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TOPLINE: 

In patients with disorders of gut-brain interaction (DGBI) , factor analysis of an enhanced Rome questionnaire identified 10 distinct symptom clusters. Several of these diverged from Rome IV, including mixed upper-lower gastrointestinal (GI) patterns that improved or worsened after a bowel movement or passing of flatus, meal‑triggered abdominal pain with prominent gas, and a meal‑related diarrhea and abdominal‑pain syndrome relieved by bowel movement or passing of flatus.

METHODOLOGY:

• The Rome diagnostic criteria classify DGBIs by the GI region where predominant symptoms are perceived to originate. Although a recent Asian study using the Enhanced Asian Rome questionnaire found symptom clusters spanning multiple regions, whether this finding applies to other parts of the world remains unknown.
• Researchers performed a factor analysis of 1074 patients with DGBI (mean age, 42.6 years; 66.8% women) to identify and compare symptom clusters, particularly clusters involving more than one anatomic region, in patients from Eastern and Western regions.
• The analysis included patients from 11 secondary and tertiary care facilities across five Eastern regions (n = 503) and six Western regions (n = 571) from September 2020 to April 2023.
  • All patients completed an Enhanced Asian Rome IV questionnaire ( EAR4Q), developed by combining Rome IV items with additional items to assess whether each symptom was worsened or relieved by meal intake, bowel movement, or flatus passage; an exploratory analysis grouped symptoms that tended to occur together into clusters.
  • A confirmatory factor analysis was also performed to verify that the symptom clusters identified by exploratory analysis reflected the observed symptom correlations and to test whether the same factor structure was consistent across patients in Eastern and Western regions.

TAKEAWAY:

• Ten distinct symptom factors emerged and together explained 50% of symptom variance. Meal-related diarrhea with abdominal pain relieved by bowel movement or flatus passage accounted for 18% of this variance, whereas constipation and belching relieved by bowel movement or flatus passage accounted for 1%.
• Two clusters — chronic constipation and globus — aligned closely with Rome IV definitions. Other clusters — including a meal-related diarrhea and abdominal pain cluster, in which symptoms were relieved by bowel movement or flatus passage, a meal-related pain and gas cluster, and several mixed upper-lower gastrointestinal clusters — diverged.
• The same 10 symptom clusters were identified among patients in both Western and Eastern regions, but the relationships between these clusters differed between regions.

IN PRACTICE:

"[Our findings] should guide future research in DGBI to place greater emphasis on broader symptom assessment, evaluating relationships to physiological events such as meal intake and defecation, and should drive specific clinical trials in these patient groups ," the authors of the study concluded.

SOURCE:

The study was led by Esther Colomier, PhD , KU Leuven, in Leuven, Belgium. It was published online in The American Journal of Gastroenterology.

LIMITATIONS:

The EAR4Q questionnaire was not validated. Patient recruitment relied on physician diagnoses made during routine, time‑limited consultations, which tended to record only the dominant syndrome, whereas the systematically administered Rome questionnaire identified multiple overlapping functional GI syndromes. Language and cultural differences between Eastern and Western countries may have affected symptom perception and reporting.

DISCLOSURES:

The study was supported by grants and fellowship from KU Leuven and the Flanders Research Foundation. Some authors reported providing scientific advice, serving as consultants or advisory board members, or participating in speaker bureaus for various biopharmaceutical, pharmaceutical, and medical nutrition companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.