The prevalence and burden of disorders of gut-brain interaction (DGBI) before vs after the COVID-19 pandemic

Background & Aims: COVID-19 infection may increase the risk of developing disorders of gut-brain interaction (DGBI). However, the extent of this effect on a population level is poorly understood. We performed a 2-country survey to address this issue.

Methods: A population-based Internet survey with predefined demographic quotas was conducted across the United Kingdom (UK) and United States (U.S.) in 2017 (pre-pandemic; n = 4050) and repeated in 2023 (post-pandemic; n = 4002). The surveys included the Rome IV diagnostic questionnaire, and questions about nongastrointestinal somatic symptoms, anxiety and depression, quality of life, and health care utilization. The 2023 survey also included questions regarding COVID-19 infection and illness history.

Results: The overall DGBI prevalence (ie, meeting diagnostic criteria for at least 1 DGBI) has significantly increased from the pre- to post- pandemic era (38.3% vs 42.6%; odds ratio [OR], 1.20; 95% confidence interval, 1.09–1.31), with similar findings independently noted in the UK and U.S. The rise in DGBI was observed within the esophageal (8.8% vs 10.1%; OR, 1.16), gastroduodenal (11.9% vs 16.4%; OR, 1.45), and bowel domains (30.1% vs 32.5%; OR, 1.12). The 2 most widely investigated DGBIs showed large post-pandemic prevalence increases, with functional dyspepsia rising from 8.3% to 11.9% (OR, 1.48) and irritable bowel syndrome from 4.7% to 6.0% (OR, 1.31). In multivariable analysis, factors significantly associated with having DGBI in the post-pandemic era included younger age, female sex, anxiety, depression, medium-to-high somatic symptom severity, increasing number of COVID-19 infections, experiencing abdominal pain or diarrhea during COVID-19 infection, and suffering with long COVID. Individuals with DGBI in the post-pandemic era, in particular those with long COVID, reported reduced quality of life and higher mood disturbances, somatic symptom reporting, and health care use than individuals with DGBI in the pre-pandemic era.

Conclusion: The population prevalence and burden of DGBI have increased following the COVID-19 pandemic. Health care services and research funding bodies need to adapt to this post-COVID rise in DGBI and address how to best manage this patient group.