Background: Patients with organic gastrointestinal (GI) diseases and diabetes mellitus (DM) can have concomitant disorders of gut‐brain interaction (DGBI). Objective: This study aimed to compare the global prevalence of DGBI‐compatible symptom profiles in adults with and without self‐reported organic GI diseases or DM. Methods: Data were collected in a population‐based internet survey in 26 countries, the Rome Foundation Global Epidemiology Study ( n = 54,127). Individuals were asked if they had been diagnosed by a doctor with gastroesophageal reflux disease, peptic ulcer, coeliac disease, inflammatory bowel disease (IBD), diverticulitis, GI cancer or DM. Individuals not reporting the organic diagnosis of interest were included in the reference group. DGBI‐compatible symptom profiles were based on Rome IV diagnostic questions. Odds ratios (ORs [95% confidence interval]) were calculated using mixed logistic regression models. Results: Having one of the investigated organic GI diseases was linked to having any DGBI‐compatible symptom profile ranging from OR 1.64 [1.33, 2.02] in GI cancer to OR 3.22 [2.80, 3.69] in IBD. Those associations were stronger than for DM, OR 1.26 [1.18, 1.35]. Strong links between organic GI diseases and DGBI‐compatible symptom profiles were seen for corresponding (e.g., IBD and bowel DGBI) and non‐corresponding (e.g., IBD and esophageal DGBI) anatomical regions. The strongest link was seen between fecal incontinence and coeliac disease, OR 6.94 [4.95, 9.73]. After adjusting for confounding factors, associations diminished, but persisted. Conclusion: DGBI‐compatible symptom profiles are more common in individuals with self‐reported organic GI diseases and DM compared to the general population. The presence of these concomitant DGBIs should be considered in the management of organic (GI) diseases.

Background: Abdominal pain can be an overlooked symptom in patients with ulcerative colitis (UC).Aims: The aim of this study was to investigate the prevalence and factors associated with abdominal pain in active and quiescent UC.Methods: Three study cohorts of adult UC patients were used. Cross‐sectional cohorts I and II included 130 (46 active) and 288 (156 active) patients. Longitudinal cohort III included 83 patients with active disease at diagnosis that reached deep remission during follow‐up. The Gastrointestinal Symptom Rating Scale was used to assess abdominal pain and other validated questionnaires to assess psychological distress, fatigue and quality of life (QoL).Results: In the two cross‐sectional cohorts, 63% and 58% of the active vs. 54% and 33% of the quiescent UC patients reported abdominal pain (both p ≤ 0.02). In the longitudinal cohort, 71% had abdominal pain at diagnosis vs. 46% when in remission (p < 0.001). In multivariable models, symptoms of anxiety were associated with higher abdominal pain levels in both cross‐sectional cohorts (OR 1.75 [IQR 1.11–2.76] and OR 1.99 [1.45–2.73]), whereas in cohort II, active disease (OR 2.68 [1.61–4.45]) and female sex (OR 2.03 [1.21–3.41]) were also associated with pain. QoL was negatively correlated with higher levels of abdominal pain, both in active and quiescent disease.Conclusions: Abdominal pain in UC is prevalent and associated with lower QoL in both active and quiescent disease. Associated factors are active disease, female sex and psychological symptoms, especially anxiety. We suggest considering a holistic approach when treating UC patients with abdominal pain.

Background: Bloating refers to the sensation of tension in the abdomen, reported in the presence or absence of visible abdominal distension. These and other gas‐related symptoms are often reported by patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). However, the prevalence of bloating and visible abdominal distension as separate symptoms in these disorders is not well known. The aim of this study was to investigate the link between bloating, distension, and intestinal gas‐related symptoms with IBS and FD, and their overall impact. Methods: Data from a population‐based internet survey of adults from the US, UK, and Mexico were used. This survey included Rome IV diagnostic questions for IBS and FD, questions to distinguish between ≥ weekly bloating and/or distension, and the Intestinal Gas Questionnaire (IGQ) to assess the impact of six gas‐related symptoms. Results: The analyses included 131 individuals with only IBS, 360 with only FD, 217 with IBS + FD and 4740 without IBS and FD (reference group). Individuals with IBS (64.9%), FD (50.6%), and especially IBS + FD (88.5%) reported bloating and/or distension more frequently than the reference group (13.7%). Bloating and distension as distinct and combined symptoms were strongly linked to IBS and FD even after correcting for confounding factors. Also, other gas‐related symptoms had a higher impact on individuals with IBS and/or FD compared with the reference group. Discussion: Bloating and visible abdominal distension can occur as concomitant or distinct impactful symptoms and are, together with other gas‐related symptoms, strongly linked to IBS and FD. These findings may provide arguments to include bloating and distension as supportive criteria for IBS and FD diagnoses.

Purpose of review: The role of gluten and wheat in irritable bowel syndrome (IBS) is unclear, whereas it plays a key-role in the diagnosis and treatment of noncoeliac gluten or wheat sensitivity (NCGWS). This review aims to provide the most recent insights in pathophysiological mechanisms and to summarize the evidence for a gluten- or wheat-free diet in IBS and NCGWS. Recent findings: The exact role of gluten and wheat in IBS and NCGWS pathophysiological mechanisms remains complex. However, recent findings suggest a role for antigliadin antibodies to identify those IBS patients who may benefit from a gluten-free diet and low levels of fecal calprotectin to differentiate IBS and NCGWS. The importance of gut-brain interactions in self-reported gluten sensitive individuals was shown by a strong nocebo effect, although a role of gluten could not be excluded. Evidence for a gluten-free diet remains debatable in both conditions, whereas a wheat-free diet may have more potential, especially in NCGWS. Summary: IBS and NCGWS are two closely related conditions with a complex and largely unrevealed pathophysiology. The role of gluten may have been overestimated in the past, but it is likely that certain wheat components, along with gut-brain interactions, play a role in both conditions.

The global prevalence of fecal incontinence (FI) is likely underestimated with an unmet need to identify associated factors to improve patient care. This study aimed to report the global prevalence of FI and to identify associated factors. Data from the internet survey of the cross-sectional Rome Foundation Global Epidemiology Study, including 26 countries, were used. The prevalence of any FI, defined as any accidental leakage of stool during the last 3 months, and the prevalence of Rome IV FI were evaluated. The association between other bowel and anorectal symptoms and FI was assessed using individual items of the Rome IV diagnostic questionnaire. Any FI was reported in 13.8% and Rome IV FI in 1.6%. The prevalence of any FI ranged from 10.9% in Eastern Europa to 19.7% in North America, and Rome IV FI from 0.8% in the Middle East to 3.3% in North America. The prevalence of any FI was higher in males, elderly, and obese, with similar patterns in Rome IV FI, except for no sex difference. In multivariable analyses, all bowel and anorectal symptoms were associated with having any FI and Rome IV FI, with urgency, loose stools, and abdominal and rectal pain showing the strongest links. Both any FI and Rome IV FI were associated with a lower quality of life. FI is common across the globe, but with regional differences. Strong associations with abdominal and rectal pain, as well as diarrhea- and constipation-specific symptoms suggest a role of both altered stool consistency and visceral hypersensitivity in FI pathophysiology.

Irritable bowel syndrome (IBS) is subtyped based on bowel habits. However, a more comprehensive subgrouping based on combined gastrointestinal (GI), non-GI somatic, and psychological symptom profiles has been proposed. This study aimed to validate this new approach, including the exploration of differences in patient-reported outcomes and gut physiology across subgroups. Six subgroups were identified based on Gaussian mixture model analysis including 760 patients with IBS: diarrhea with low or high comorbidity burden, constipation with low or high comorbidity burden, overall mild severity, and mixed GI symptoms with high comorbidity burden. IBS symptoms, GI-specific anxiety, and fatigue were more severe, and quality of life was lower in those with high comorbidity burden. Oro-anal transit time differed between the diarrhea and constipation subgroups, but only between those with low comorbidity burden. Our data revealed a relevance for the proposed novel subgrouping strategies, including links to distinct pathophysiological mechanisms.