Elana S. Lavine, BSc

Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder typically characterized by abdominal pain, bloating, and constipation and/or diarrhea. There is no known organic disease process in the gastrointestinal tract, and no pathology is observed when the colons of patients with IBS are examined via endoscopy. IBS can, therefore, be categorized as a functional illness. However, certain differences have been observed experimentally between the colons of IBS patients and normal controls (see pathophysiology). The onset of novel IBS-like symptoms in the elderly patient merits a thorough investigation. Successful management may require both symptomatic treatment and emotional support from a physician.

Epidemiology
IBS is considered a syndrome of the young and middle-aged; in the elderly, it may be a reluctant diagnosis.¹ Fifty percent of patients experience an onset of symptoms before age 35, and another 40% between the ages of 35 to 50.2 One recent study followed a cohort of 2,956 newly-diagnosed IBS patients, ranging in age from 20-79, and noted that only 12% were above 60 years of age.³ One national study conducted in the UK indicated that prevalence rates dropped between 78% and 92% from middle to old age.⁴ The question has been raised as to whether such statistics reflect a true decline in incidence with age, or an underreporting.

Leora Horn, MSc

Inflammatory bowel disease (IBD) is the general term used to describe idiopathic chronic disorders that cause inflammation or ulceration of the gastrointestinal system. Canada is believed to have one of the highest incidences of IBD in the world with an estimated one hundred thousand people suffering from the disease (Crohn's and Colitis Foundation of Canada). The majority of IBD cases are characterized by periods of remission and exacerbation of symptoms often requiring long-term drug therapy, hospitalization, and recurrent surgery. IBD may develop at any age in the geriatric population, but the peak incidence falls between ages 60 and 80. IBD is a chronic disease; people who develop IBD when they are young will carry the disease into old age. Within the elderly population, two-thirds of IBD patients develop the disease in their sixties, a quarter of patients develop IBD in their seventies, and one tenth of patients develop IBD in their eighties.

IBD is classified as either ulcerative colitis (UC) or Crohn's disease. UC is three times more likely than Crohn's disease to occur in the elderly, with twelve percent of UC patients developing the disease when they are over sixty years of age. Approximately four percent of people with Crohn's disease develop symptoms when they are over sixty with incidence among women being higher than among men.¹