Irritable bowel syndrome: from young to older age

Abstract

El síndrome de intestino irritable (SII) puede aparecer en la infancia y continuar en la edad adulta y factores de riesgo tempranos de la vida han sido asociados con el desarrollo del SII más tarde en la adultez; sin embargo, se conoce poco sobre la transición infancia-edad adulta en este trastorno. Por lo anterior nuestro objetivo fue revisar: (1) Factores de riesgo tempranos de la vida que contribuyen al desarrollo de SII en la adultez; (2) la transición de la atención médica; (3) la historia natural del SII y la estabilidad de los síntomas; (4) la prevalencia del SII en los adultos jóvenes hasta la madurez; (5) el tratamiento en la madu-rez; y (6) medidas preventivas. De acuerdo con lo anterior, múltiples factores tempranos de la vida han sido relacionados con el SII en la edad adulta incluyendo dolor abdominal crónico, aprendizaje social de la conducta de enfermedad, trauma en la infancia y la ABSTRACT Irritable bowel syndrome (IBS) may start in childhood and continues into adulthood and risk factors early in life (EL) have been associated with the development of IBS later in life; however, little is known about the childhood-adulthood transition. Therefore, we aimed at reviewing: (1) EL risk factors that contribute to IBS in adulthood; (2) transition of care; (3) the natural history and IBS-symptom stability; (4) prevalence of IBS from young adults to older age; (5) treatment in older age; and (6) preventive measurements. Accordingly, multiple EL factors have been related to IBS in adulthood including chronic abdominal pain, social learning of illness behavior, infantile and childhood trauma, birth weight < 1500 g, gastric suctioning, and cesarean section (may impair gut-micro-biota colonization and immunoregulation: disappearing microbiome), history of abuse, parental deprivation, and low socioeconomical level. There is a controversy of early enteric infections as these may be protective for post-infectious IBS later in life as well as for pet exposure and higher living density (hygiene factors). As for the transition of care from pediatric to adult care – crucial in managing a chronic disorder –, there is no experience in IBS as with other gastrointestinal diseases. Whether the prevalence of IBS increases or decreases with age, the data are inconsistent; however, at least a third of IBS patients become asymptomatic, a third remain stable, and the remaining turnover to another disorder of gut-brain interaction along time. Furthermore, distress among IBS patients with medical comorbidities varies with age, with higher levels of anxiety and depression among younger adults than older patients. Finally, treatment of IBS at an older age is similar to that in younger patients. In conclusions, EL risk factors need to be identified to establish preventive measurements for IBS later in life. A transition of care guidelines need to be developed for IBS and treatment adjustments are required according to the comorbidities.