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

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)e945-e956
JournalClinical Gastroenterology and Hepatology
Issue number5
StatePublished - May 2022


  • DGBI
  • Epidemiology
  • Functional Disorders
  • Overlap
  • Psychosocial
  • Severity of Illness Index
  • Brain
  • Irritable Bowel Syndrome/diagnosis
  • Humans
  • Male
  • Gastrointestinal Diseases/diagnosis
  • Rome
  • Quality of Life
  • Adult
  • Female
  • Surveys and Questionnaires

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology


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