Paediatric gut-brain disorders affect more than a quarter of children

Design

multinational cross-sectional online survey using Rome V criteria, caregiver-completed

Population

caregivers of 8,000 children aged 0–17 years in China, Italy, Mexico and the USA

Primary outcome

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

Effect

overall 28.0% (95% CI 27.0–29.0); lower disorders 23.7%, of which defecation and anorectal 20.2%; upper disorders 8.7%; prevalence fell from ~41% at 0–3 years to 22% in adolescents

Prevalence figures for functional gastrointestinal disorders in children have been unusable because every study used different criteria. The Rome Foundation ran a single instrument across four countries: caregivers of 8,000 children aged 0–17 in China, Italy, Mexico and the USA completing a Rome V survey covering symptoms, illness burden and comorbidity.

Twenty-eight per cent of children met criteria for a disorder of gut-brain interaction (95% CI 27.0–29.0). Lower disorders dominated at 23.7%, almost entirely defecation and anorectal disorders at 20.2%, with abdominal pain disorders at 4.4%. Upper disorders were 8.7%, led by gastroduodenal disorders at 6.6%. Prevalence fell steeply with age, from about 41% in children aged 0–3 to 22% in adolescents, and varied by country — highest in Mexico, lowest in China.

The burden data is what makes this more than an epidemiological curiosity. These disorders were associated with anxiety, depression, functional disability and healthcare use, and with substantial parental time spent coordinating care — particularly where upper and lower disorders overlapped. That overlap group is the one that consumes the most and is served the least well, because it gets referred twice.

• Defecation and anorectal disorders are the bulk of this — constipation, not abdominal pain, is the commonest presentation.
• The 41% figure in 0–3 year olds reflects caregiver-reported infant regurgitation and dyschezia, most of which resolves; do not read it as disease requiring treatment.
• Screen for anxiety and low mood in a child with persistent functional gastrointestinal symptoms — the association is strong and the comorbidity is treatable.
• Where upper and lower symptoms coexist, manage them as one problem with one clinician rather than two referrals.
• No Indian data is included, and the four-country variation was substantial — do not transfer the prevalence figure directly.

Why it matters

It puts a number and a burden on a group of conditions that are routinely dismissed as not real problems.

Don't overread it

This is a caregiver-reported online survey in four countries — it measures symptom criteria being met, not clinically diagnosed disease.

The statistics, in plain English

The confidence intervals are narrow (27.0 to 29.0 for the headline figure) because 8,000 is a large sample — but narrow intervals describe precision, not accuracy. These are caregiver-completed online surveys, so the sample skews toward households with internet access and literate caregivers, and symptoms are reported by a parent rather than assessed clinically. Rome criteria are symptom-based by design, so a prevalence figure here is a measure of how many children meet a definition, not how many have a problem needing treatment.

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