Grant Chen, MD, FRCPC, Clinical Associate, Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, ON.

Chronic abdominal pain is a common problem that is frustrating for both the patient and the physician. This article provides a general approach to chronic abdominal pain, including diagnostic considerations (both organic and functional) as well as important features for diagnosis and management of the common chronic functional abdominal pain syndromes.
Key words: chronic abdominal pain, functional abdominal pain, irritable bowel syndrome, functional dyspepsia.

Richard Saad, MD, Lecturer, Division of Gastroenterology, Department of Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.
William D. Chey, MD, AGAF, FACG, FACP, Associate Professor of Internal Medicine; Director, GI Physiology Laboratory, University of Michigan Medical Center, Ann Arbor, MI, USA.

Irritable bowel syndrome (IBS) is traditionally considered a disorder of young adulthood; however, it affects adults of all ages, including older adults. As the older population increases so will the impact of IBS in this age group. Irritable bowel syndrome with constipation (IBS-C) is believed to be particularly significant given the prevalence of constipation among the aged. At present, the evaluation and management of this disorder has been largely driven by data obtained from younger adults. However, there are numerous aspects of the underlying pathophysiology, evaluation, and treatment of IBS-C that remain unique to older adults, of which the clinician should be cognizant.
Key words: irritable bowel syndrome, constipation, older adults, functional bowel disorder.

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Anil Minocha, MD, FACP, FACG, Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
Thomas Abell, MD, FACG, Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.

Irritable bowel syndrome (IBS) in the older adult offers challenges for diagnosis and treatment; however, very little research has been done in this regard. IBS has significant impact on the quality of life, especially in frail individuals. The diagnostic criteria have not been validated in older subjects. Diagnostic strategy needs to be modified to account for the expanded list of differential diagnosis, including high prevalence of colorectal cancer. There is a lack of evidence related to the efficacy of the treatment regimens used. Therapy should focus on specific symptoms and be matched for the potential for side effects and drug interactions. The prognosis for IBS is excellent and in a majority of cases symptoms disappear within five years.

Key words: Irritable bowel syndrome, Functional bowel disorder, Rome II criteria, older adults, spastic colon

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.