More than a quarter of children meet criteria for a gut-brain disorder

Design

multinational cross-sectional online survey using the Rome V paediatric questionnaire, completed by caregivers

Population

8,000 children aged 0-17 years in China, Italy, Mexico and the USA

Primary outcome

prevalence of paediatric disorders of gut-brain interaction, by category, country, sex and age

Effect

28.0% overall (95% CI 27.0-29.0); lower disorders 23.7%, upper 8.7%; defecation and anorectal disorders 20.2%; prevalence about 41% at ages 0-3 falling to 22% in adolescents

Caregivers of 8,000 children aged 0 to 17 in China, Italy, Mexico and the United States completed an online Rome V survey covering gastrointestinal symptoms, illness burden and comorbid conditions. It is the first multinational prevalence estimate for paediatric disorders of gut-brain interaction using consistent methods.

At least one disorder was present in 28.0% of children (95% CI 27.0 to 29.0). Lower disorders accounted for most of it at 23.7%, upper disorders for 8.7%. Defecation and anorectal disorders dominated at 20.2%, well ahead of abdominal pain disorders at 4.4% and discomfort disorders at 1.8%. Among upper disorders, gastroduodenal disorders led at 6.6%, then functional feeding disorders at 3.4% and oesophageal disorders at 0.6%. Prevalence fell steeply with age, from about 41% in children aged 0 to 3 years to 22% in adolescents, was highest in Mexico and lowest in China, and showed a female predominance in gastroduodenal and discomfort disorders.

The burden data are the part worth carrying into clinic. These disorders were associated with anxiety, depression, functional disability and healthcare use, and with substantial parental time spent on care and coordination, particularly where upper and lower disorders overlapped. That overlap is the group that consumes most of the family's and the service's effort.

Read the prevalence figures with the method in mind. These are caregiver-reported symptoms from an online survey, so they measure how many children meet symptom criteria, not how many need referral; the very high figure in the youngest children partly reflects that infant regurgitation and functional constipation are common and usually self-limiting. The clinical use is to expect these presentations, to look for the anxiety and school disruption that travel with them, and to ask specifically about overlapping upper and lower symptoms.

• Expect defecation and anorectal disorders to be the commonest presentation by a wide margin in children
• Ask about school absence, anxiety and low mood in every child with persistent gastrointestinal symptoms
• Ask specifically whether upper and lower symptoms coexist, since the overlap group carries the greatest burden
• Ask what the family is spending in time and appointments; that burden is often invisible in the consultation
• Treat high prevalence in infants as a reason for explanation and follow-up, not for investigation

The statistics, in plain English

The confidence interval around the headline prevalence, 27.0% to 29.0%, is narrow because the sample is large, so the estimate is precise for the four countries surveyed; it is not necessarily transferable to countries not included, and the spread between Mexico and China shows how much geography moves the figure. Because caregivers reported symptoms through an online questionnaire, families without internet access are missing and reporting depends on parental interpretation, both of which can shift prevalence in either direction. The steep fall with age is consistent with many of these conditions resolving, but a cross-sectional survey cannot show that directly.

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