS patients can be clustered based on clinical, dietary, lifestyle, and psychosocial factors.

Methods: Between 2013 and 2020, the Mayo Clinic Biobank surveyed and received 40,291 responses to a questionnaire incorporating Rome III criteria. Factors associated with IBS were determined and latent class analysis, a model-based clustering, was performed on IBS cases.

Results: We identified 4021 IBS patients (mean 64 years; 75% women) and 12,063 controls. Using 26 variables separating cases from controls, the optimal clustering revealed 7 latent clusters. These were characterized by perceived health impairment (moderate or severe), psychoneurological factors, and bowel dysfunction (diarrhea or constipation predominance). Health impairment clusters demonstrated more pain, with the severe cluster also having more psychiatric comorbidities. The next 3 clusters had unique enrichment of psychiatric, neurological, or both comorbidities. The bowel dysfunction clusters demonstrated less abdominal pain, with diarrhea cluster most likely to report pain improvement with defecation. The constipation cluster had the highest exercise score and consumption of fruits, vegetables, and alcohol. The distribution of clusters remained similar when Rome IV criteria were applied. Physiologic tests were available on a limited subset (6%), and there were no significant differences between clusters.

Conclusions: In this cohort of older IBS patients, 7 distinct clusters were identified demonstrating varying degrees of gastrointestinal symptoms, comorbidities, dietary, and lifestyle factors. Further research is required to assess whether these unique clusters could be used to direct clinical trials and individualize patient management.

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