Age differences in core symptoms and symptom relationships in patients with irritable bowel syndrome: A network analysis

Authors: YANG, PEI-LIN - Taipei Medical University; KAMP, KENDRA - University Of Washington; BURR, ROBERT - University Of Washington; TANG, HSIN-YI - University Of Washington; DOBRA, ADRIAN - University Of Washington; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); HEITKEMPER, MARGARET - University Of Washington

Submitted to: American Journal of Gastroenterology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/4/2023
Publication Date: 5/8/2023
Citation: Yang, P., Kamp, K.J., Burr, R.L., Tang, H., Dobra, A., Shulman, R.J., Heitkemper, M.M. 2023. Age differences in core symptoms and symptom relationships in patients with irritable bowel syndrome: A network analysis. American Journal of Gastroenterology. https://doi.org/10.14309/ajg.0000000000002280.
DOI: https://doi.org/10.14309/ajg.0000000000002280

Interpretive Summary: Irritable bowel syndrome causes abdominal pain and stool changes (like diarrhea) and affects 1 to 2 children and adults in 10 around the world. It can be associated with other symptoms like bloating, increased gas, fatigue, and stress symptoms like anxiety. Research has suggested that different symptoms may affect different age groups differently. We studied numerous adults and used a cutting-edge method (network analysis) to analyze the data so that we could tease out the most important symptoms. We found that fatigue was an important symptom in both age groups (over or under 45 years) as was intestinal gas and/or bloating. In contrast, anxiety was an important symptom in the younger age group but not the older age group. Our results highlight the need to target fatigue in treating these patients and treating anxiety in the younger age group. We plan to investigate whether these findings apply to children with irritable bowel syndrome.

Technical Abstract: 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. 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. 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. 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.