Irritable bowel syndrome in the elderly: epidemiology, diagnosis, treatment, and relationship with frailty

Irritable bowel syndrome (IBS) is a common problem in elderly patients defined as over the age of 65 years, and presents unique clinical challenges that distinguish it from IBS in younger populations.

Here, we emphasize the need for age-specific approaches to optimize clinical outcomes. An inverse relationship exists between age and IBS prevalence, which may be due to reduced intestinal visceral hypersensitivity or lower levels of anxiety in older people affected. Although the prevalence of IBS in the elderly is lower than in younger populations, it may be rising due to demographic shifts and increasing life expectancy. Emerging evidence indicates IBS is a risk factor for frailty syndrome, driven by multiple factors, which may, in turn, perpetuate IBS. This review covers a broad range of applicable comparative studies, including observational and population studies, as well as randomized controlled trials and meta-analyses, dating back to 1992.

IBS likely contributes to functional decline in the elderly, thereby leading to increased frailty, promoting a self-perpetuating cycle of deteriorating health outcomes. This highlights the importance of incorporating frailty assessment when managing older patients with IBS because early identification and intervention can potentially improve IBS management, and also serve as an outcome measure.