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Background

Irritable bowel syndrome (IBS) is a pain disorder classified by bowel habits, disregarding other factors that may influence the clinical course. The aim of this study was to determine if IBS patients can be clustered based on clinical, dietary, lifestyle, and psychosocial factors.

Methods

Between 2013-2020, Mayo Clinic Biobank surveyed and received 40,291 responses to a questionnaire incorporating Rome III criteria. Factors associated with IBS were determined, and latent class analysis, a model-based clustering, was performed on IBS cases.

Results

We identified 4,021 IBS patients (mean age 64 years, 75% female) and 12,063 controls. Using 26 variables separating cases from controls, the optimal clustering revealed seven latent clusters. These were characterized by perceived health impairment (moderate or severe), psychoneurological factors, and bowel dysfunction (diarrhea or constipation predominance). Health impairment clusters demonstrated more pain, with the "severe" cluster also having more psychiatric comorbidities. The next three clusters had unique enrichment of psychiatric, neurological, or both comorbidities. The bowel dysfunction clusters demonstrated less abdominal pain, with the diarrhea cluster most likely to report pain improvement with defecation. Constipation cluster had the highest exercise score, and consumption of fruits, vegetables, and alcohol. The distribution of clusters remained similar when Rome IV criteria were applied. Physiologic tests were available on a limited subset (6%), and there were no significant differences between clusters.

Conclusions

In this cohort of older IBS patients, seven distinct clusters were identified demonstrating varying degrees of GI symptoms, comorbidities, and dietary and lifestyle factors. Further research is required to assess whether these unique clusters could be used to direct clinical trials and individualize patient management.

You can read an interview with the senior study author here, and about the clinical implications of the study here.