Introduction
Disorders of Gut-Brain Interaction (DGBI) are chronic, remitting and relapsing conditions which may originate in childhood. Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are two most common DGBIs seen in clinical practice. However many childhood illnesses are minor self-limiting viral or bacterial diseases with no known long-term consequences. There is currently a poor understanding of whether DGBI diagnosed in childhood has direct consequences for the same condition persisting or recurring in adulthood, or what might be risk or risk-protective factors for such persistence. Further, there are no data on this question from general practice, where the majority of DGBIs are diagnosed and managed. This study aimed to document the proportion of childhood-diagnosed IBS and FD that was further identified in patients’ general practice medical record in adulthood and what factors were associated with recurrence.
Methods
General practice records were obtained for over 1.2 million patients in the United Kingdom, of whom over 60,000 spanned both childhood and adulthood years. Patients with diagnosed organic gastrointestinal disorder were excluded. Other gastrointestinal and psychological conditions diagnosed in childhood, prior to DGBI diagnosis, or at any time, along with available sociodemographic factors were used to identify factors associated with repeat diagnosis in adulthood.
Results
Overall, 11% of IBS and 20% of FD patients diagnosed in childhood were found to have repeat diagnoses of the same condition in adulthood. Female sex (OR=2.02) was associated with increased risk of repeat diagnosis for IBS but socioeconomic status and ethnicity were not risk factors for either DGBI studied. Childhood diagnosis of gastritis (OR=0.46) was a protective factor for IBS while childhood prescription of NSAIDs (OR=1.31, 95% CI 1.09, 1.56) was a risk factor. For FD, a childhood diagnosis of asthma (OR=1.30, 95% CI 1.00, 1.70) was a risk factor for a repeat diagnosis in adulthood. Anxiety was associated with increased risk of both IBS (OR=1.24, 95% CI 1.00, 1.54) and FD (OR=1.48 95% CI 1.11, 1.97) as was depression for both IBS (OR=1.34, 95% CI 1.11, 1.62) and FD (OR=1.88 95% CI 1.47, 2.42).
Conclusions
Childhood diagnoses of DGBI are associated with the same disorder as adults in a small but significant percentage of patients. This underscores the importance of effective management of childhood cases of DGBI and that monitoring should continue into adulthood. Risk factor analysis suggests that female patients should receive particular attention, anxiety and depression should be effectively treated and the prescription of NSAIDs to children should be done judiciously.

Guy Eslick

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