S533 Adverse Childhood Events (ACE) and Irritable Bowel Syndrome (IBS): A Meta-Analysis on Prevalence of IBS in Those with a History of ACE

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 1A). 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 1B). Conclusion: 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 1.: Scatterplot and Linear Regression Calculation of GSRS-IBS Score to Bowel Sound Analysis Score.Table 1.: Patients' demographics and RGA cut-off values with their specificity, sensitivity, PPV and NPV