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Bloating and Distention Patients Form 6 Distinct Latent Clusters Based on Symptoms, Diet, Psychosocial, and
Anjali Byale1,2, Olafur S Palsson3,4, Magnus Simrén3,4,5
1Division of Gastroenterology and Hepatology, Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA.
Introduction:
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 modeling in a large multinational survey.
Methods:
A nationwide survey of adults in the United States, United Kingdom, and Mexico used quota sampling for demographic balance. It included Rome IV diagnostic questions, Intestinal Gas Questionnaire, 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 was performed using "depmix" in RStudio 4.2.3.
Results:
A total of 3,471 subjects experiencing bloating and/or distention (mean age 43 years, 57% female) were included. Using 42 demographic and pertinent clinical variables, latent class analysis revealed 6 distinct clusters. The first 2 clusters demonstrated limited-to-moderate impairment in health-related quality of life (HRQoL), with both characterized by some degree of dietary and supplement associations; however, cluster 2 lacked specific triggers observed in other clusters. The subsequent 2 clusters showed favorable HRQoL and mild gas-related symptoms, with only cluster 4 exhibiting distinct dietary triggers. The final 2 clusters, associated with bowel dysfunction, showed a higher prevalence of irritable bowel syndrome (IBS) with constipation and IBS mixed in cluster 5, and IBS with diarrhea in cluster 6. These bowel dysfunction clusters exhibited severe gas symptoms in the preceding 24 hours and greater HRQoL impairment compared with the other 4 clusters. Notably, cluster 5 was linked to dietary triggers, whereas cluster 6 was defined by psychosocial comorbidities.
Discussion:
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.
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