Original article—alimentary tract
Association Between Early Adverse Life Events and Irritable Bowel Syndrome

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Background & Aims

Although childhood and adult abuse are more prevalent among patients with irritable bowel syndrome (IBS) than healthy individuals (controls), other types of early adverse life events (EALs) have not been well characterized. We investigated whether different types of EALs, before age 18 years, are more prevalent among patients with IBS, and the effects of sex and nongastrointestinal symptoms on the relationship between EALs and IBS.

Methods

EALs were evaluated in 294 IBS patients (79% women) and 435 controls (77% women) using the Early Trauma Inventory Self-Report Form, which delineates subcategories of general trauma and physical, emotional, and sexual abuse. Validated questionnaires assessed gastrointestinal, psychological, and somatic symptoms.

Results

Compared with controls, IBS patients reported a higher prevalence of general trauma (78.5% vs 62.3%), physical punishment (60.6% vs 49.2%), emotional abuse (54.9% vs 27.0%), and sexual events (31.2% vs 17.9%) (all P < .001). These significant differences were observed mainly in women. Of the EAL domains, emotional abuse was the strongest predictor of IBS (P < .001). Eight of the 27 EAL items were significant (P < .001) and increased the odds of having IBS by 108% to 305%. Although EALs and psychological variables were related, EALs had an independent association with IBS (P = .04).

Conclusions

Various types of EALs are associated with the development of IBS—particularly among women. Psychological distress and somatic symptoms might contribute to this relationship. When appropriate, EALs and nongastrointestinal symptoms should be assessed in IBS patients.

Section snippets

Study Subjects

Male and female IBS patients who were 18 years of age and older were recruited from newspaper or internet community advertisements and from GI clinics and fulfilled Rome III diagnostic criteria.19 Healthy control subjects (HCs) were recruited by advertisement without a history of IBS or other chronic GI or pain conditions, and were not taking psychotropic medication or participating in psychotherapy. Subjects were compensated $50 for the completion of a medical history and physical examination

Subject Characteristics

Subjects were recruited primarily from community advertisements in the greater Los Angeles area and included 294 IBS patients and 435 HCs (79% and 77% women, respectively) (Table 1). Ninety-four percent of the IBS patients were recruited from an advertisement. There were no significant differences in demographic or clinical symptoms between those recruited by advertisement and from the GI clinic. Forty-two percent of the subjects recruited from advertisements had seen a physician in the past

Discussion

The main findings of the current study were as follows: (1) IBS patients had a significantly greater prevalence of EALs, including general trauma, and physical, emotional, and sexual abuse compared with HCs; (2) these differences were seen mainly in women; (3) of the EAL domains measured, emotional abuse was the strongest predictor of having IBS; and (4) the strength of the relationship between EALs and IBS was reduced after controlling for the presence of psychological and other non-GI

References (41)

  • D.K. Chitkara et al.

    Early life risk factors that contribute to irritable bowel syndrome in adults: a systematic review

    Am J Gastroenterol

    (2008)
  • C. Heim et al.

    Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood

    JAMA

    (2000)
  • J.D. Bremner et al.

    Psychometric properties of the Early Trauma Inventory Self Report

    J Nerv Ment Dis

    (2007)
  • R.F. Anda et al.

    Adverse childhood experiences and smoking during adolescence and adulthood

    JAMA

    (1999)
  • R.F. Anda et al.

    The enduring effects of abuse and related adverse experiences in childhoodA convergence of evidence from neurobiology and epidemiology

    Eur Arch Psychiatry Clin Neurosci

    (2006)
  • R.F. Anda et al.

    Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients

    BMC Public Health

    (2008)
  • E.A. Mayer et al.

    V. Stress and irritable bowel syndrome

    Am J Physiol Gastrointest Liver Physiol

    (2001)
  • M.B. Bengtson et al.

    Irritable bowel syndrome in twins: genes and environment

    Gut

    (2006)
  • D.A. Drossman et al.

    Sexual and physical abuse in women with functional or organic gastrointestinal disorders

    Ann Intern Med

    (1990)
  • I.G. Hislop

    Childhood deprivation: an antecedent of the irritable bowel syndrome

    Med J Aust

    (1979)

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    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by National Institutes of Health grant P50 DK64539.

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