Impact of pediatric gastrointestinal disorders on learning and cognitive development in schoolchildren

Schoolchildren nowadays encounter multiple challenges within the teaching process. Learning disabilities (LD) are characterized as complex conditions that affect academic achievement and cognitive performance. LD are typically linked to neurodevelopmental and genetic factors. However, emerging evidence suggests they may be associated with gastrointestinal (GI) pathologies, including celiac disease, inflammatory bowel disease, irritable bowel syndrome, gastroesophageal reflux disease and Helicobacter pylori infection. The aforementioned GI disorders have been (indirectly) linked with a spectrum of outcomes, such as school functioning, attention regulation, fatigue, and broader cognitive and psychosocial development. The gut-brain axis enacts a crucial role in both cognition and behavior. Furthermore, functional GI disorders may also coexist with somatic symptom anxiety, including school refusal and hypervigilance to bodily sensations. A typical paradigm is emetophobia, an intense fear of vomit, which might result in food avoidance, social withdrawal or even academic disengagement. Moreover, iron and vitamin deficiencies, as manifestation of a malabsorption due to GI diseases, might impact concentration and memory. Additionally, sleep disturbances, chronic discomfort and psychological stress could deteriorate cognitive and educational functioning. This work reviews current evidence linking GI health to LD and related neurodevelopmental/psychological outcomes. Timely diagnosis and treatment, targeting both GI and psychological factors, might improve cognitive outcomes and learning potential in schoolchildren with LD. Future studies with longitudinal and interventional designs are warranted, in order to elucidate any causal relationships and to determine whether targeted treatment of GI disorders leads to objective improvement in learning and cognitive outcomes.