Disorders of Gut-Brain Interaction like symptoms in Children with Inflammatory Bowel Disease: A Multicenter Prospective Study from the Pediatric IBD Porto Group of the ESPGHAN.

Abstract

Disorders of gut-brain interaction (DGBI) are frequently reported in patients with inflammatory bowel disease (IBD), but pediatric data are scarce. We aimed to determine the prevalence of DGBI-like symptoms in children with quiescent IBD compared with healthy controls (HC), and to evaluate their impact on health-related quality of life (HR-QoL), anxiety and symptoms burden. This multicenter, prospective, observational study enrolled children aged 10-18 years with biochemically quiescent IBD, with or without endoscopic confirmation of remission from seven European ESPGHAN centers (January 2021-August 2023). Age and sex-matched HC were recruited through primary care pediatricians and screened for subclinical inflammation using fecal calprotectin. DGBI were assessed using Rome IV criteria. HR-QoL and psychological burden were evaluated using IMPACT III, PROMIS Anxiety, Visceral Sensitivity Index-Child, and Behavioral Response Questionnaire-Child. A total of 253 children were enrolled (IBD: n=131; HC: n=122). The prevalence of DGBI-like symptoms did not differ between IBD and HC [34.4% vs 41.8%, p=0.30]. Functional abdominal pain disorders were present in 24.4% of children with IBD. Children with IBD and DGBI-like symptoms showed significantly lower IMPACT III scores compared with those without DGBI [median 74 (IQR 62.5-81) vs 84 (70-90); p=0.001], with the greatest impairment in IBD symptoms, energy, and social domains. PROMIS Anxiety scores were higher in the DGBI group [31 (20-44) vs 21.5 (16-28); p<0.001], with a greater proportion exceeding the clinical threshold (>50) (17.8% vs 3.5%; p=0.008). Female sex was the only independent predictor of DGBI (OR 5.2, 95% CI 1.6-16.1; p=0.005). DGBI-like symptoms are common in children with quiescent IBD and are associated with a substantial psychological and quality-of-life burden.