Role of Anxiety and Depression on the Interplay Between Disorders of Gut-Brain Interaction and Eating Disorders

Disorders of gut-brain interaction (DGBI) are frequently encountered among patients with eating disorders (ED). Underlying both ED and DGBI may be psychological comorbidities, but it is uncertain how often psychological disorder explains the development of either disorder. We hypothesized a DGBI may predispose to a new onset ED. We aimed to determine the associations and chronological presentation of DGBI, ED, and psychological comorbidities.

Data were collected from a retrospective cohort of n = 1,256,331 patients attending general practices in the UK; 1,018 patients diagnosed with both a DGBI and an ED were included, with 777 also having data on anxiety and/or depression. Timing of order of onset and potential moderators of the sequence of occurrence were considered. Clinical significance level was set at P < 0.01 and odds ratio (OR) ≥ 2.0.

Prevalence of any ED was 0.7%. Chronic constipation was associated with anorexia nervosa (OR = 2.12; 95% confidence interval 1.84-2.45) and any ED (OR = 2.06; 95% confidence interval 1.79-2.36). Irritable bowel syndrome and functional dyspepsia were significantly associated with one or more ED. More patients in primary care were diagnosed with an ED (59.5%, n = 606) preceding a DGBI than vice versa (40.5%, n = 412, P < 0.001). Independent predictors of having a diagnosed DGBI preceding an ED were younger age at first diagnosis of DGBI ( P < 0.001), antecedent depression ( P < 0.003), and antecedent proton pump inhibitor use ( P < 0.001).

Psychological disorders, ED, and DGBI overlap. ED more frequently preceded the onset of a DGBI diagnosis; younger age, antecedent depression, and proton pump inhibitor use were independently associated with a DGBI predicting an ED.