Greater Overlap of Rome IV Disorders of Gut-Brain Interactions Leads to Increased Disease Severity and Poorer Quality of Life

Ami D Sperber; Tamar Freud; Imran Aziz; Olafur S Palsson; Douglas A Drossman; Dan L Dumitrascu; Xuicai Fang; Shin Fukudo; Uday C Ghoshal; John Kellow; Rutaba Khatun; Edith Okeke; Eamonn M M Quigley; Max Schmulson; Magnus Simren; Jan Tack; William E Whitehead; Peter Whorwell; Shrikant I Bangdiwala

doi:10.1016/j.cgh.2021.05.042

Greater Overlap of Rome IV Disorders of Gut-Brain Interactions Leads to Increased Disease Severity and Poorer Quality of Life

Clin Gastroenterol Hepatol. 2022 May;20(5):e945-e956. doi: 10.1016/j.cgh.2021.05.042. Epub 2021 May 27.

Authors

Ami D Sperber¹, Tamar Freud², Imran Aziz³, Olafur S Palsson⁴, Douglas A Drossman⁵, Dan L Dumitrascu⁶, Xuicai Fang⁷, Shin Fukudo⁸, Uday C Ghoshal⁹, John Kellow¹⁰, Rutaba Khatun¹¹, Edith Okeke¹², Eamonn M M Quigley¹³, Max Schmulson¹⁴, Magnus Simren¹⁵, Jan Tack¹⁶, William E Whitehead¹⁷, Peter Whorwell¹⁸, Shrikant I Bangdiwala¹⁹

Affiliations

¹ Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. Electronic address: [email protected].
² Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
³ Academic Department of Gastroenterology & Department of Infection, Immunity and Cardiovascular Sciences, University of Sheffield, Sheffield, United Kingdom.
⁴ Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁵ Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, Chapel Hill, North Carolina.
⁶ Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
⁷ Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁸ Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
⁹ Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
¹⁰ Discipline of Medicine, Northern Clinical School, University of Sydney, Sydney, Australia.
¹¹ Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
¹² Department of Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria.
¹³ Lynda K. and David M. Underwood Center for Digestive Disorders, Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas.
¹⁴ Laboratory of Liver, Pancreas and Motility, Unit of Research in Experimental Medicine, Faculty of Medicine, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico.
¹⁵ Department of Clinal and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹⁶ Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.
¹⁷ Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, Chapel Hill, North Carolina.
¹⁸ Neurogastroenterology Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom.
¹⁹ Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.

PMID: 34052391
DOI: 10.1016/j.cgh.2021.05.042

Abstract

Background and aims: Conditions such as irritable bowel syndrome (IBS), functional dyspepsia, and functional constipation are among the prevalent gastrointestinal (GI) disorders classified as disorders of gut-brain interaction (DGBI), which can adversely affect the lives of sufferers. This study aimed to assess the degree and consequences of overlapping DGBI in a large population-based global scale.

Methods: Internet survey data from 54,127 adults (49.1% women) in 26 countries were analyzed by 4 GI anatomic regions (esophageal, gastroduodenal, bowel, and anorectal). The number of DGBI-affected GI regions was assessed, including associations with sex, age, disease severity, quality of life, psychosocial variables, and health care utilization.

Results: A total of 40.3% of surveyed individuals met Rome IV criteria for a DGBI. The percentages with 1-4 DGBI-affected GI regions were 68.3%, 22.3%, 7.1%, and 2.3%, respectively. The IBS symptom severity score increased significantly from 1 (207.6) to 4 (291.6) regions, as did non-GI symptom reporting (somatization), anxiety and depression, concerns and embarrassment about bowel function, doctor visits, medications, and abdominal surgeries (all P < .0001). Quality of life decreased with increasing number of DGBI regions (P < .0001). In a logistic mixed model, non-GI symptoms (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.08-1.10), being very vs not concerned (OR, 2.55; 95% CI, 2.27-2.90), being very vs not embarrassed about bowel function (OR, 1.20; 95% CI, 1.08-1.33), and mean number of doctor visits (OR, 1.23; 95% CI, 1.115-1.32) were most strongly associated with number of DGBI regions.

Conclusions: DGBI in multiple anatomic GI regions is associated with increased psychological comorbidity, health care utilization, and IBS severity. Physician awareness of overlap could improve quality of care, prevent unnecessary interventions, and yield more positive health outcomes.

Keywords: DGBI; Epidemiology; Functional Disorders; Overlap; Psychosocial.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brain
Female
Gastrointestinal Diseases* / diagnosis
Gastrointestinal Diseases* / epidemiology
Humans
Irritable Bowel Syndrome* / diagnosis
Irritable Bowel Syndrome* / epidemiology
Male
Quality of Life
Rome
Severity of Illness Index
Surveys and Questionnaires