P2477 - Adverse Childhood Events (ACE) and Irritable Bowel Syndrome (IBS): A Meta-Analysis on Prevalence of IBS in Those with a History of ACE

Award: Presidential Poster Award

Award: Presidential Poster Award

Shreeya Joshee, BS, Alexis Wybrecht, BS, Lauren Lim, BS, Riley Berriesford, BS, Mark Riddle, MD, DrPH
University of Nevada School of Medicine, Reno, NV

Introduction: Irritable Bowel Syndrome (IBS) is a gut-brain interaction disorder characterized by abdominal pain, bowel habits alterations, and constipation or diarrhea that accounts for substantial health and economic costs in the United States. Adverse Childhood Experiences (ACEs) are events such as abuse, mental illness, domestic violence that cause childhood trauma. The pathophysiology of IBS is not fully known but many studies have reported a higher prevalence of ACEs in IBS patients. Thus, a systematic review was conducted to evaluate current literature and research gaps in the relationship between ACEs and IBS in adults.

Methods: A preliminary search across PubMed, Embase, PsychINFO and Google Scholar for articles in English with keywords ('childhood adversity' OR 'childhood trauma' OR 'adverse childhood events') AND ('irritable colon' OR 'irritable bowel syndrome') yielded 106 studies with 24 duplicates. 82 were screened with their title and abstracts, 34 were reviewed in their entirety and 15 selected for the meta-analysis (Table 1). Odds ratios with 95% Confidence Intervals (CI) were calculated from selected papers to determine incidence of ACE in IBS vs. non-IBS groups.

Results: Random-effects meta-analysis of 15 studies with 272,686 participants found ACE to be significant risk factor in developing IBS (pooled OR [pOR]=1.82, 95% CI[1.36, 2.44], p < 0.001) with significant heterogeneity (I²=93.58%, p < 0.001) (Figure A). ACE and IBS reporting methods based on objective assessments explained some heterogeneity. Evidence of publication bias was present (Egger test, P < 0.001) and some risk of bias was found in 12 studies. A sub-analysis of available gender-stratified data (n=3 studies) found ACE a risk factor for IBS in females (f) (pOR=2.20, 95% CI[1.13, 4.29]), but not in males (m) (pOR=1.30, 95% CI[0.62, 2.78]) (Figure B).

Discussion: This meta-analysis supports a biopsychosocial perspective of IBS and the role of ACEs as potential risk factors. The current population of studies suffers from risks of publication and design biases, but substantiates that further research is needed. If an association is confirmed, further mechanistic research and targeted psychological therapies development is warranted. These data support the importance of a growing number of adverse health outcomes associated with ACEs and substantiate community- and societal-based interventions to reduce them.


Figure: Figure A: Forest Plot with Odds Ratios reported by selected studies of Adverse Childhood Events (ACE) and Irritable Bowel Syndrome (IBS).
Figure B: Forest Plot with Odds Ratios reported by selected studies of Adverse Childhood Events (ACE) and Irritable Bowel Syndrome (IBS) separated by gender.

First Author, Year	Study Design	Location	Participants	Population	Mean Age (Years)	IBS Diagnosis Criteria	ACE Evaluation Criteria	Odds Ratio (95% CI)
Berens, 2020	Cross-Sectional	Germany	381	Adults	36.17 IBS 29.45 Control	Rome III	ACE Criteria (10Q)	1.90 (1.15,3.14)
Bradford, 2012	Cross-Sectional	United States	729	Adults	23.4 IBS 35.1 Control	Rome III with physician evaluation for FGID	ETI-SR	5.83 (4.18, 8.14)
Chandan, 2020	Retrospective Cohort	United Kingdom	241,971	Adults	23.4 All	THIN Diagnostic Codes	Exposure Code from EMR	1.27 (1.19, 1.35)
Fuller-Thompson, 2011	Cross-Sectional	Canada	7,342	Adults and Children	Not Listed	Self-Reported Physician Diagnosis	Canadian Community Health Survey	1.52 (2.12, 1.09)a
Goodwin, 2013	Retrospective Cohort	United Kingdom	17,415	Adults and Children	Not Listed	Self-Reported	Self-, Guardian or Physician Reported	1.18 (0.98, 1.42)a
Heitkemper, 2001	Case-Control	United States	Multiple Distinct Samples		Multiple Distinct Samples	BDQ, Symptoms and GI diagnostic testing	Structured Interview	Multiple Distinct Samples
			88	Adult Women (1989-1994)	33.5 IBS 32.7 Control			2.12 (0.89, 5.00)
			165	Adult Women (1994-1999)	32.3 IBS 32.1 Control			1.49 (0.69, 3.20)
Heitkemper, 2011	Case-Control	United States	72	Adult Women	Not Listed	Rome II and currently symptomatic	Childhood Trauma Questionnaire	34.26 (21.22, 2.21)
Jones, 2013	Cross-Sectional	Australia	307	Adults	46.4 IBS 53.2 Control	Rome I	Self-Reported	1.00 (1.81, 0.62)
Ju, 2020	Case-Control	United States	362	Adults	31 IBS 30 Control	BSQ	CTES	1.36 (1.14, 1.62)
Park, 2016	Cross-Sectional	United States	302	Adults	34.4 IBS 30.4 Control	Rome II	ACE Criteria (18Q)	2.05 (1.21, 3.48)
Rahal, 2020	Cross-Sectional	Germany	824	Adults	44.59 IBS 30 Control	BSQ	ETI-SR	2.68 (2.02, 3.56)
Talley, 1993	Cross-Sectional	United States	104	Adults	54 IBS 58 Control	BDQ with Manning Criteria	30-minute semi-structured interview from DSM III-R	4.22 (1.43, 12.43)
Talley, 1994	Cross-Sectional	United States	919	Adults	39.6 IBS 39.5 Control	BSQ with Manning Criteria	Drossman Sexual et. al Questionnaire	1.73 (1.01, 2.95)
Talley, 1998	Cross-Sectional	Australia	726	Adults	45 IBS 43 Control	BSQ	Drossman Sexual et. al Questionnaire	2.02 (1.29, 2.15)
Videlock, 2009	Cross-Sectional	United States	86	Adults	40.4 IBS 37.3 Control	Rome II	Structured Clinical Interview from DSM IV	1.06 (0.45, 2.53)

Table: Table 1: Characteristics of the studies included in the meta-analysis;
a= adjusted odds ratios
Abbreviations: IBS, Irritable Bowel Syndrome; ACE, Adverse Childhood Events; 95% CI, 95% Confidence Interval; ETI-SR, Early-Trauma Inventory Self Report; THIN, The Health Improvement Network; EMR, Emergency Medical Records; BDQ, Bowel Disease Questionnaire; BSQ, Bowel Symptom Questionnaire; CTES, Childhood Trauma Event Scale; DSM, Diagnostic and Statistical Manual of Mental Disorders; ETISR-SF, Early-Trauma Inventory Self Report-Short Form



Disclosures:
Shreeya Joshee indicated no relevant financial relationships.
Alexis Wybrecht indicated no relevant financial relationships.
Lauren Lim indicated no relevant financial relationships.
Riley Berriesford indicated no relevant financial relationships.
Mark Riddle indicated no relevant financial relationships.


Shreeya Joshee, BS, Alexis Wybrecht, BS, Lauren Lim, BS, Riley Berriesford, BS, Mark Riddle, MD, DrPH. P2477 - Adverse Childhood Events (ACE) and Irritable Bowel Syndrome (IBS): A Meta-Analysis on Prevalence of IBS in Those with a History of ACE, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.