Abstract
In patients with disorders of gut–brain interaction (DGBI), overlapping non-gastrointestinal conditions such as fibromyalgia, headaches, gynaecological and urological conditions, sleep disturbances and fatigue are common, as is overlap among DGBI in different regions of the gastrointestinal tract. These overlaps strongly influence patient management and outcome. Shared pathophysiology could explain this scenario, but details are not fully understood. This overlap has been shown to be of great relevance for DGBI. In addition, symptoms considered to be caused by a DGBI could have a detectable organic cause, and in patients with a diagnosed organic gastrointestinal disease, symptoms not clearly explained by the pathology defining this organic disease are common. Thus, the aims of this Rome Foundation Working Team Report were to review the literature on overlapping conditions among patients with paediatric and adult DGBI and, based on the available epidemiological and clinical evidence, make recommendations for the current diagnostic and therapeutic approach, and for future research. Specifically, we focused on other DGBI in the same or different gastrointestinal anatomical region(s), DGBI overlap with organic bowel diseases in remission, and DGBI overlap with non-gastrointestinal, non-structural conditions.
Key points
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Overlap in disorders of gut–brain interaction (DGBI) diagnoses across and within anatomical regions is commonly observed in both children and adults.
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With an increasing number of DGBI diagnoses there is a gradual increase in the severity of symptoms and psychological comorbidity and health-care utilization, and a decrease in quality of life.
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Treating DGBI overlaps requires a comprehensive strategy, and therapeutic regimens can be strategically selected based on the type of overlapping symptoms.
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In patients with a diagnosed organic gastrointestinal disease, symptoms not clearly explained by the pathology defining this organic disease are common.
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The recognition of the occurrence of DGBI in patients with organic gastrointestinal disease in remission helps to avoid overtreatment with drugs with potential adverse effects.
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In patients with DGBI, overlapping non-gastrointestinal conditions such as fibromyalgia, headaches, gynaecological and urological conditions, sleep disturbances and fatigue are common; these are best managed with a multidisciplinary approach.
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This Working Team Report was supported by the Rome Foundation.
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G.B., L.C., S.N. and M. Simrén are on the Rome Foundation Board of Directors. G.B. declares consultancies, business interests or sources of honoraria payments from Aboca, AB Biotics, Agave, Alfa Sigma, AGPharma, Bayer, Biocodex, Boehringer, Bromatech, Cadigroup, Danone, Diadema, Falk Pharma, GE Healthcare, Giuliani, Mayoly, Malesci, Sanofi, Sofar and Yakult. L.C. is a consultant for AbbVie, Ardelyx, Atmo, Bausch Health, Food Marble, Ironwood Pharmaceuticals, Trellus Health and Vibrant; and receives grant support from AnX Robotica and Ironwood Pharmaceuticals. L.C. also has stock options in Food Marble, ModifyHealth and Trellus Health. S.N. is a consultant for Abbvie. M. Saps is a consultant for AbbVie and Ironwood, and has received study funding from QOL Medical. G.S. is a speaker and consultant for Sanofi/Regeneron, Salix, Phathom, Ardelyx, Ironwood, AbbVie and GI Health Foundation, and is a Council member of the American Neurogastroenterology and Motility Society. M. Simrén. is a consultant for Danone Nutricia Research, Biocodex, Tillotts, Takeda, Kyowa Kirin, Abbvie, BioGaia, Renapharma and Cinclus Pharma; and has received speaker fees from Tillotts, Kyowa Kirin, Takeda, Biocodex, Sanofi, Abbvie, Janssen Immunology, Pfizer, BioGaia, Renapharma, Mayoly and Bromatech. M. Simrén has also received unrestricted research grants from Genetic Analysis AS and BioGaia. The other authors declare no competing interests.
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Barbara, G., Aziz, I., Ballou, S. et al. Rome Foundation Working Team Report on overlap in disorders of gut–brain interaction. Nat Rev Gastroenterol Hepatol 22, 228–251 (2025). https://doi.org/10.1038/s41575-024-01033-9
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DOI: https://doi.org/10.1038/s41575-024-01033-9
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