Psycho-gastroenterological profile of an Italian population of children with disorders of gut-brain interaction: A case-control study 2025 Giorgio+

Andy

Andy

Retired committee member
BACKGROUND Disorders of gut-brain interaction (DGBI) are common, but knowledge about their physiopathology is still poor, nor valid tools have been used to evaluate them in childhood. AIM To develop a psycho-gastroenterological questionnaire (PGQ) to assess the psycho-gastroenterological profile and social characteristics of a pediatric population with and without DGBI.

METHODS One hundred and nineteen Italian children (age 11-18) were included: 28 outpatient patients with DGBI (Rome IV criteria) and 91 healthy controls. They filled the PGQ, faces pain scale revised (FPS-R), Bristol stool chart, gastrointestinal symptoms rating scale, state-trait anxiety inventory, Toronto alexithymia scale 20, perceived self-efficacy in the management of negative emotions and expression of positive emotions (APEN-G, APEP-G), irritable bowel syndrome-quality of life questionnaire, school performances, tobacco use, early life events, degree of digitalization.

RESULTS Compared to controls, patients had more medical examinations (35% of them went to the doctor more than five times), a higher school performance (23% vs 13%, P < 0.05), didn’t use tobacco (never vs 16%, P < 0.05), had early life events (28% vs 1% P < 0.05) and a higher percentage of pain classified as 4 in the FPS-R during the examination (14% vs 7%, P < 0.05).

CONCLUSION Pediatric outpatients with DGBI had a higher prevalence of early life events, a lower quality of life, more medical examinations rising health care costs, lower anxiety levels.

Key Words: Disorders of gut-brain interaction; Functional gastrointestinal disorders; Psycho-gastroenterological profile; Gut-brain axis; Rome IV criteria; Pediatric patients

Core Tip: Little is known with respect to the presence of psychological issues in association with gastrointestinal problems among children and adolescents with disorders of gut-brain interaction. The psycho-gastroenterological questionnaire could be useful to better identify such issues to tailor a possible psychological and pharmacological treatment.

Open access
 
Four of the 8 significant results tell us nothing about causal directions (lower quality of life, more medical examinations, rising health care costs, and higher pain scores). They could all be the consequences of undiagnosed or untreated physiopathology.

One (higher prevalence of early life events) appears to be derived from retrospective recall, which is well known to be problematic, often reporting a greater effect size than methodologically superior prospective studies.

Three showed better scores for patients (a higher school performance, much lower tobacco use, and lower anxiety levels – the sole psych health measure to report a difference).

And apparently none of the other measures, including some mental health measures, reported any difference.

I really don't see the justification for all the psycho-speculation fluff in this study.

The main limit is the small sample considered.​

No the main limit is the retrospective basis for the early life events. Take that problematic result away and you basically got nothing at all.
 
Great analysis @Sean.

These people are doing harm, blundering about labelling gastrointestinal symptoms in children as being due to psychological factors.

Biological (gastrointestinal symptoms), psychological [anxiety and depression, emotion dysregulation, insecure attachment, alexithymia, somatosensory amplification, quality of life (QoL)], and social (interpersonal problems) factors play also an important role in contributing to the development and maintenance of DGBI[11,12]. Hence, psychological factors interact with gastrointestinal symptoms and form a vicious circle that can slow recovery and exacerbate healthcare seeking[13]. Moreover, events that occur early in life could also predispose children to the development of functional gastrointestinal conditions[14,15]. The QoL is also an important factor to consider in children and adolescents with DGBI[16-18].
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A prevalence study on DGBI based on Rome III criteria in the pediatric age, along the Mediterranean areas, was published in 2017. In the 4-year-old to 10-year-old group DGBI prevalence rate was 20.7% in comparison to a global prevalence of 26.6% observed in the 11-year-old to 18-year-old group. These data demonstrated how prevalent DGBI were in children and how these impacted on socio-economic aspects of health and life[20].
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On one hand, they are suggesting that Disorders of Gut Brain Interaction are extremely common, 1 in 5 children. And yet, among 956 patients at a Pediatric Gastroenterology Outpatient Unit (already a highly selected sample), only 28 children were deemed to be suitable for this study and enrolled. The selection bias is therefore huge. Parents of children who believe in the concept of DGBI and who believe that their children have it are far more likely to allow their child to be enrolled.
In this control-case study we consecutively screened all patients referred to the Pediatric Gastroenterology Outpatient Unit of Università Cattolica del Sacro Cuore of Rome, between February 2017 and February 2018. Among 956 screened patients, we enrolled 28 children aged 11-18 years diagnosed with DGBI according to Rome IV criteria. We excluded all patients with concomitant psychiatric conditions, type I and type II diabetes, thyroid diseases, history of abdominal surgery, connective tissue diseases or other gastrointestinal diseases other than DGBI. We also enrolled 91 sex and age-matched healthy controls attending the High School “Istituto Magistrale Tommaso Stigliani” of Matera (in Southern Italy).
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This study appears to have been done in 2017, and yet it is only being published now.
 
The control group appears to be very poorly matched.
On sex: 64% of the cases were male; only 10% of the controls were male
On age: mean age of the cases was 14 years; mean age of the controls was 16.5 years (this surely affecting cigarette smoking rates)

Concerning family members, using a semi-structured interview, we found out that in 1 (1%) control early life events occurred (identified as parents’ separation and the presence of mother’s partner) vs 8 (28%) cases (P < 0.05).
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On 'early life events', it seems that it wasn't just a question asked of the participants and their parents. There was a 'semi-structured interview', providing ample opportunities for the researcher's bias to be expressed as they fished for 'early life events'.
 
Apparently, the journal has a peer review grading system! I have no idea how it works, but these were in the footnotes at the bottom of the page:

Peer-review report’s classification
Scientific Quality: Grade C, Grade C
Novelty: Grade B, Grade C
Creativity or Innovation: Grade B, Grade C Scientific Significance: Grade B, Grade C
 
This paper is awful in just about every respect. Maybe I give them some admiration for actually publishing the null results for the tests such as anxiety.

I think this is one where a complaint to the ethics committee could be warranted, to try to head off further work on young people by this group.
 
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