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Across the developmental continuum of irritable bowel syndrome: clinical and pathophysiologic considerations
1Division of Gastroenterology, Hepatology, and Nutrition, Children's Memorial Hospital, 2300 Children's Plaza, #57, Chicago, IL 60614-3394, USA.
Insights
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Stress, particularly in childhood, is key to IBS development, with symptoms evolving from infancy through adulthood.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Neurogastroenterology
Background:
- Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder affecting all age groups.
- Lack of diagnostic consensus and clear pathophysiology has impeded clinical advancements in IBS.
- Recent progress includes Rome diagnostic criteria, neuroimaging of brain-gut pathways, and understanding serotonergic pharmacology.
Purpose of the Study:
- To propose a developmental continuum for irritable bowel syndrome.
- To elucidate how IBS clinical presentation evolves across different age groups.
- To highlight the role of stress in IBS initiation and symptom exacerbation.
Main Methods:
- Review of recent advancements in IBS diagnostics and understanding.
- Analysis of the impact of chronic and acute life stress, especially in childhood.
- Conceptualization of a developmental model for IBS symptom presentation.
Main Results:
- Stress is recognized as central to IBS onset and symptom induction.
- A developmental continuum of IBS presentation is proposed.
- Symptoms change with age: infancy (irritability), toddlers (diarrhea), school age (abdominal pain), adolescence/adulthood (pain and altered bowel habits).
Conclusions:
- The understanding of IBS has significantly advanced with new criteria and research.
- Stress plays a critical role in the etiology and symptomology of IBS across the lifespan.
- Recognizing the developmental trajectory of IBS can improve diagnosis and management.
Abstract:
Irritable bowel syndrome is a common functional gastrointestinal disorder that affects children and adults. The lack of consensus diagnostic criteria and pathophysiologic understanding has hampered clinical progress in diagnosing and treating this disorder. The recent development of the Rome diagnostic criteria, mapping of brain-gut pathways using neuroimaging, and serotonergic pharmacology have greatly advanced the field. Chronic and acute life stress, especially during childhood, has been recognized as central to the initiation of the disorder and the induction of acute symptoms. We propose a developmental continuum whereby the clinical presentation of irritable bowel syndrome changes with age from irritability during infancy, to diarrhea in toddlers, to recurring abdominal pain during school age, and to pain and altered bowel habits during later adolescence and adulthood.
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