Overlap of DGBI Subtype Is Common in Tertiary Care Settings

Compared with population-based analyses, there is a higher prevalence of overlap of disorders of gut-brain interaction in tertiary care settings.

Overlap of disorders of gut-brain interaction (DGBI) subtypes is common, more prevalent in tertiary care settings, and is associated with psychological comorbidities, according to a study in The Lancet Gastroenterology & Hepatology.

Researchers conducted a systematic review and meta-analysis to assess the prevalence of overlap of DGBI.

They searched the MEDLINE (PubMed) and Embase electronic databases for all studies reporting a prevalence of DGBI overlap in adults. Other sources included Google Scholar, conference abstracts, and contacting experts.

A total of 46 studies with 75,682 patients with DGBI participants and DGBI overlap in 24,424 participants were included. The pooled prevalence of DGBI overlap was 36.5% (95% CI, 30.7-42.6), although considerable between-study heterogeneity was observed (I²=99.51, P =.0001).

In people with overlap, psychological comorbidities, including anxiety and depression, are more severe and quality of life is more adversely affected.

In 13 studies reporting data on the association between DGBI overlap prevalence and sex, female sex was associated with a small, but statistically significant increase in the odds of DGBI overlap (odds ratio [OR], 1.12; 95% CI, 1.03-1.22; P =.007), with moderate between-study heterogeneity occurring (I²=41.84; P =.056).

A total of 20 studies reported DGBI overlap in 39,749 participants from a population-based setting, 22 studies included 22,617 participants from a tertiary care setting, and 2 studies included 12,674 participants from a primary care setting. The tertiary care setting had the highest pooled prevalence of DGBI overlap (47.3%; 95% CI, 33.2-61.7), followed by the primary care setting (27.1%; 95% CI, 14.4-45.1) and the population-based setting (26.5%; 95% CI, 20.5-33.4).

Meta-regression analysis indicated that the prevalence of DGBI overlap was significantly increased in tertiary care vs population-based cohorts (OR, 2.50; 95% CI, 1.28-4.87; P =.0084), and other comparisons showed no significance difference. Considerable between-study heterogeneity was observed in these analyses.

Quality of life was reported in 3 studies with use of the short-form health survey (SF)-36 or SF-12 questionnaires. Participants with overlapping DGBI had a significantly lower physical component score (standardized mean difference [SMD], -0.47; 95% CI, -0.80 to -0.14; P =.025), with minimal between-study heterogeneity (I²=0, P =.52).

Anxiety was reported in 9 studies with 3,539 DGBI participants, and 11 studies with 3,922 DGBI participants included depression. Patients with DGBI overlap had significantly increased anxiety scores (SMD, 0.39; 95% CI, 0.24-0.54, P =.0001), with substantial between-study heterogeneity. Depression scores were increased significantly in patients with DGBI overlap vs those without overlap (0.41, 95% CI, 0.30-0.51; P =.0001), with moderate heterogeneity.

Among several limitations, most of the studies included used a cross-sectional design, although DGBI symptoms fluctuate over time. Another limitation is the different methodology in recruiting participants and variations in diagnostic work-up. Also, studies with patients with gastroesophageal reflux disease were excluded, and some of the studies had a small sample size.

“[O]verlap is common among people with DGBI, and more than a third of people with DGBI have an overlapping DGBI, with greater prevalence found in tertiary care settings,” study authors wrote. “In people with overlap, psychological comorbidities, including anxiety and depression, are more severe and quality of life is more adversely affected.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Gastroenterology Advisor


Fairlie T, Shah A, Talley NJ, et al. Overlap of disorders of gut–brain interaction: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. Published online May 18, 2023. doi:10.1016/S2468-1253(23)00102-4