Overlap of Structural Gastrointestinal Disorders in Children With Disorders of Gut‐Brain Interaction

BACKGROUND: Disorders of gut-brain interactions (DGBI) are increasingly prevalent in children and adults and can significantly impact quality of life starting in childhood and extending into adulthood. DGBI encompass a range of gastrointestinal symptoms in the absence of identifiable structural etiologies with biopsychosocial implications. Ongoing research efforts aim to understand the etiology and pathophysiology of DGBI, with disruptions of the gut-brain axis leading to visceral hypersensitivity and hypervigilance believed to be involved in symptom manifestation. Currently, there are 17 pediatric DGBI that are diagnosed via the Rome IV criteria. However, there is a paucity of research evaluating the clinical presentation, diagnosis, and management of pediatric patients with DGBI and concurrent structural gastrointestinal conditions despite the significant symptom overlap and diagnostic challenges. PURPOSE: This summative review will aid clinicians by providing an updated overview of pediatric studies assessing the overlap between DGBI and inflammatory bowel disease, celiac disease, and eosinophilic gastrointestinal disorders. Functional abdominal pain, irritable bowel syndrome, and functional constipation are common DGBI subtypes in pediatric patients with underlying structural gastrointestinal disorders. It is imperative that clinicians be cognizant of this overlap, particularly when gastrointestinal symptoms persist despite appropriate management of structural conditions. In such cases, a multidisciplinary approach may be necessary if there is concern for a comorbid DGBI to provide comprehensive care for patients and to improve quality of life, provider satisfaction, and successful clinical outcomes.