Introduction
Disorders of gut-brain interaction (DGBI) and obesity are common and overlap between these two conditions has been reported in patient samples (1). However, the prevalence of DGBI among obese subjects in the general population is unknown.
Aims & Methods
Our aim was to assess the prevalence of DGBI among obese subjects in the general population in comparison with non-obese subjects, as well as exploring factors associated with DGBI in obesity in Europe.
We included subjects who completed the internet-based survey of the Rome Foundation Global Epidemiology study (2) in 11 European countries (Belgium, United Kingdom, France, Germany, Italy, Poland, Romania, Russia, Spain, Sweden, and the Netherlands). Obesity was defined as a BMI>30 and categorized to 3 classes: 1: BMI 30 to <35, 2: BMI 35 to <40, and 3: BMI 40 or higher. In the non-obese population, we included participants with normal BMI (between 18.5 and <25) and overweight (between 25 and <30), but excluded underweight participants (BMI<18.5, n=744). The prevalence of DGBI was determined, and then compared between obese and non-obese participants. Factors potentially associated with DGBI and obesity including demographics, psychological distress (PHQ-4), somatization (PHQ-15) and quality of life (PROMIS) were assessed.
Results
We included 20,117 participants in our analysis, and 2,023 patients were excluded because of missing BMI information. The prevalence of obesity was 17.8% (95%CI 17.3, 18.4), with 12.6%, 3.7% and 1.6% in obesity classes 1, 2 and 3, respectively. The prevalence of any DGBI was 44.2% in the obese group vs. 39.6% in the non-obese group (OR=1.20 (1.12, 1.30)). Most DGBI were more prevalent in the obese vs. non-obese group (table), with the exception of functional constipation where the opposite was seen. Female sex, higher level of psychological distress and somatization were found in the group with DGBI associated with obesity, as well as lower quality of life.
Table: Prevalence of any DGBI, by anatomical region and individual DGBI in obese and non-obese subjects
Variable
| Non-obese (N=15784)
| Obese (N=3589)
| OR (95%CI)
|
Any DGBI
Esophageal DGBI
Functional Heartburn
Functional Chest Pain
Reflux Hypersensitivity
Globus
Functional Dysphagia
| 39.6% (38.9-40.4)
6.1% (5.8-6.5)
1.0% (0.9-1.2)
1.5% (1.3-1.7)
0.8% (0.7-0.9)
0.9% (0.8-1.1)
3.1% (2.9-3.4)
| 44.2% (42.5-45.8)
7.3% (6.5-8.2)
1.3% (1.0-1.8)
1.8% (1.4-2.3)
1.1% (0.8-1.5)
0.9% (0.6-1.3)
3.6% (3.0-4.3)
| 1.20 (1.12, 1.30)
1.21 (1.05, 1.39)
1.28 (0.92, 1.76)
1.18 (0.88, 1.54)
1.38 (0.95, 1.96)
0.98 (0.66, 1.43)
1.17 (0.96, 1.42)
|
Gastroduodenal DGBI
Postprandial Distress Syndrome
Epigastric Pain Syndrome
Functional Dyspepsia
Excessive Belching
Chronic Nausea and Vomiting
Cyclic Vomiting
Rumination Syndrome
| 9.9% (9.4-10.4)
5.8% (5.5-6.2)
2.6% (2.3-2.8)
7.0% (6.6-7.4)
0.7% (0.6-0.9)
0.9% (0.7-1.0)
1.1% (0.9-1.2)
2.4% (2.2-2.7)
| 12.3% (11.2-13.4)
6.7% (5.9-7.5)
2.8% (2.3-3.4)
8.2% (7.3-9.1)
1.1% (0.8-1.5)
0.9% (0.6-1.3)
1.3% (1.0-1.7)
3.6% (3.0-4.3)
| 1.28 (1.14, 1.43)
1.15 (0.99, 1.33)
1.10 (0.88, 1.37)
1.18 (1.03, 1.35)
1.54 (1.06, 2.18)
1.04 (0.70, 1.51)
1.24 (0.89, 1.70)
1.51 (1.23, 1.84)
|
Bowel DGBI
Irritable Bowel Syndrome
Functional Constipation
Functional Diarrhea
Functional Bloating
Unspecified Functional Bowel Disorder
Opioid-Induced Constipation
| 33.2% (32.4-33.9)
3.9% (3.6-4.2)
12.0% (11.5-12.6)
4.3% (4.0-4.6)
3.6% (3.3-3.9)
8.7% (8.2-9.1)
1.2% (1.1-1.4)
| 36.6% (35.0-38.2)
4.9% (4.2-5.7)
10.2% (9.2-11.2)
7.3% (6.5-8.2)
4.2% (3.5-4.9)
9.0% (8.1-10.0)
1.5% (1.1-2.0)
| 1.16 (1.08, 1.25)
1.27 (1.07, 1.51)
0.83 (0.73, 0.93)
1.77 (1.53, 2.05)
1.17 (0.97, 1.41)
1.04 (0.91, 1.18)
1.21 (0.88, 1.62)
|
Anorectal DGBI
Fecal Incontinence
Levator Ani Syndrome
Proctalgia Fugax
| 7.5% (7.1-7.9)
1.2% (1.0-1.4)
1.1% (1.0-1.3)
5.6% (5.3-6.0)
| 8.7% (7.8-9.7)
2.1% (1.6-2.6)
1.2% (0.9-1.6)
5.8% (5.1-6.6)
| 1.18 (1.03, 1.34)
1.78 (1.35, 2.32)
1.11 (0.78, 1.53)
1.04 (0.89, 1.21)
|
Conclusion
DGBI are common among obese subjects in the general population and linked with certain demographic and disease-related factors. This should be acknowledged in the management of patients with obesity.
References
- Aasbrenn M, Høgestøl I, Eribe I, Kristinsson J, Lydersen S, Mala T, et al. Prevalence and predictors of irritable bowel syndrome in patients with morbid obesity: a cross-sectional study. BMC Obes. 2017;4:22.
- Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.e3.
Disclosure
C.M. has served as a consultant/advisory board member for Kyowa Kirin, Norgine, Biocodex, Mayoly Spindler, Tillots, Ipsen and Nestlé HealthScience.
OP has received salary support from Royal DSM and the Rome Foundation, consulting fees from iHealth, and royalties from MetaMe Health.
MS has received grants and personal fees from Glycom and Danone Nutricia Research; personal fees from Ironwood, Menarini, Biocodex, Adnovate, Arena, Tillotts, Kyowa Kirin, Takeda, Alimentary Health, AlfaSigma, and the Falk Foundation; and grants from Genetic Analysis.
J.T. has given scientific advice to Adare, AlfaWassermann, Allergan, Arena, Bayer, Christian Hansen, Clasado, Danone, Devintec, Falk, Grünenthal, Ironwood, Janssen, Kiowa Kirin, Menarini, Mylan, Neurogastrx, Neutec, Novartis, Noventure, Nutricia, Shionogi, Shire, Takeda, Theravance, Tramedico, Truvion, Tsumura, Zealand, and Zeria Pharmaceutical; received research support from Shire, Sofar, and Tsumura; and served on the Speakers Bureau for Abbott, Allergan, AstraZeneca, Janssen, Kyowa Kirin, Menarini, Mylan, Novartis, Shire, Takeda, Truvion, and Zeria Pharmaceutical, all outside the submitted work.
J.M.S. report personal fees from Biocodex, Kyowa Kirin, Norgine, Mayoly Spindler, Arko Pharma, and Tillots Pharma outside the submitted work.
J.P.H., J.K., Q.A., S.I.B., and A.S. have no conflict of interest.