Risk Factors for Abdominal Pain-Related Disorders of Gut-Brain Interaction in Adults and Children: A Systematic Review

Abstract

Background & aims: Many studies have assessed risk factors of irritable bowel syndrome (IBS) and other abdominal pain-related disorders of gut-brain interaction (AP-DGBI); however, the role of these factors is unclear due to heterogeneous study designs. The aim of this systematic review was to extensively evaluate the literature and determine clinical risk and protective factors for the presence and persistence of AP-DGBI in children and adults.

Methods: A PubMed search identified studies investigating potential risk and protective factors for AP-DGBI in adults and children. Inclusion criteria included fully published studies with a control group; exclusion criteria included poor-quality studies (using a validated scale). For each factor, the proportion of studies that found the factor to be a risk factor, protective factor, or neither was summarized. The number of studies, diagnostic criteria, number of subjects, and average study quality rating provided further context. Whenever possible, a meta-analysis generated pooled odds ratios or mean difference.

Results: The systematic review included 348 studies. Female sex, gastroenteritis, abuse, stress, psychological disorders, somatic symptoms, and poor sleep were consistent risk factors for developing AP-DGBI in adults and children. In adults, additional risk factors included obesity, smoking, and increased use of medical resources. Protective AP-DGBI factors in adults included social support and optimism; no studies for protective factors were found for children.

Conclusions: There are multiple risk factors for AP-DGBI in adults and children. These include female sex, gastroenteritis, abuse, stress, poor sleep, obesity, psychological disorders, and somatic symptoms. Additional studies are needed in children, on protective factors, and on factors associated with persistence of AP-DGBI.

Keywords: Functional Gastrointestinal Disorders; Irritable Bowel Syndrome; Recurrent Abdominal Pain.

Figure 1.

Flow diagram of assessment of studies identified in systematic review.

Figure 2.

Summary of the number of studies finding a factor to be a risk factor, protective factor, or neither for AP-DGBI in adults. The blue arrow depicts that the number of studies finding female sex as a risk factor for the presence of AP-DGBI was 67 studies (over the displayed maximum x-axis value of 30).

Figure 3.

Summary of the number of studies finding a factor to be a risk factor, protective factor, or neither for AP-DGBI in children.

Figure 4.

Forest plots showing ORs for AP-DGBI (formerly termed functional gastrointestinal disorders) in female vs male adults (A) or children (B). M-H, Mantel-Haenszel.

Figure 5.

Forest plots showing ORs for AP-DGBI in obese vs nonobese adults (A) and mean BMI in AP-DGBI (formerly termed functional gastrointestinal disorders) vs controls (B). Dec, decreased; Inc, increased; IV, inverse variance; M-H, Mantel-Haenszel.

Figure 6.

Forest plots showing ORs for AP-DGBI (formerly termed functional gastrointestinal disorders) in adults (A) or children (B) with vs without a history of infectious gastroenteritis. GE, gastroenteritis; M-H, Mantel-Haenszel.

Figure 7.

Forest plots showing ORs for AP-DGBI (formerly termed functional gastrointestinal disorders) in adults with history of emotional (A), sexual (B), or physical (C) abuse vs those without any abuse history. M-H, Mantel-Haenszel.