Do Extraintestinal IBS Symptoms Differ by Age?

Core symptoms like fatigue are common in both younger and older adults with IBS.

Fatigue and anxiety are core symptoms in irritable bowel syndrome (IBS); but, the presence of each can vary by age, according to study results published in The American Journal of Gastroenterology.

Biological, psychological, and environmental factors contribute to the varying presentation of IBS symptoms. A considerable amount of individuals with IBS also have comorbidities. Researchers aimed to investigate the age-based prevalence of these symptoms in an effort to provide a network of the most significant comorbidities and to help refine symptom management.

Using data from 2 randomized controlled trials and a cross-sectional study, the researchers conducted secondary data analysis on patient-reported symptoms of IBS. All patients were enrolled through a university-based gastroenterology practice within the United States. Patients completed a symptom diary from a list (28 total) that included gastrointestinal, somatic, and mood symptoms. Cumulative symptoms over 28 days were recorded and assessed for symptom severity and frequency. Symptoms were then visualized using network analysis, which interprets relationships among core presenting symptoms.

Core symptoms were also evaluated for strength centrality, which is a reflection of how connected a specific symptom is among other symptoms. Highly connected symptoms were considered more important within the network.

Network analysis results suggest fatigue is a critical target for IBS symptom management, regardless of age.

A total of 355 adults with IBS were included in the final analysis, with 147 (41.4%) aged over 45 years and 208 (58.6%) aged 45 years or younger. Compared with the younger subgroup, the older subgroup disclosed a greater symptom severity of intestinal gas, joint pain, muscle pain, and diminished sleep quality and a lower symptom severity of nausea, stomach pain, and decreased desire to talk or move.

The top 5 symptoms with strength centrality in the young subgroup included fatigue, anxiety, abdominal pain, bloating, and intestinal gas. Of those, fatigue and anxiety had the highest strength centrality.

In the older subgroup, the most common symptoms with the greatest strength centrality included fatigue, difficulty concentrating, abdominal pain, intestinal gas, and anxiety. Fatigue had the highest strength centrality.

Additionally, core symptoms were evaluated based on sex. However, no significant differences were found in relation to core symptoms and network structure between women vs all participants that included both women and men.

Of note, fatigue was found to be the most influential symptom in younger and older adults with IBS. Anxiety significantly influenced symptom network in young adults. Although diagnostic criteria (Rome IV) do not consider intestinal gas as part of diagnosis, it did emerge as one of the top 5 symptoms in both young and older adults with IBS.

Limitations include the need for a larger and diverse IBS population to verify results.

“Network analysis results suggest fatigue is a critical target for IBS symptom management, regardless of age,” the study authors wrote. “Similarly, comorbid anxiety is likely important treatment target for young adults with IBS.”


Yang P-L, Kamp KJ, Burr RL, et al. Age differences in core symptoms and symptom relationships in patients with irritable bowel syndrome: a network analysis.  Am J Gastroenterol. Published online May 8, 2023. doi:10.14309/ajg.0000000000002280