Abdominal pain-related disorders of gut-brain interaction from childhood to adulthood: A birth cohort study on natural history, risk factors, and quality of life

Abstract

Recurrent abdominal pain (RAP) is a common issue across the lifespan and a defining feature of abdominal pain-related disorders of gut-brain interaction (AP-DGBI), including irritable bowel syndrome (IBS). These disorders are highly prevalent and impose significant burdens on both individuals and society. This thesis, based on a longitudinal, population-based Swedish birth cohort, examines the natural history of RAP and AP-DGBI from childhood to adulthood, identifies childhood risk factors for their presence and persistence, and investigates their impact on health-related quality of life (HRQoL).

Study I demonstrated that RAP is prevalent in childhood, peaking in adolescence. While preadolescent RAP is a strong risk factor for adolescent RAP and AP-DGBI, most affected children do not experience persistent abdominal pain through adolescence. Study II found that childhood eczema and food hypersensitivity are associated with an increased risk of adolescent AP-DGBI, while childhood asthma and food hypersensitivity are linked to adolescent IBS, suggesting a shared pathophysiology between these conditions. Study III showed that adolescents and young adults with IBS have significantly impaired HRQoL, with overall HRQoL impairment and anxiety/depression in adolescence predicting new-onset IBS in adulthood, while adolescent AP-DGBI increases the risk of new-onset anxiety/depression in adulthood. Study IV identified multiple childhood risk factors for adult IBS, with adolescent IBS being the strongest predictor. However, nearly 70% of adolescents with IBS do not have IBS as young adults. Other risk factors include female sex, impaired HRQoL, psychological distress, somatic pain, cumulative antibiotic use, short sleep, and parental IBS history, the latter also being a strong predictor of IBS persistence from adolescence into adulthood. Similar results were found for RAP presence and persistence.

In conclusion, this thesis provides valuable insights into the natural history and long-term impact of childhood RAP and AP-DGBI into adulthood. It identifies several risk factors for their development and suggests potential targets for interventions aimed at reducing the risk of developing adult AP-DGBI.