Introduction

Irritable bowel syndrome patients frequently suffer from comorbid mental (anxiety or depression) or somatic (fibromyalgia or chronic fatigue) conditions. In this pan-European project (the DISCOvERIE project), IBS patients with and without comorbidities were compared with disease controls and healthy controls, to further elucidate the effect of comorbid conditions in IBS on the disease burden.

Aims & Methods

We included participants from nine different European centers – IBS patients according to Rome IV criteria, disease controls (patients with comorbid conditions; i.e. fulfilling diagnostic criteria for anxiety, depression, fibromyalgia and/or chronic fatigue, but no IBS) and healthy controls. The participants were further divided into eight groups based on presence or absence of comorbitidies: IBS with no/ mental/ somatic/ mental and somatic comorbidity, disease controls with mental/ somatic/ mental and somatic comorbidity, and healthy controls. The severity of IBS symptoms (IBS-SSS), depression (PHQ-9), anxiety (GAD-7), somatic symptoms (PHQ-15), fibromyalgia symptoms (FIQ) and general and mental fatigue (MFI) were compared between these groups.

Results

In total, 849 participants (median age 44 years) were included. A majority were females (76%), with the most pronounced female predominance (83%-86%) in the IBS groups with comorbidities. The most severe IBS symptoms were noted among IBS with both mental and somatic comorbidity and IBS with somatic comorbidity (Table 1). In IBS, the severity of IBS symptoms increased gradually with increasing number of comorbidities (partial eta squared: 0.053, p<0.001), as did severity of anxiety, depression, somatic symptoms and general fatigue (partial eta squared: 0.214, 0.247, 0.240, 0.239, respectively, all p<0.001). The groups with both mental and somatic comorbidity had the highest levels of anxiety, depression and mental fatigue. Somatic symptoms and general fatigue were most severe among IBS and disease controls with somatic comorbidity or both somatic and mental comorbidity. Fibromyalgia symptoms were most severe in IBS and disease controls with somatic comorbidity.

Table 1: Symptom severity of the study groups.

Conclusion

This large European multicenter study strengthens the importance of the impact of mental and somatic comorbid conditions and symptoms in IBS, and their influence on outcomes and disease burden.

Disclosure

Hans Törnblom: Consultant or advisory board member for Allergan, Cinclus Pharma, Medifactia, and VIPUN and as a speaker for Tillotts, Takeda, and Shire.

Daisy Jonkers: Part of the work of DJ, outside the submitted work has been financed by public-private partnership grants of Top Knowledge Institute (TKI) Agri&Food and Health Holland, by the Carbokinetics program as part of the NWO-CCC Partnership Program, by Organic A2BV/Mothersfinest BV.

Introduction

Emerging evidence suggests that poor oral health may play a role in gastrointestinal carcinogenesis through inflammatory and microbiome-mediated mechanisms. However, its association with esophageal cancer remains insufficiently explored.

Aims & Methods

We aimed to assess the association of oral health indicators and oral hygiene behaviors with esophageal cancer risk using both dental health screening and claims-based data. We conducted a population-based case-control study using the Korean National Health Insurance Service (NHIS) database and the National Health Screening (NHS) records. To enhance the reliability of our study, we examined oral hygiene from two complementary perspectives: (1) oral health assessed through dental examinations and questionnaires in the NHS database and (2) periodontal disease status determined based on a claim-based analysis of the NHIS database. Individuals newly diagnosed with esophageal cancer were identified and matched at a 1:4 ratio to cancer-free controls through rigorous propensity score (PS) matching based on sociodemographic factors, comorbidities, lifestyle behaviors, and laboratory parameters. Oral health variables were assessed using national dental screening program data (status of decayed, missing, and filled teeth; gingivitis severity; dental calculus; and self-reported oral hygiene practices) and NHIS claims data identifying periodontal disease using ICD-10 codes and procedure codes. Multivariable-adjusted conditional logistic regression analyses were performed to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results

After PS matching, the oral health analysis included 4,238 cancer cases and 16,904 controls, while the claim-based periodontal disease analysis comprised 18,905 cancer cases and 75,604 matched controls in the final analysis. In multivariable analysis, missing teeth (adjusted OR, 1.16; 95% CI, 1.08–1.25) and inadequate oral hygiene behaviors—including brushing fewer than three times daily (aOR, 1.14; 95% CI, 1.07–1.23), infrequent toothbrushing before bedtime (aOR, 1.08; 95% CI, 1.00–1.16), infrequent use interdental cleaning tools (aOR, 1.10; 95% CI, 1.01–1.19), and dental visits in the past year (aOR, 1.09; 95% CI, 1.02–1.16)—were significantly associated with an increased risk of esophageal cancer. Additionally, claim-based periodontal disease was independently associated with elevated risk (aOR, 1.05; 95% CI, 1.01–1.09). Subgroup analyses revealed consistent associations across smoking and obesity strata, while sex-, age-, and alcohol-stratified analyses demonstrated differential patterns.

Conclusion

This study provides comprehensive, population-based evidence that both clinically assessed dental health indicators and behavioral oral hygiene practices are associated with esophageal cancer risk. The integration of screening-based and claims-based data enhances the validity of the findings and highlights oral health as a potential modifiable risk factor for esophageal cancer prevention.

Introduction

Avoidant/restrictive food intake disorder (ARFID) is characterized by reduced dietary intake leading to medical and/or psychosocial impairment, independent of body image concerns. Its prevalence in gastrointestinal (GI) disorders remains unclear despite frequent symptom-induced restrictive eating behaviors.

Aims & Methods

We aim to assess the prevalence and characteristics of ARFID in patients with various GI disorders compared to healthy volunteers (HV), and its associations with symptom severity, extraintestinal somatic symptoms and depression.
Data from 92 HV and 467 GI patients across seven tertiary care diagnostic categories —including irritable bowel syndrome (IBS, n=88), functional dyspepsia (FD, n=83), (refractory slow transit) constipation (n=59), reflux (n=107), globus (n=45), (non-obstructive) dysphagia (n=37), and achalasia (n=48)—were analyzed. Questionnaires included Rome IV criteria, ARFID screening, extraintestinal symptoms and depression scores (PHQ-12/9). Positive NIAS screening (NIAS+) was defined as meeting any subscale cutoff (≥10 for Picky Eating, ≥9 for Appetite, and ≥10 for Fear). Medical and/or psychosocial impairment in NIAS+ individuals was evaluated using the ARFID DSM-5 checklist. ARFID+ was defined as NIAS+ plus DSM-5 impairment. Odds ratios were calculated using a multiple logistic regression model with three-level hierarchical approach. Odds of fulfilling ARFID or NIAS criteria between DGBI diagnoses (step 1) were adjusted for z-scores of symptom severity (step 2) and extra-intestinal somatic symptoms and depression (step 3). Esophageal and non-esophageal disorders were analyzed separately.

Results

Table 1 shows demographics and characteristics of patients. Compared to HV, ARFID+ was significantly associated with IBS (OR: 15.00, p < 0.001), FD (OR: 10.59, p = 0.002), constipation (OR: 18.21, p < 0.001), dysphagia (OR: 7.03, p = 0.024) and reflux (OR: 5.16, p = 0.036), but not with achalasia and globus. Within disease categories, there were no differences in the odds of ARFID+ after adjusting for symptom severity (step 2) and for comorbid extraintestinal symptoms and depression (step 3). Increase in PHQ9, contributed independently to the presence of ARFID in non-esophageal disorders (OR: 1.11, p = 0.009).

Conclusion

ARFID symptoms are prevalent across various GI disorders. While mechanical factors may drive ARFID in esophageal conditions, psychological factors (e.g., depression) may play a role in ARFID in non-esophageal disorders. Further research is needed to establish the contribution of mechanical factors to ARFID in esophageal conditions. Routine ARFID screening is crucial to address psychosocial and nutritional impacts in GI patients.