Prevalence and Burden of Fatigue Across Disorders of Gut–Brain Interaction: Results From the Rome Foundation Global Epidemiology Study

BACKGROUND: Overlap among disorders of gut-brain interaction (DGBI) is common, with many patients experiencing concomitant non-gastrointestinal symptoms. Fatigue is frequently reported, yet population-based prevalence estimates across DGBI are limited. AIMS: To examine the prevalence and burden of fatigue among DGBI. METHODS: Data were derived from the Rome Foundation Global Epidemiology Study's internet-based survey, conducted in 26 countries using the Rome IV Adult Diagnostic Questionnaire. Fatigue was assessed with single items from the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 and the Patient Health Questionnaire-12 (PHQ-12). Prevalence of fatigue was compared across three groups, including no DGBI, one DGBI and multiple DGBI, with potential associated factors examined using logistic regression. RESULTS: Among 54,127 participants (49% female; mean age 44 years), 59.9% had no DGBI, 26.6% had one DGBI and 13.5% had multiple DGBI. Fatigue prevalence was higher with more DGBI overlap: PROMIS 7.7% (95% CI:7.46-8.04), 16.4% (95% CI: 15.79-17.00), 30.2% (95% CI: 29.16-31.26); PHQ-12 12.6% (95% CI: 12.24-12.96), 25.8% (95% CI: 25.06-26.49), 42.0% (95% CI: 40.83-43.09) for no, one, and multiple DGBI. Fatigue was most common in reflux hypersensitivity (PROMIS 46%, PHQ-12 58%) and irritable bowel syndrome (PROMIS 39%, PHQ-12 53%). Among individuals with DGBI, fatigue was consistently associated across both definitions with female sex, age, BMI, sleep disturbance, higher anxiety and depression scores, greater somatic symptom burden, lower psychological well-being, antidepressant use, and satiety, abdominal pain, and bloating. CONCLUSIONS: Fatigue is common and burdensome in DGBI, particularly with overlapping diagnoses. Given the cross-sectional design, directionality between fatigue and DGBI symptom burden remains unclear. Future research should employ longitudinal fatigue assessments to inform targeted management.