{
  "abstract": "Functional Gastrointestinal Disorders (FGIDs), now defined as Disorders of Gut–Brain Interaction (DGBI), are increasingly recognised in children and adolescents. 1 These disorders, though long present in society, have only recently been systematically studied, categorised, and managed through structured evidence-based approaches.2 The Rome IV symptom-based criteria have improved diagnostic consistency and clinical research design.3 International data suggest that over 40% of adults and up to 27% of children experience FGIDs, highlighting a significant global health burden.4 With emerging evidence supporting behavioural interventions such as hypnotherapy and cognitive behavioural therapy (CBT), understanding current clinical practice and access to these treatments in paediatric settings is crucial.4 Pharmacological therapy, though supported by limited evidence, remains integral to management, alone or as an adjunct.5 6We aimed to evaluate the prevalence, diagnostic approach, and management of children with DGBI referred to our tertiary centre, alongside assessing clinicians’ access to appropriate support services within the Southwest region. A retrospective review of all DGBI referrals between September 2023 and September 2024 was undertaken. Data collected included demographics, DGBI subtypes, comorbidities, investigations, treatments, and supportive measures. Additionally, an anonymous survey was distributed to regional clinicians to assess awareness, clinical burden, and access to specialist services.Among 579 total referrals, 161 (28%) were diagnosed with DGBI according to Rome IV criteria, comparable to IBD referrals (33%). Most patients were aged between 10–15 years (63%), with a slight female predominance (55%). The most common diagnoses were functional abdominal pain–unspecified (46, 28%), functional constipation (36), irritable bowel syndrome (25), and rumination syndrome (18). Other less frequent presentations included abdominal migraine, functional dyspepsia, functional vomiting, functional nausea, aerophagia, functional dysphagia, and cyclical vomiting syndrome. Twenty-two percent had additional gastrointestinal or non-gastrointestinal diagnoses, and 11% had associated mental health conditions such as anxiety, depression, or chronic fatigue. Seventeen patients were neurodivergent, and one had a learning difficulty. Forty percent underwent specialist investigations, including endoscopy, MRI, or motility studies. Sixty percent received pharmacological therapy, including antispasmodics, PPIs, probiotics, and neuromodulators. Dietary interventions were offered in 14 cases, and supportive measures were offered, including breathing techniques, educational leaflets, hypnosis, or referral to chronic pain and psychology services. However, only nine patients accessed psychological support, and just one received input via school-based services. Ninety-five percent had follow-up appointments.Clinician survey responses (n=25) revealed that nearly half had over ten years of independent practice, and 40% saw more than three DGBI patients monthly. Most expressed the need for tertiary input, citing limited regional access to psychology—70% reported none, and 30% occasional access.Our findings suggest a significant clinical burden of DGBI, comparable to IBD, with substantial variability in diagnostic and management approaches. Access to evidence-based psychological and behavioural therapies remains limited both in secondary and tertiary care. Following this audit, we are implementing strategies to enhance care, including improved psychology access, digital self-help resources, and workshops to support children and families. A larger, nationwide study is warranted to better quantify the burden and improve service provision for paediatric DGBI.References Drossman DA, Hasler WL. Rome IV—functional GI disorders: disorders of gut–brain interaction. Gastroenterol. 2016;150:1257–1261.Drossman DA. Functional Gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterol. 2016;150:1262–1279.Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders: results of the Rome foundation global study. Gastroenterol. 2021;160(1):99–114.Robin SG, Keller C, Zwiener R, et al. Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV criteria. J Pediatr. 2018;195:134–139.Sinopoulou V, Groen J, Gordon M, et al. Efficacy of interventions for the treatment of irritable bowel syndrome, functional abdominal pain—not otherwise specified, and abdominal migraine in children: a systematic review and network meta-analysis. J Pediatr Gastroenterol Nutr. 2025;9(5):315–324.Groen J, Gordon M, Borrelli O, et al. ESPGHAN/NASPGHAN guidelines for treatment of irritable bowel syndrome and functional abdominal pain—not otherwise specified in children aged 4–18 years. J Pediatr Gastroenterol Nutr. 2023;76(4):650–668.",
  "authors": [
    {
      "affiliations": [
        "Bristol Royal Hospital for Children"
      ],
      "name": "Akshatha Mallikarjuna"
    },
    {
      "affiliations": [
        "Bristol Royal Hospital for Children"
      ],
      "name": "Nicholas Clarke"
    }
  ],
  "title": "OC19 Disorders of gut–brain interaction (DGBI) in the Southwest region of the United Kingdom: are we doing enough?",
  "uid": "21fba6b7-7b4f-5cb5-83bc-e7bfa8314014"
}