Irritable Bowel Syndrome

  • Eamonn M. M. QuigleyEmail author
  • Vineet Gudsoorkar
Living reference work entry


Though traditionally viewed as a disorder of young adult females, it is now evident that irritable bowel syndrome (IBS) does occur in the elderly. Whether physiological aging contributes to the emergence of IBS-type symptoms has yet to be defined, and areas such as the gut microbiome are of considerable interest in this regard. On a much more practical level the major challenge that confronts the clinician in making the diagnosis of IBS in the elderly is the differential diagnosis. Given the high prevalence of disorders such as colon cancer, diverticulitis, microscopic colitis, and depression in the elderly, the clinical assessment of the older individual with IBS-type symptoms is certainly more daunting, and there is a great need for the validation of a positive criteria-based diagnosis of IBS in this population. There is little data on management strategies for IBS in the elderly; at the very least, the prescriber needs to be alert to possible side effects and drug interactions.


Irritable bowel syndrome Gut-brain axis Microbiome Diverticulosis Microscopic colitis Rome criteria 


  1. Agrawal A, Khan MH, Whorwell PJ. Irritable bowel syndrome in the elderly: An overlooked problem? Dig Liver Dis. 2009;41(10):721–4.CrossRefGoogle Scholar
  2. Banarjee A, Srinivas M, Eyre R, et al. Faecal calprotectin for differentiating between irritable bowel syndrome and inflammatory bowel disease: a useful screen in daily gastroenterology practice. Front Gastroenterol. 2015;6:20–6.CrossRefGoogle Scholar
  3. Barroso AO, Quigley EM. Diverticula and Diverticulitis: Time for a Reappraisal. Gastroenterol Hepatol. 2015;11(10):680–8.Google Scholar
  4. Bian G, Gloor GB, Gong A et al. The Gut Microbiota of Healthy Aged Chinese Is Similar to That of the Healthy Young. mSphere. 2017;2(5). pii: e00327–17.Google Scholar
  5. Camilleri M. Advances in understanding of bile acid diarrhea. Expert Rev Gastroenterol Hepatol. 2014;8(1):49–61.CrossRefGoogle Scholar
  6. Camilleri M, Lee JS, Viramontes B, et al. Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people. J Am Geriatr Soc. 2000;48(9):1142–50.CrossRefGoogle Scholar
  7. Chang L, Tong K, Ameen V. Ischemic colitis and complications of constipation associated with the use of alosetron under a risk management plan: clinical characteristics, outcomes, and incidences. Am J Gastroenterol. 2010;105(4):866–75.CrossRefGoogle Scholar
  8. Claesson MJ, Cusack S, O’Sullivan O, et al. Composition, variability, and temporal stability of the intestinal microbiota of the elderly. Proc Natl Acad Sci U A. 2011;108(1):4586–91.CrossRefGoogle Scholar
  9. Cohen E, Fuller G, Bolus R, et al. Increased risk for irritable bowel syndrome after acute diverticulitis. Clin Gastroenterol Hepatol. 2013;11(12):1614–9.CrossRefGoogle Scholar
  10. Collin P, Vilppula A, Luostarinen L, et al. Review article: coeliac disease in later life must not be missed. Aliment Pharmacol Ther. 2018;47(5):563–72.CrossRefGoogle Scholar
  11. Cremon C, Bellacosa L, Barbaro MR, et al. Diagnostic challenges of symptomatic uncomplicated diverticular disease. Minerva Gastroenterol Dietol. 2017;63(2):119–29.PubMedGoogle Scholar
  12. Distrutti E, Monaldi L, Ricci P, Fiorucci S. Gut microbiota role in irritable bowel syndrome: New therapeutic strategies. World J Gastroenterol. 2016;22(7):2219–41.CrossRefGoogle Scholar
  13. Drayer RA, Mulsant BH, Lenze EJ, et al. Somatic symptoms of depression in elderly patients with medical comorbidities. Int J Geriatr Psychiatry. 2005;20(10):973–82.Google Scholar
  14. Drossman DA. Gastroenterology. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. 2016. pii: S0016–5085(16)00223–7.Google Scholar
  15. Ford AC, Lacy BE, Talley NJ. N Engl J Med. 2017;376(26):2566–78.CrossRefGoogle Scholar
  16. Ford AC, Moayyedi P, Chey WD, et al. Irritable Bowel Syndrome. Am J Gastroenterol. 2018;113(2):1–18.CrossRefGoogle Scholar
  17. Freeman HJ. World J Gastroenterol. Segmental colitis associated diverticulosis syndrome. 2016;22(36):8067–9.CrossRefGoogle Scholar
  18. Ghoshal UC, Shukla R, Ghoshal U. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut Liver. 2017;11(2):196–208.CrossRefGoogle Scholar
  19. Gudsoorkar VS, Quigley EM. Distinguishing Microscopic Colitis From Irritable Bowel Syndrome. Clin Gastroenterol Hepatol. 2016;14(5):669–70.CrossRefGoogle Scholar
  20. Gwee KA, Ghoshal UC, Chen M. J Irritable bowel syndrome in Asia: Pathogenesis, natural history, epidemiology, and management. Gastroenterol Hepatol. 2018;33:99–110.Google Scholar
  21. Haug TT, Mykletun A, Dahl AA. Are anxiety and depression related to gastrointestinal symptoms in the general population? Scand J Gastroenterol. 2002;37(3):294–8.CrossRefGoogle Scholar
  22. Horwitz BJ, Fisher RS. N Engl J Med. The irritable bowel syndrome. 2001;344:1846–50.CrossRefGoogle Scholar
  23. Irvine AJ, Chey WD, Ford AC. Screening for Celiac Disease in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis. Am J Gastroenterol. 2017;112(1):65–76.CrossRefGoogle Scholar
  24. Johnson MW, Ellis HJ, Asante MA, et al. Celiac disease in the elderly. Nat Clin Pract Gastroenterol Hepatol. 2008;5(12):697–706.CrossRefGoogle Scholar
  25. Jung HK, Choung RS, Locke GR 3rd, et al. Diarrhea-predominant irritable bowel syndrome is associated with diverticular disease: a population-based study. Am J Gastroenterol. 2010;105(3):652–61.CrossRefGoogle Scholar
  26. Kamp EJ, Kane JS, Ford AC. Clin Gastroenterol Hepatol. 2016;14(5):659–68.CrossRefGoogle Scholar
  27. Kosako M, Akiho H, Miwa H, et al. Impact of symptoms by gender and age in Japanese subjects with irritable bowel syndrome with constipation (IBS-C): a large population-based internet survey. Biopsychosoc Med. 2018;12:18.Google Scholar
  28. Lee C, Doo E, Choi JM, et al. The Increased Level of Depression and Anxiety in Irritable Bowel Syndrome Patients Compared with Healthy Controls: Systematic Review and Meta-analysis. J Neurogastroenterol Motil. 2017;23(3):349–62.CrossRefGoogle Scholar
  29. Lewis JH. Drug Saf. The risk of ischaemic colitis in irritable bowel syndrome patients treated with serotonergic therapies. 2011;34(7):545–65.CrossRefGoogle Scholar
  30. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10:712–21.CrossRefGoogle Scholar
  31. Menees SB, Powell C, Kurlander J, et al. A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. Am J Gastroenterol. 2015;110:444–54.CrossRefGoogle Scholar
  32. Mukherjee A, Biswas A, Das SK. Gut dysfunction in Parkinson’s disease. World J Gastroenterol. 2016;22(25):5742–52.CrossRefGoogle Scholar
  33. Neiberg RH, Rejeski JJ, Applegate WB, et al. Self-Reported Gastrointestinal Symptoms in Type 2 Diabetes Improve With an Intensive Lifestyle Intervention: Results From the Action for Health in Diabetes (Look AHEAD) Clinical Trial. Clin Diabetes. 2015;33(4):181–8.CrossRefGoogle Scholar
  34. Pan CH, Chang CC, Su CT, et al. Trends in Irritable Bowel Syndrome Incidence among Taiwanese Adults during 2003-2013: A Population-Based Study of Sex and Age Differences. PLoS One. 2016;11(11):e0166922.CrossRefGoogle Scholar
  35. Patel P, Bercik P, Morgan DG, et al. Prevalence of organic disease at colonoscopy in patients with symptoms compatible with irritable bowel syndrome: cross-sectional survey. Scand J Gastroenterol. 2015;50(7):816–23.CrossRefGoogle Scholar
  36. Peery AF, Keku TO, Addamo C. et al. Colonic Diverticula Are Not Associated With Mucosal Inflammation or Chronic Gastrointestinal Symptoms. Clin Gastroenterol Hepatol. 2018;16(6):884–891.e1.CrossRefGoogle Scholar
  37. Quigley EM. Curr Opin Gastroenterol. Small intestinal bacterial overgrowth: what it is and what it is not. 2014;30(2):141–6.CrossRefGoogle Scholar
  38. Quigley EM. Ther Adv Gastroenterol. Overlapping irritable bowel syndrome and inflammatory bowel disease: less to this than meets the eye? 2016;9(2):199–212.CrossRefGoogle Scholar
  39. Rashtak S, Murray JA. Gastroenterol Clin N Am. Celiac disease in the elderly. 2009;38(3):433–46.CrossRefGoogle Scholar
  40. Rinninella E, Raoul P, Cintoni M et al. What is the Healthy Gut Microbiota Composition? A Changing Ecosystem across Age, Environment, Diet, and Diseases. Microorganisms. 2019;7(1). pii: E14.Google Scholar
  41. Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014;20(22):6759–73.CrossRefGoogle Scholar
  42. Sayuk GS, Wolf R, Chang L. Comparison of Symptoms, Healthcare Utilization, and Treatment in Diagnosed and Undiagnosed Individuals With Diarrhea-Predominant Irritable Bowel Syndrome. Am J Gastroenterol. 2017;112(6):892–9.CrossRefGoogle Scholar
  43. Scarpignato C, Barbara G, Lanas A, et al. Management of colonic diverticular disease in the third millennium: Highlights from a symposium held during the United European Gastroenterology Week 2017. Ther Adv Gastroenterol. 2018;11:1756284818771305.CrossRefGoogle Scholar
  44. Tang YR, Yang WW, Liang ML, et al. Age-related symptom and life quality changes in women with irritable bowel syndrome. World J Gastroenterol. 2012;18(48):7175–83.CrossRefGoogle Scholar
  45. Wedlake L, A’Hern R, Russell D, et al. Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2009;30(7):707–17.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and HepatologyHouston Methodist HospitalHoustonUSA

Personalised recommendations