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Meal-Related Symptoms Define Distinct and Clinically Significant Phenotypes in Children With Pain-Related Disorders
Hung-Wen Yeh1, Bruno P Chumpitazi2,3, Miranda A L van Tilburg4,5
1Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA.
Introduction:
Many children with abdominal pain-associated disorders of gut-brain interaction (AP-DGBI) have meal-related symptoms. The aim of the current study was to determine if meal-related symptoms defined specific mutually exclusive subgroups (classes) and, if so, whether these relate to other pathophysiologic factors.
Methods:
Between 2020 and 2022, 289 children with AP-DGBI completed questionnaires evaluating gastrointestinal symptoms, psychosocial variables (e.g., somatization), and health-related quality of life (HRQoL). Latent class analysis (LCA) evaluated symptom patterns using 10 gastrointestinal symptoms, while univariable latent class regression (LCR) analyzed associations with covariates.
Key Results:
Three latent classes emerged: Class 1 (characterized by low meal- and stool-related symptom burden, 35.0%), Class 2 (exhibiting meal-related symptoms, 32.2%), and Class 3 (manifesting meal- and stool-related symptoms, 32.8%). Compared to Class 1, odds of belonging to Class 2 were significantly associated with increasing age, female sex, and lower HRQoL in physical and school functioning. Compared to Class 1, odds of belonging to Class 3 were similarly associated with increasing age, female sex, somatization, and with reduced HRQoL in physical, social, and psychosocial domains. There were no group differences with respect to depression, social stress, or anxiety.
Conclusions And Inferences:
In youth with AP-DGBI, three distinct phenotypic groups are identified. Two of these distinct groups experience meal-related symptoms: one with associated bowel symptoms and the other without. These two meal-related symptom groups are associated with increasing age, female sex, somatization, and reduced HRQoL (particularly physical). These findings underscore the distinctness and importance of identifying the drivers of meal-related symptoms in children with AP-DGBI.
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