Background

Rome criteria differentiate distinct types of disorders of gut–brain interaction (DGBI); also known as functional gastrointestinal disorders. Overlap of symptom categories frequently occurs. This systematic review and meta-analysis aimed to define the prevalence of DGBI overlap and compare overlap in population-based, primary care or tertiary care health settings. Furthermore, we aimed to compare symptom severity of psychological comorbidities in DGBI with and without overlap.

Methods

For this systematic review and meta-analysis we searched MEDLINE (PubMed) and Embase electronic databases from inception until March 1, 2022, for original articles and conference abstracts of observational cross-sectional, case-controlled, or cohort design studies that reported the prevalence of DGBI overlap in adult participants (aged ≥18 years). We included only those studies where the diagnosis of DGBI was based on clinical assessment, questionnaire data, or specific symptom-based criteria. Studies were excluded if reporting on mixed populations of DGBI and organic diseases. Aggregate patient data were extracted from eligible published studies. The prevalence of DGBI overlap in all studies was pooled using the DerSimonian and Laird random effects model, and further analysis stratified by subgroups (care setting, diagnostic criteria, geographic region, and gross domestic product per capita). We also assessed the relationship between DGBI overlap with anxiety, depression, and quality of life symptom scores. This study was registered with PROSPERO (CRD42022311101).

Findings

46 of 1268 screened studies, reporting on 75 682 adult DGBI participants, were eligible for inclusion in this systematic review and meta-analysis. Overall, 24 424 (pooled prevalence 36·5% [95% CI 30·7 to 42·6]) participants had a DGBI overlap, with considerable between-study heterogeneity (I²=99·51, p=0·0001). In the tertiary health-care setting, overlap among participants with DGBI was more prevalent (8373 of 22 617, pooled prevalence 47·3% [95% CI 33·2 to 61·7]) compared with population-based cohorts (11 332 of 39 749, pooled prevalence 26·5% [95% CI 20·5 to 33·4]; odds ratio 2·50 [95% CI 1·28 to 4·87]; p=0·0084). Quality of life physical component scores were significantly lower in participants with DGBI overlap compared with participants without overlap (standardised mean difference –0·47 [95% CI –0·80 to –0·14]; p=0·025). Participants with DGBI overlap had both increased symptom scores for anxiety (0·39 [95% CI 0·24 to 0·54]; p=0·0001) and depression (0·41 [0·30 to 0·51]; p=0·0001).

Interpretation

Overlap of DGBI subtypes is frequent, and is more prevalent in tertiary care settings and associated with more severe symptom manifestations or psychological comorbidities. Despite the large sample size, the comparative analyses revealed substantial heterogeneity, and the results should be interpreted with caution.

Funding

National Health and Medical Research Council and Centre for Research Excellence.

中文翻译：

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肠脑相互作用障碍的重叠：系统回顾和荟萃分析

背景

罗马标准区分不同类型的肠脑相互作用障碍 (DGBI)；也称为功能性胃肠道疾病。经常出现症状类别的重叠。该系统回顾和荟萃分析旨在确定 DGBI 重叠的流行程度，并比较基于人群、初级保健或三级保健医疗机构中的重叠。此外，我们的目的是比较有无重叠的 DGBI 心理合并症的症状严重程度。

方法

对于这项系统回顾和荟萃分析，我们搜索了从开始到 2022 年 3 月 1 日的 MEDLINE (PubMed) 和 Embase 电子数据库，以查找报告患病率的观察性横断面、病例对照或队列设计研究的原始文章和会议摘要成人参与者（≥18 岁）的 DGBI 重叠。我们仅纳入了 DGBI 诊断基于临床评估、问卷数据或基于特定症状的标准的那些研究。如果报告 DGBI 和器质性疾病的混合人群，则研究被排除在外。总计的患者数据是从符合条件的已发表研究中提取的。使用 DerSimonian 和 Laird 随机效应模型汇总所有研究中 DGBI 重叠的发生率，并进一步按亚组（护理环境、诊断标准、地理区域和人均国内生产总值）进行分层分析。我们还评估了 DGBI 重叠与焦虑、抑郁和生活质量症状评分之间的关​​系。本研究已在 PROSPERO (CRD42022311101) 注册。

发现

1268 项筛选研究中的 46 项报告了 75682 名成人 DGBI 参与者，符合纳入本系统评价和荟萃分析的条件。总体而言，24 424（汇总患病率 36·5% [95% CI 30·7 至 42·6]）参与者有 DGBI 重叠，具有相当大的研究间异质性 ( I ²=99·51，p=0·0001）。在三级医疗机构中，与基于人群的队列（11 332 39 749，汇总患病率 26·5% [95% CI 20·5 至 33·4]；比值比 2·50 [95% CI 1·28 至 4·87]；p=0·0084）。与没有重叠的参与者相比，有 DGBI 重叠的参与者的生活质量身体成分评分显着较低（标准化平均差 –0·47 [95% CI –0·80 至 –0·14]；p=0·025）。具有 DGBI 重叠的参与者的焦虑（0·39 [95% CI 0·24 至 0·54]；p=0·0001）和抑郁（0·41 [0·30 至 0·51]； p=0·0001）。

解释

DGBI 亚型的重叠很常见，在三级医疗机构中更为普遍，并且与更严重的症状表现或心理合并症相关。尽管样本量很大，但比较分析显示出很大的异质性，应谨慎解释结果。

资金

国家卫生与医学研究委员会和卓越研究中心。