What are Disorders of Gut-Brain Interaction (DGBI)?
DGBIs are a group of chronic functional gastrointestinal disorders. That means that they are not structural or organic in nature, meaning that there is no visible or structural abnormality in the gastrointestinal tract. Instead, the symptoms are believed to arise from a complex interplay between the gut and the brain, involving things such as altered gut motility, increased sensitivity to pain, and the brain processing of those signals from the gut. They are characterized by a wide range of symptoms related to digestion and bowel function but lack visible disease in testing.
Key Aspects of DGBIs:
Functional, Not Structural: This is the core of the definition. In DGBIs, standard medical tests (like endoscopies, imaging) don't reveal any identifiable abnormalities in the digestive system. The issue isn't with the anatomy or tissue itself but rather the functionality and communication within the system.
Gut-Brain Axis Dysfunction: The symptoms are thought to be due to disruptions in the gut-brain axis (or "microbiome-gut-brain axis"), a complex two-way communication network linking the brain and the gastrointestinal tract.
Varied Symptoms: DGBIs can present with a range of symptoms, including:
Abdominal pain (can be recurrent, chronic, or intermittent)
Bloating
Gas
Changes in bowel habits (constipation, diarrhea, or alternating patterns)
Nausea
Vomiting
Feeling of incomplete bowel movement
Common in Children: DGBIs are quite common in children and adolescents.
Not a Single Disease: DGBI is an umbrella term encompassing various specific conditions, such as:
Irritable Bowel Syndrome (IBS): The most well-known example of a DGBI.
Functional Abdominal Pain (FAP): Chronic or recurring abdominal pain without a structural cause.
Functional Dyspepsia (FD): Upper abdominal discomfort without ulcers or other identifiable pathology.
Functional Constipation: Constipation without a clear underlying organic reason.
Cyclic Vomiting Syndrome: Episodes of severe nausea and vomiting.
Diagnosis: Diagnosis often relies on detailed symptom evaluation, clinical history, and ruling out other conditions with standard medical testing (ex. endoscopies, imaging, and biopsies). The "Rome criteria" are commonly used to standardize diagnostic criteria for these conditions.
Why is DGBI Relevant in the "Practice Points" about H. pylori?
DGBI is More Likely than H. pylori in Recurrent Abdominal Pain (No Alarm Symptoms): The text explicitly states that if a child has recurrent abdominal pain without accompanying "alarm" signs (like weight loss, vomiting, blood in stool, fevers, etc.), they are much more likely to have a DGBI than an issue arising directly from H. pylori.
H. pylori Eradication is Not Helpful: The guidelines note that in cases of recurrent abdominal pain that fit the DGBI description, even if H. pylori is found in testing, its eradication is not likely to improve their symptoms unless there are also ulcers or erosions, and, therefore, should not be the standard of care.
Avoid Unnecessary Testing and Anxiety: Because testing for H. pylori when DGBI is suspected is not likely to benefit the patient, the guidelines discourage testing. A positive result can lead to unnecessary anxiety, treatments, and procedures.
In summary, DGBIs represent a group of functional gastrointestinal disorders arising from complex communication issues between the brain and gut. It's important to understand that H. pylori and DGBI are different entities. In children with recurrent abdominal pain, it's crucial to consider DGBIs as the more probable cause (when no alarming symptoms are present) and to avoid unnecessary H. pylori testing and treatment in these cases. The "practice points" highlight the need for a nuanced and targeted approach when dealing with pediatric gastrointestinal complaints.
DGBIs are a group of chronic functional gastrointestinal disorders. That means that they are not structural or organic in nature, meaning that there is no visible or structural abnormality in the gastrointestinal tract. Instead, the symptoms are believed to arise from a complex interplay between the gut and the brain, involving things such as altered gut motility, increased sensitivity to pain, and the brain processing of those signals from the gut. They are characterized by a wide range of symptoms related to digestion and bowel function but lack visible disease in testing.
Key Aspects of DGBIs:
Functional, Not Structural: This is the core of the definition. In DGBIs, standard medical tests (like endoscopies, imaging) don't reveal any identifiable abnormalities in the digestive system. The issue isn't with the anatomy or tissue itself but rather the functionality and communication within the system.
Gut-Brain Axis Dysfunction: The symptoms are thought to be due to disruptions in the gut-brain axis (or "microbiome-gut-brain axis"), a complex two-way communication network linking the brain and the gastrointestinal tract.
Varied Symptoms: DGBIs can present with a range of symptoms, including:
Abdominal pain (can be recurrent, chronic, or intermittent)
Bloating
Gas
Changes in bowel habits (constipation, diarrhea, or alternating patterns)
Nausea
Vomiting
Feeling of incomplete bowel movement
Common in Children: DGBIs are quite common in children and adolescents.
Not a Single Disease: DGBI is an umbrella term encompassing various specific conditions, such as:
Irritable Bowel Syndrome (IBS): The most well-known example of a DGBI.
Functional Abdominal Pain (FAP): Chronic or recurring abdominal pain without a structural cause.
Functional Dyspepsia (FD): Upper abdominal discomfort without ulcers or other identifiable pathology.
Functional Constipation: Constipation without a clear underlying organic reason.
Cyclic Vomiting Syndrome: Episodes of severe nausea and vomiting.
Diagnosis: Diagnosis often relies on detailed symptom evaluation, clinical history, and ruling out other conditions with standard medical testing (ex. endoscopies, imaging, and biopsies). The "Rome criteria" are commonly used to standardize diagnostic criteria for these conditions.
Why is DGBI Relevant in the "Practice Points" about H. pylori?
DGBI is More Likely than H. pylori in Recurrent Abdominal Pain (No Alarm Symptoms): The text explicitly states that if a child has recurrent abdominal pain without accompanying "alarm" signs (like weight loss, vomiting, blood in stool, fevers, etc.), they are much more likely to have a DGBI than an issue arising directly from H. pylori.
H. pylori Eradication is Not Helpful: The guidelines note that in cases of recurrent abdominal pain that fit the DGBI description, even if H. pylori is found in testing, its eradication is not likely to improve their symptoms unless there are also ulcers or erosions, and, therefore, should not be the standard of care.
Avoid Unnecessary Testing and Anxiety: Because testing for H. pylori when DGBI is suspected is not likely to benefit the patient, the guidelines discourage testing. A positive result can lead to unnecessary anxiety, treatments, and procedures.
In summary, DGBIs represent a group of functional gastrointestinal disorders arising from complex communication issues between the brain and gut. It's important to understand that H. pylori and DGBI are different entities. In children with recurrent abdominal pain, it's crucial to consider DGBIs as the more probable cause (when no alarming symptoms are present) and to avoid unnecessary H. pylori testing and treatment in these cases. The "practice points" highlight the need for a nuanced and targeted approach when dealing with pediatric gastrointestinal complaints.