Meal-Related Gastrointestinal Symptoms Common in Patients With Disorders of Gut-Brain Interaction

In an international cohort, patients with disorders of the gut-brain interaction (DGBI) experienced meal-related symptoms in all anatomical regions of the gastrointestinal (GI) tract, according to data presented at Digestive Disease Week (DDW) 2023.¹ Investigators noted that the nature of these symptoms should be considered for DGBI diagnostic criteria in the future and evaluating meal association of DGBI symptoms may be an important factor to individualize treatment in clinical practice.

“Meal-related symptoms in patients with DGBI are an important medical challenge,” wrote Esther Colomier, PhD Student, a joint PhD researcher at KU Leuven, Belgium, and the University of Gothenburg, Sweden, and colleagues. “To examine the role of meal intake in symptom generation, we aimed to investigate the prevalence of GI symptoms, how often they are meal-related, and how soon after meal intake symptoms arise in an international DGBI cohort.”

Adult DGBI patients, diagnosed by their clinicians, from 9 international tertiary care neurogastroenterology outpatient clinics between May 2021 and November 2022 were included in the analysis. Patients submitted the Diagnostic Rome IV survey which was supplemented with items that evaluated the link between GI symptoms and meal intake, as well as abdominal discomfort and flatulence.

The added item questions were “How often was symptom x triggered or worsened after a meal?” (0−100% of the time) and “How soon after the end of the meal do you start having symptom x?” (defined as already during meal intake, 1-30 minutes afterwards, 31-60 minutes afterwards, 61-120 minutes afterwards, or >120 minutes afterwards). Answers were categorized as the symptom not being meal-related, occasionally meal related (10-40% of the time), and frequently meal-related (≥ 50% of the time). The globus, nausea, belching, epigastric pain, bloating, heartburn, abdominal pain and discomfort, constipation, flatulence, and loose stools were evaluated.

In total, 660 DGBI patients were included in the study, with a mean age of 43 years, body mass index (BMI) of 23±5 kg/m2, and most (63%) were female. The primary diagnoses were functional dyspepsia (34%), irritable bowel syndrome (29%), functional constipation (9%), functional diarrhea (6%), functional bloating (5%), functional heartburn (4%), reflux hypersensitivity (4%), and other DGBI (9%).

Within the cohort, 66% of patients reported experiencing symptoms of bloating and distention, 65% had abdominal pain and discomfort, 60% had loose stools, 58% experienced flatulence, 57% had constipation, 49% had epigastric pain, 45% had heartburn, 36% had nausea, 34% reported globus, and 33% had belching.

A proportion of patients reported triggering or worsening symptoms after a meal, with the largest proportion experiencing bloating or distention, followed by abdominal pain or discomfort, and epigastric pain. The symptom least associated with meal intake was constipation. Symptom onset was most commonly reported between 1-30 minutes after meal intake for all symptoms except for constipation, which occurred >120 minutes after meal intake.

References

1. ^{Colomier E. PREVALENCE OF MEAL-RELATED GASTROINTESTINAL SYMPTOMS IN PATIENTS WITH A DISORDER OF GUT-BRAIN INTERACTION. Abstract presented at Digestive Disease Week (DDW) 2023 Annual Meeting. Chicago, IL. May 6-10, 2023.}