Bloating and distention patients form 6 distinct latent clusters based on symptoms, diet, psychosocial and quality of life parameters.

BACKGROUND/AIMS Bloating, distention, and gas-related gastrointestinal (GI) symptoms are frequently reported by patients across the spectrum of Disorders of Gut-Brain Interaction (DGBI). We aimed to characterize these using latent class modelling in a large multi-national survey. METHODS A nationwide survey of adults in the US, UK, and Mexico used quota sampling for demographic balance. It included Rome IV diagnostic questions, Intestinal Gas Questionnaire (IGQ), Patient Health Questionnaires for anxiety and depression (PHQ-4) and somatization (PHQ-12), quality of life (PROMIS Global-10), and lifestyle questions. Latent class analysis (LCA) was performed using 'depmix' in RStudio 4.2.3. RESULTS 3,471 subjects experiencing bloating and/or distention (mean age 43 years, 57% female) were included. Using 42 demographic and pertinent clinical variables, LCA revealed 6 distinct clusters. The first two clusters demonstrated limited to moderate impairment in health-related quality of life (HRQoL) and with both characterized by some degree of dietary and supplement associations, however, cluster 2 lacked specific triggers observed in other clusters. The subsequent two clusters showed favorable HRQoL and mild gas-related symptoms, with only cluster 4 exhibiting distinct dietary triggers. The final two clusters, associated with bowel dysfunction, showed a higher prevalence of IBS-C and IBS-M in cluster 5, and IBS-D in cluster 6. These bowel dysfunction clusters exhibited severe gas symptoms in the preceding 24 hours and greater HRQoL impairment compared to the other four clusters. Notably, cluster 5 was linked to dietary triggers, whereas cluster 6 was defined by psychosocial comorbidities. CONCLUSIONS Bloating and distention patients are likely driven by variable influences of dietary, psychological and bowel dysfunction. Further studies are needed to identify mechanisms and titrate treatment suited to specific mechanistic drivers.