Prevalence of disorders of gut–brain‐interaction in pediatric patients with in‐remission inflammatory bowel disease: An Italian multicenter study

OBJECTIVES: Pediatric patients with in-remission inflammatory bowel disease (IBD) often report persistent gastrointestinal symptoms, suggesting a potential overlap with disorders of gut-brain-interaction (DGBIs). While DGBIs affect up to 40% of the general population, their prevalence in quiescent IBD children remains limited. We aimed to evaluate the prevalence and distribution of DGBIs, based on Rome-IV criteria, in children with quiescent IBD compared to healthy controls, identifying demographic, clinical and therapeutic factors associated with DGBIs. METHODS: In this multicenter, prospective, controlled study, in-remission IBD pediatric patients and healthy controls were enrolled completing the Rome IV-Questionnaire. IBD-remission was defined by pediatric ulcerative colitis activity index (PUCAI)/pediatric Crohn's disease activity index scores < 10, normal inflammatory markers and recent endoscopic mucosal healing. RESULTS: Forty-one pediatric patients with IBD in remission and 179 healthy controls were enrolled. DGBIs were found in 41.46% of IBD-patients versus 27.93% of controls (p = 0.089). Functional Dyspepsia was significantly more prevalent in IBD patients (p < 0.001), while irritable bowel syndrome was more frequent among controls, though not significantly (p = 0.466). No differences in DGBI prevalence emerged between Crohn's disease and ulcerative colitis (p = 0.54). At the multivariate analysis, psychological comorbidities (odds ratio [OR] 40.767, p < 0.001) and low weight (0.953, p ≤ 0.001) were significantly associated with DGBIs. Notably, 5-aminosalicylic-acid (ASA) administration was associated with reduced DGBIs likelihood (OR 0.139, p = 0.005). CONCLUSIONS: In our cohort, the overall DGBIs prevalence was numerically but not significantly higher in quiescent-IBD patients compared to controls, while upper gastrointestinal DGBIs were significantly more frequent in IBD patients. Psychological and nutritional factors emerged as strong predictors of DGBIs, while 5-ASA may be associated with lower likelihood of DGBIs.