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. 2022 Feb 17;20(1):71.
doi: 10.1186/s12916-022-02259-7.

Global prevalence and burden of meal-related abdominal pain

Esther Colomier  1   2 , Chloé Melchior  3   4   5 , Joost P Algera  3 , Jóhann P Hreinsson  3 , Stine Störsrud  3 , Hans Törnblom  3 , Lukas Van Oudenhove  6   7 , Olafur S Palsson  8 , Shrikant I Bangdiwala  9   10 , Ami D Sperber  11 , Jan Tack  3   12 , Magnus Simrén  3   8
Affiliations

Global prevalence and burden of meal-related abdominal pain

Esther Colomier et al. BMC Med. .

Abstract

Background: Patients with disorders of gut-brain interaction (DGBI) report meal intake to be associated with symptoms. DGBI patients with meal-related symptoms may have more severe symptoms overall and worse health outcomes, but this subgroup has not been well characterized. We aimed to describe the global prevalence of meal-related abdominal pain and characterize this subgroup.

Methods: The data analyzed originated from the Internet survey component of the population-based Rome Foundation Global Epidemiology Study, completed in 26 countries (n = 54,127). Adult subjects were asked whether they had abdominal pain and how often this was meal-related. Respondents were categorized into "no," "occasional," and "frequent" meal-related abdominal pain groups based on 0%, 10-40%, and ≥50% of the pain episodes being meal-related, respectively. DGBI diagnoses, frequency of other GI symptoms, psychological distress, non-GI somatic symptoms, quality of life, and healthcare utilization were compared between groups. Mixed linear and ordinal regression was used to assess independent associations between psychological distress, non-GI somatic symptoms, quality of life, other GI symptoms, and meal-related abdominal pain.

Results: Overall, 51.9% of the respondents reported abdominal pain in the last 3 months, and 11.0% belonged to the group with frequent meal-related abdominal pain, which included more females and younger subjects. DGBI diagnoses were more common in subjects with frequent meal-related abdominal pain, and the frequency of several GI symptoms was associated with having more frequent meal-related abdominal pain. Having meal-related abdominal pain more frequently was also associated with more severe psychological distress, non-GI somatic symptoms, and a poorer quality of life. The group with frequent meal-related abdominal pain also more often consulted a doctor for bowel problems compared to the other groups of meal-related abdominal pain.

Conclusion: Reporting frequent meal-related abdominal pain is common across the globe and associated with other GI and non-GI somatic symptoms, psychological distress, healthcare utilization, and a poorer quality of life. Individuals who frequently experience meal-related abdominal pain also more frequently fulfill the diagnostic criteria for DGBI. Assessing meal-related symptoms in all DGBI patients could be of major importance to improve and individualize symptom management.

Keywords: Burden; Disorders of the gut-brain interaction; Epidemiology; Food; Functional gastrointestinal disorders; Gastrointestinal symptoms; Global prevalence; Meal-related abdominal pain.

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Conflict of interest statement

C.M. has served as a consultant/advisory board member for Kyowa Kirin, Norgine, Biocodex, MayolySpindler, Tillots, and Ipsen. S.S. has served as an advisory board member for Takeda and speaker for Viatris. H.T. has served as an advisory board member/consultant for Almirall and Shire. L.V.O. is assistant research professor of the KU Leuven Special Research Fund (Bijzonder Onderzoeksfonds, BOF). A.D.S. has served as a consultant for Lapidot Israel and AbbVie-Israel outside the submitted work. O.S.P. has received a research contract from the Rome Foundation during the conduct of the study and received a research contract from Glycom A/S and Royal DSM and personal fees from metaMe Health, outside the submitted work. J.T. has given scientific advice to Adare, AlfaWassermann, Allergan, Arena, Bayer, Christian Hansen, Clasado, Danone, Devintec, Falk, Grünenthal, Ironwood, Janssen, Kiowa Kirin, Menarini, Mylan, Neurogastrx, Neutec, Novartis, Noventure, Nutricia, Shionogi, Shire, Takeda, Theravance, Tramedico, Truvion, Tsumura, Zealand, and Zeria Pharmaceutical; received research support from Shire, Sofar, and Tsumura; and served on the Speakers Bureau for Abbott, Allergan, AstraZeneca, Janssen, Kyowa Kirin, Menarini, Mylan, Novartis, Shire, Takeda, Truvion, and Zeria Pharmaceutical, all outside the submitted work. M.S. has received grants and personal fees from Gkycom and Danone Nutricia Research; personal fees from Ironwood, Menarini, Biocodex, Adnovate, Arena, Tillotts, Kyowa Kirin, Takeda, Alimentary Health, AlfaSigma, and the Falk Foundation; and grants from Genetic Analysis AS, outside the submitted work. The remaining authors disclose no conflicts.

Figures

Fig. 1
Fig. 1
Flowchart of the subjects participating and reporting meal-related abdominal pain. We included subjects who completed the internet-based survey of the Rome Foundation Global Epidemiology Study. The analysis focused on individuals who report abdominal pain that is related to meal intake. If subjects reported meal-related abdominal pain, they were categorized into three subgroups: subjects reporting no (0% of the abdominal pain episodes were meal-related), occasional (10–40% of the abdominal pain episodes were meal-related), and frequent (≥ 50% of the abdominal pain episodes were meal-related) meal-related pain.
Fig. 2
Fig. 2
The prevalence of frequent meal-related abdominal pain across the participating countries. The global prevalence of frequent meal-related pain (≥ 50% of the abdominal pain episodes were meal-related) was determined in the adult population and differed across countries, ranging from 5.1% in Italy to 18.0% in Turkey. A total of 54,127 subjects were included in the study of which 5932 experienced frequent meal-related abdominal pain (11.0%). The countries colored in gray did not participate in the Rome Foundation Global Epidemiology Study
Fig. 3
Fig. 3
Proportion of subjects having 0–4 DGBI diagnoses grouped according to the frequency of When the number of DGBI diagnoses increased (going from having zero to having four DGBI diagnoses), a gradual increase in the proportion of subjects with frequent meal-related abdominal pain (≥ 50% of the abdominal pain episodes were meal-related) was noted. A gradual decrease in the proportion of subjects with no meal-related abdominal pain (0% of the abdominal pain episodes were meal-related) was observed. DGBI diagnoses were grouped within the main anatomical DGBI categories, i.e., esophageal, gastroduodenal, bowel, and anorectal disorders, for this analysis
Fig. 4
Fig. 4
The frequency of having other GI symptoms is associated with having meal-related abdominal pain more frequently. Mixed ordinal regression models with the frequency of meal-related pain (11-item scale, 0–100%) as outcome indicated that having meal-related abdominal pain more frequently was associated with having other GI symptoms more frequently. The frequency of all other GI symptoms questioned in the Adult Diagnostic Rome IV questionnaire was used as an independent variable for the separate mixed ordinal regression models. Country was included as a random intercept effect to account for variability among countries. OR > 1 corresponds to higher odds of having meal-related abdominal pain more frequently. All models were corrected for the following confounders: demographical variables (age, gender, education, BMI) and psychological distress. *not associated with a bowel movement. **without laxative medication or enema
Fig. 5
Fig. 5
Psychological, somatic conditions and quality of life of subjects grouped by frequency of meal-related abdominal pain. Psychological distress and non-GI somatic symptoms were measured with the PHQ-4 and PHQ-12 questionnaires, respectively. Both measures indicated higher scores in the frequent meal-related abdominal pain group (≥ 50% of the abdominal pain episodes were meal-related). Higher scores represented more severe indications on psychological distress and a higher burden of non-GI somatic symptoms. The physical and mental quality of life of the three groups was assessed with the PROMIS-10 questionnaire. The frequent meal-related abdominal pain group had lower physical and mental quality of life compared to the no (0% of the abdominal pain episodes were meal-related) and occasional (10–40% of the abdominal pain episodes were meal-related) meal-related abdominal pain group
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