Abstract
Introduction: The world population is ageing, resulting in increased prevalence of age-related comorbidities and healthcare costs. Limited data are available on intestinal health in elderly populations. Structural and functional changes, including altered visceroperception, may lead to altered bowel habits and abdominal symptoms in healthy individuals and irritable bowel syndrome (IBS) patients. Our aim was to explore age-related changes in gastrointestinal symptoms and underlying mechanisms. Methods: In total, 780 subjects (IBS patients n = 463, healthy subjects n = 317) from two separate studies were included. Subjects were divided into different age groups ranging from young adult to elderly. Demographics and gastrointestinal symptom scores were collected from all participants using validated questionnaires. A subset of 233 IBS patients and 103 controls underwent a rectal barostat procedure to assess visceral hypersensitivity. Sigmoid biopsies were obtained from 10 healthy young adults and 10 healthy elderly. Expression of the visceral pain-associated receptors transient receptor potential (TRP) Ankyrin 1 (TRPA1) and Vanilloid 1 (TRPV1) genes were investigated by quantitative RT-PCR and immunofluorescence. Results: Both elderly IBS and healthy individuals showed significantly lower scores for abdominal pain (p < 0.001) and indigestion (p < 0.05) as compared to respective young adults. Visceral hypersensitivity was less common in elderly than young IBS patients (p < 0.001). Relative TRPA1 gene transcription, as well as TRPA1 and TRPV1 immunoreactivity were significantly lower in healthy elderly versus healthy young adults (p < 0.05). Conclusions: Our findings show an age-related decrease in abdominal pain perception. This may in part be related to decreased TRPA1 and/or TRPV1 receptor expression. Further studies are needed to reveal precise underlying mechanisms and the associations with intestinal health.
Highlights
The world population is ageing, resulting in increased prevalence of agerelated comorbidities and healthcare costs
Gender was distributed in irritable bowel syndrome (IBS) patients (Maastricht IBS cohort) and healthy subjects from the biopsy study
We have previously reported that a significant proportion of IBS patients demonstrates lower gastrointestinal symptom scores over a follow-up period of 5 years as compared to their baseline values (Weerts et al, 2019)
Summary
The world population is ageing, resulting in increased prevalence of agerelated comorbidities and healthcare costs. Ageing affects gut functioning on several levels; for example motility, gut microbiota composition, local immune and inflammatory responses and sensory functions (e.g. gustatory and nociceptive) (Soenen et al, 2016; DeJong et al, 2020) are reported to change with age. Perturbations in these functions can be linked to common gastrointestinal (GI) disorders in the elderly: for example constipation and diverticulitis occur more frequently with ageing (Higgins and Johanson, 2004; Hays and Roberts, 2006). Two population-based studies demonstrated the disappearance of abdominal pain with ageing (Choung et al, 2014; Rottenberg et al, 2015)
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