Study Identifies Triggers Beyond GI Infections for Pediatric p-DGBI

A recent study identified gastrointestinal infections (GI) as the most frequent vulnerability factor for the development of pain-predominant disorders of gut-brain interaction (p-DGBI) in children, followed by extra-intestinal infections, psychological stress, concussion, onset of organic disease, medication reaction, surgery, and physical injury.1

“While recent data in adults has demonstrated increased visceral hypersensitivity in those with higher number of adverse childhood events, the present study is the first pediatric study to show that more vulnerability factors are associated with worse functioning,” wrote investigators, led by Beate Beinvogl, MD, MPH from the Center for Motility and Functional Gastrointestinal Disorders, Division of Pediatric Gastroenterology Boston Children's Hospital.

Gastrointestinal infections are the main trigger of p-DGBI. However, disorders of gut-brain interaction, formerly known as functional gastrointestinal disorders, result from an interplay of genetic, biological, psychological, and environmental factors.2

In this retrospective cross-sectional study, investigators sought to characterize the frequency and number of vulnerability factors for the development of p-DGBI in children.1 They also sought to examine links between vulnerability factors and pain severity or functional impairment.

The study included 252 patients (70.6% female; mean age, 13.6 ± 3.1 years) from a multidisciplinary abdominal pain program at a pediatric tertiary care center. The patients completed a series of questionnaires that addressed early life events (before 3 years old), sensory sensitivities, and developmental delays in early childhood. All patients visited a pediatric gastroenterologist, psychologist, pain specialist, nurse practitioner, dietician, and social worker.

In the sample, 37.3% had functional abdominal pain, 31.7% had irritable bowel syndrome (IBS), and 21% had functional dyspepsia. 91.3% of the participants reported ≥ 1 vulnerability, with a mean of 2.2 per patient. Vulnerabilities included chronic pain (55.2%), a family history of mental health (52.4%), mental health issues (51.2%), and early life events (42.9%).

Early life events included infections (38.9%); excessive irritability, gastroesophageal reflux or food allergies (16.7%), prematurity (16.7%), difficult deliver/transition (13.9%), feeding intolerance/failure to thrive (11.1%), surgery (8.3%), difficult pregnancy (6.5%) stress (6.5%).1 Specific infections included respiratory (40.5%), recurrent ear infections (35.7%), recurrent streptococcal pharyngitis or scarlet fever (11.9%), GI (11.9%), urinary tract infections (9.5%), sinusitis (9.5%), Coxsackie or Varicella (4.8%), and sepsis (2.4%).

A family history of mental health issues may be a potential risk factor of p-DGBI. This may be due to genetic loading and social modeling.

“However, it should be acknowledged that it may be difficult to separate this effect from other forms of parental influence, such as behavioral reinforcement of pain, and while this may not lead to the emergence of symptoms—the focus of this study—it is known to play a role in the maintenance of symptoms,” investigators noted.1

Patients with more vulnerability factors had higher functional disability scores (P = .004). This finding raised the question of whether there would be a cumulative adverse event of multiple vulnerability factors.1 The study found no link between the increased number of vulnerability factors and pain intensity.

More than half (63.9%) of the participants reported a p-DGBI trigger. Triggers included gastrointestinal infections (41.0%), extra-intestinal infections (16.1%), psychological stress (15.5%), concussion (8.7%), onset of organic disease (7.5%), medication reaction (5.0%), surgery (4.3%), and physical injury (3.7%).1

The findings suggest that patients with p-DGBI are susceptible to developing chronic pain due to vulnerabilities and environmental factors, supporting the biopsychosocial model. Investigators noted that the finding was limited by a lack of control group; they could not assess if the prevalence of early life events and vulnerabilities was different in patients with P-DGBI vs the general population. However, the lack of a control group does not affect the prevalence of p-DGBI triggers.

“Knowing that vulnerabilities predispose to the development of a p-DGBI, often in the context of a triggering event, has several implications: Individuals with significant vulnerabilities should receive anticipatory guidance, and may need to be monitored more closely for the development of a p-DGBI after possible triggers, such as infections, and if symptoms emerge may need to be followed more closely,” investigators wrote.1 “In those with a p-DGBI, explaining the effect of vulnerabilities and their interaction with triggers is also very helpful for patient education and understanding.”

References

1. Beinvogl B, Burch E, Snyder J, et al. Vulnerability factors for pediatric disorders of gut-brain interaction and implications for functional impairment. J Pediatr Gastroenterol Nutr. Published online July 14, 2025. doi:10.1002/jpn3.70155

2. Tome J, Kamboj AK, Loftus CG. Approach to Disorders of Gut-Brain Interaction. Mayo Clin Proc. 2023;98(3):458-467. doi:10.1016/j.mayocp.2022.11.001