Introduction

In patients with disorders of the gut-brain interaction abdominal bloating is a visceral sensation (sensation of pressure/fullness), whereas visible abdominal distension is a somatic manifestation with abnormal postural tone (abdominophrenic dyssynergia, i.e., diaphragmatic push and abdominal wall relaxation). Abdominophrenic dyssynergia can be corrected by a simple non-instrumental technique, and our aim was to determine the relation of distension and bloating responses over time.

Aims & Methods

In a randomized, placebo-controlled, parallel trial (ClincalTrials.gov number NCT06150638) 40 consecutive patients (34 women, 6 men; age range 18–58 years) with disorders of gut-brain interaction complaining of visible abdominal distension were randomized to receive biofeedback or placebo. Patients in the biofeedback group were explained the mechanism of distension, and were taught to relax the diaphragm and contract the abdominal wall, using an original audiovisual support and hands-on guidance by a trained operator. In the placebo group, sham measurements of abdominal and thoracic motion were performed, and a pill of placebo was administered. Three 30-min sessions were performed over a 4-week intervention period, with instructions to perform daily exercises (biofeedback group) or to take placebo three times a day (control group) at home. After the intervention, patients allocated to the placebo group were offered biofeedback treatment. After receiving biofeedback treatment, patients in both groups were instructed to continue practicing these same exercises over time, and were followed up: visible abdominal distension and sensation of abdominal pressure/fullness (bloating) were measured at 1 and 3 months using 10-cm scales for 7 consecutive days, and the mean values (±SE) were calculated.

Results

After undergoing the three treatment sessions, abdominal distension improved in the biofeedback group (n=19; by 24±7 %), but not in the placebo group (n=20; 8±3 % change; p=0.025 vs feedback group). In the 20 patients randomized to placebo, subsequent biofeedback treatment improved abdominal distension (by 35±7 %). Follow-up in all patients after biofeedback (n=36) showed a sustained improvement in abdominal distension and bloating sensation at 1 month (by 39±5 % and 36±7 %, respectively; p<0.001 vs before treatment for both), and at 3 months (by 37±5 % and 34±8 %, respectively; p<0.003 vs before treatment for both).

Conclusion

In patients with disorders of gut-brain interaction, correction of abdominophrenic dyssynergia by a simple, non-instrumental technique, produces a sustained improvement of visible abdominal distension, associated with a concomitant improvement of bloating sensation.

Disclosure

I have the following Conflict of Interest to declare: Coloplast, Schwabe

Introduction

Gastroesophageal reflux disease (GERD) is a common disorder characterized by the backward flow of stomach contents into the esophagus, impacting millions globally and significantly reducing quality of life. Typical symptoms include heartburn and acid reflux, while atypical presentations may involve noncardiac chest pain, chronic cough, and laryngitis(1).Over the past decade (2010–2021), GERD incidence and prevalence have risen sharply in Europe compared to global trends, leading to increased disability-adjusted life years (DALYs). Its multifactorial pathogenesis—driven by chemical, mechanical, psychological, and neurological mechanisms—affects symptom severity, diagnosis, and therapeutic outcomes(2).

Aims & Methods

This study aims to investigate the escalating burden of Gastroesophageal Reflux Disease (GERD) in Europe from 2010 to 2021, comparing its incidence, prevalence, and disability-adjusted life years (DALYs) with global trends to evaluate current healthcare policies and highlight the need for streamlined, evidence-based interventions that address regional disparities in disease burden. The findings will support policy refinement, ensuring healthcare systems are equipped with effective prevention strategies, optimized treatment protocols, and equitable resource allocation to reduce GERD’s long-term impact on patient health and healthcare infrastructure.
Incidence, Prevalence and disability-adjusted life years (DALYs) were calculated using the Global Burden of Disease (GBD) Database 2021. Joinpoint regression was used to calculate annual percentage changes (APCs) in ASDR, DALYs, and YLL with 95% uncertainty intervals, and significant trends over time were identified. Statistical significance was set at a p-value of <0.05

Results

Globally, GERD-related DALYs increased from 72.24 per 100,000 (95% CI: 36.45–128.77) in 2010 to 75.56 per 100,000 (95% CI: 38.05–133.87) in 2021. Prevalence rose from 9,398.70 per 100,000 (95% CI: 8,342.02–10,517.59) in 2010 to 9,838.60 per 100,000 (95% CI: 8,732.46–11,056.05) in 2021, while incidence climbed from 3,717.75 per 100,000 (95% CI: 3,298.17–4,113.24) in 2010 to 3,881.86 per 100,000 (95% CI: 3,445.56–4,299.95) in 2021.
Europe saw GERD-related DALYs rise from 75.38 per 100,000 (95% CI: 37.98–133.77) in 2010 to 77.57 per 100,000 (95% CI: 39.13–137.23) in 2021. Prevalence increased to 10,091.72 per 100,000 (95% CI: 8,938.24–11,206.79), and incidence reached 3,978.62 per 100,000 (95% CI: 3,521.81–4,418.93) in 2021.
Eastern Europe consistently showed the highest GERD burden, followed by Central Europe, while Western Europe had the lowest figures.

• Eastern Europe: 88.73 DALYs per 100,000 (95% CI: 44.67–156.85) in 2021
• Central Europe: 86.05 per 100,000 (95% CI: 43.45–152.64)
• Western Europe: 63.30 per 100,000 (95% CI: 31.76–112.67)

Conclusion

The increasing burden of Gastroesophageal Reflux Disease (GERD) in Europe from 2010 to 2021, particularly in Eastern Europe, highlights the need for targeted healthcare interventions. With rising incidence, prevalence, and disability-adjusted life years (DALYs), addressing lifestyle, environmental, and healthcare access disparities is essential. Streamlined policies, optimized treatment strategies, and preventive measures can help mitigate GERD’s impact, improve patient outcomes, and reduce the strain on healthcare systems.

References

1-Mahajan R, Kulkarni R, Stoopler ET. Gastroesophageal reflux disease and oral health: A narrative review. Spec Care Dentist. 2022;42(6):555-564. doi:10.1111/scd.12726
2-Sharma P, Yadlapati R. Pathophysiology and treatment options for gastroesophageal reflux disease: looking beyond acid. Ann N Y Acad Sci. 2021;1486(1):3-14. doi:10.1111/nyas.14501

Disclosure

No conflict of interest.

Introduction

Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common disorders of gut-brain interaction (DGBI), and bloating and visible abdominal distension are common symptoms among individuals with IBS and/or FD. Bloating refers to a subjective sensation of tension or pressure in the abdomen, which may or may not be reported together with visible abdominal distension. The underlying pathophysiological mechanisms may differ, with bloating suggested to be more related to hypersensitivity and visible abdominal distension to altered motility. The prevalence of these two symptoms in IBS and FD, especially as distinct symptoms, is not well known.

Aims & Methods

The aim was to investigate the link between bloating and distension with IBS and FD. Therefore, we performed a population-based internet survey of adults in the US, UK, and Mexico, including Rome IV IBS and FD diagnostic questions, somatization (PHQ-12), and psychological distress (PHQ-4). Four groups were created: those meeting the Rome IV criteria for IBS only, FD only, both IBS+FD, and a reference group including individuals without IBS, FD and organic diagnoses that could result in IBS- or FD-like symptoms. Within each group, we identified individuals who reported ≥weekly bloating alone (B), ≥weekly visible abdominal distension alone (D), ≥weekly combined B+D, or neither of both. The relationship between B, D and B+D in those with IBS and/or FD vs. the reference group was investigated using logistic regression models.

Results

The analysis included 5,448 participants (49.7% female; mean age 46.5 years, range 18-99), with 131 meeting criteria for IBS only, 360 for FD only, 217 for IBS+FD and 4,740 for the reference group. A larger proportion of individuals with IBS only (64.9%), FD only (50.6%), and especially those with IBS+FD (88.5%) reported bloating and/or visible abdominal distension compared to the reference group (13.7%). In the IBS only group, 16.0% reported bloating alone, 8.4% visible abdominal distension alone, and 40.5% combined bloating and visible abdominal distension. In the FD only group this was 12.8% (B), 8.9% (D), and 28.9% (B+D), and in the IBS+FD group 18.9% (B), 8.3% (D), and 61.3% (B+D), respectively. Reporting bloating alone or combined bloating and visible abdominal distension was strongly linked to fulfilling criteria for IBS only, FD only, and concomitant IBS+FD vs. the reference group, with weaker links for visible abdominal distension in the absence of bloating (Table). After adjusting for age, sex, BMI, psychological distress and somatization, the links persisted. The strongest association was observed between combined bloating and visible abdominal distension (vs. neither) and concomitant IBS+FD (vs. the reference group); adjusted odds ratio 28.6 [95%CI 17.6-46.6].

Conclusion

Bloating and visible abdominal distension as distinct and overlapping symptoms are strongly linked to IBS, FD, and concomitant IBS+FD in the general population. Assessing bloating and visible abdominal distension as separate symptoms may be important to enable individualized treatment for individuals with IBS and FD.

Introduction

Subjectively reported sleep disturbances are common in IBS¹, as are psychological comorbidities². Whilst sleep and psychological disorders are clearly linked, it has been demonstrated that sleep disturbances amongst IBS patients appear to exist independently of psychological factors³, raising the potential for sleep as a novel intervention target in IBS. Developing our understanding of the role and associations of sleep within the disease experience of IBS patients could lead to better treatment.

Aims & Methods

We aimed to compare the characteristics of patients with IBS according to the quality of their sleep. Participants were recruited from the NIHR research register ContactME-IBS. We collected data for demographics, gastrointestinal symptoms^4,5,6, psychological health⁷, quality of life^8,9, and impact on work and daily activities¹⁰using validated questionnaires among adults with Rome IV IBS. We dichotomised the cohort according to whether they were good or poor sleepers, defined by a Pittsburgh sleep index score >5¹¹. We compared the characteristics of the two groups to explore significant associations.

Results

Of 341 respondents with Rome IV IBS, 287 (84.16%) were poor sleepers. A significantly higher proportion of poor sleepers had been diagnosed with IBS for 5 years or more (82.2% vs 66.7% p=0.009). A greater proportion of good sleepers had a university or postgraduate level of education (59.3% vs 41.1% p=0.014), though this did not meet our threshold for statistical significance. Poor sleepers had a significantly higher burden of severe somatisation, nearly fivefold that of good sleepers (60.3% vs 13% p=<0.001). Poor sleepers reported higher levels of anxiety and depression symptoms. Amongst the good sleepers, none had abnormal depression scores. Poor sleepers experienced greater impairment of their work activities, and were more adversely affected in their home and social activities (p=<0.001 across all analyses). Though not statistically significant, poor sleepers reported higher IBS symptom severity. There was no statistically significant difference between poor and good sleepers in relation to their IBS subtype.

Table 1. Characteristics of Individuals with Rome IV IBS according to the quality of their sleep.

Conclusion

Individuals with Rome IV IBS who report poor sleep have significantly higher levels of somatisation and psychological comorbidity and are more adversely affected in both their work and personal lives, compared with those who report good sleep. Our findings could support the potential of sleep as an intervention target in the management of IBS.

References

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4. Palsson OS et al. Gastroenterology. 2016:S0016-5085 (16) 00180.
5. Whitehead W et al. Rome III: The functional gastrointestinal disorders, 3rd editionVirginia: Degnon Associates Inc. 2006:835-53.
6. Labus JS et al. Alimentary pharmacology & therapeutics. 2004;20(1):89-97.
7. Spiller R et al. Alimentary pharmacology & therapeutics. 2010;32(6):811-20.
8. Patrick DL et al. Digestive diseases and sciences. 1998;43:400-11.
9. Drossman DA et al. Official journal of the American College of Gastroenterology| ACG. 2000;95(4):999-1007.
10. Reilly M et al. Alimentary pharmacology & therapeutics. 2004;20(4):459-67.
11. Buysse DJ et al. Psychiatry research. 1989;28(2):193-213