Evidence for Brain-To-Gut and Gut-To-Brain Pathways in Primary Care Patients With Disorders of Gut-Brain Interaction, Inflammatory Bowel Disease and Gastroesophageal Reflux Disease.

Background: Apart from disorders of gut-brain interaction (DGBI), little data exist on the magnitude of the brain-to-gut pathway in other chronic gastrointestinal conditions such as gastroesophageal reflux disease (GERD) or inflammatory bowel disease (IBD) and what factors modify order of diagnosis. We aimed to determine the proportion of patients who received a diagnosis of a DGBI, GERD, or IBD prior to a new psychological diagnosis (gut-to-brain), and vice versa (brain-to-gut), and whether specific factors moderate the order of diagnosis.

Method: Data was collected from a retrospective study of 1,129,104 patients attending general practices in the United Kingdom. Patients diagnosed with DGBI, GERD, or IBD and a psychological disorder (anxiety and/or depression) were included (excluding those with other organic GI disease). Information on which diagnosis appeared first was recorded. Multiple logistic regression was performed to compare a diagnosis of a DGBI, GERD, or IBD first versus a psychological diagnosis first on sociodemographic factors, medical conditions, and medication usage.

Key results: Just over half of patients were diagnosed with a psychological condition first versus after for IBS (53.9%) and ulcerative colitis (55.6%). This proportion was higher for FD (61.5%) and GERD (64.2%) but lower for Crohn's disease (45.7%). In a multivariate model, being female (OR = 1.37, 95% CI 1.25, 1.49), prior PPI (OR = 9.17, 95% CI 8.4, 10.0), antibiotic (OR = 2.54, 95% CI 2.29, 2.81) and NSAID use (OR = 1.29, 95% CI 1.18, 1.42), and prior gastroenteritis (OR = 2.19, 95% CI, 1.79, 2.67) were significant predictors for being diagnosed with GERD first. Similar results were found for DGBI.

Conclusions & inferences: Prior medication usage and gastroenteritis may play a role in generating gut-to-brain pathway disturbances.