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Gut-associated lymphadenopathy — Clinical Guidelines

Overview

Disorders of gut-brain interaction (DGBI) encompass a spectrum of gastrointestinal disorders influenced by bidirectional communication between the gut and the brain, often presenting with abdominal pain, altered gut motility, and impaired quality of life 1 2 6.

Diagnosis

Key Diagnostic Criteria: Identification of specific symptoms such as abdominal pain, altered bowel habits, and functional gastrointestinal disorders, often guided by Rome IV criteria 7.

Recommended Tests: Noninvasive tests (e.g., symptom questionnaires) and invasive procedures (e.g., endoscopy) to rule out organic causes 7.

Grading: Diagnostic accuracy varies; multidisciplinary evaluation improves outcomes 7.

Management

First-Line Treatments: Psychosocial interventions, dietary modifications, and neuromodulators (e.g., antispasmodics, tricyclic antidepressants, selective serotonin reuptake inhibitors) 5 10.

Adjunctive Treatments: Multidisciplinary care programs incorporating gastroenterology, psychology, and nutrition 3 10.

Specific Drug Classes: Neuromodulators targeting central and peripheral pain pathways; specific dosing not detailed in abstracts 5.

Special Populations

Pediatrics: Multidisciplinary programs are crucial for managing abdominal pain-related DGBI in children 3.

Comorbidities: Limited training and awareness impact management across all age groups, necessitating specialized training 13 16.

Key Recommendations

Implement multidisciplinary approaches for diagnosis and management of DGBI to improve patient outcomes (Evidence: Moderate 3 10).

Incorporate psychosocial assessments into routine clinical practice to address psychological factors impacting DGBI (Evidence: Moderate 10).

Enhance gastroenterology training curricula to include comprehensive DGBI education and competency-based training (Evidence: Expert opinion 4 13).

References

1 Barr MP, Adetayo T, Evans CT, Wakefield EO, Dimmitt RA, Goodin BR. Experience of Maltreatment Is Associated With Abdominal Pain Intensity and Health-Related Quality of Life in Children With Pain-Predominant Disorders of Gut-Brain Interaction. Neurogastroenterology and motility 2026. link 2 Bassotti G, Lambiase C, Galeazzi F, Bellini M. Neurogastroenterology: The Cinderella among the ecological niches of gastroenterology?. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2025. link 3 Rodrigo M, Chumpitazi BP, Chiappini EA, Brown ML, Wicker Velez S, Kutty S. Characterization of Multidisciplinary Programs for Abdominal Pain-Related Disorders of Gut-Brain Interaction. Clinical pediatrics 2025. link 4 Luo Y, Shah BJ, Vélez C. The Path Forward: Assessing a Pilot Competency-Based Curriculum on Disorders of Gut-Brain Interaction for Gastroenterology Trainees. Neurogastroenterology and motility 2025. link 5 Gómez-Escudero O, Remes-Troche JM, Coss-Adame E, García-Zermeño KR, Aquino-Matus J, Jiménez-Pavón J et al.. Clinical practice recommendations on the use of neuromodulators in gastroenterology: AMG (Asociación Mexicana de Gastroenterología) - AMNM (Asociación Mexicana de Neurogastroenterología y Motilidad) expert joint review. Revista de gastroenterologia de Mexico (English) 2025. link 6 Drug V, Petrea OC, Barboi O, Blaga TS, Dimitriu A, Bancila I et al.. Unveiling the Unseen: Building a Neurogastroenterology Unit - Current Challenges in Clinical Practice. Journal of gastrointestinal and liver diseases : JGLD 2025. link 7 Spatuzzo M, Imondi C, De Angelis P, Civitelli F, Giorgio V, Strisciuglio C et al.. Endoscopy and noninvasive tests in pediatric disorders of gut-brain interaction: A multicenter retrospective study of the Italian Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Journal of pediatric gastroenterology and nutrition 2025. link 8 Nguyen CT, Barrett K, Gupta P, Winstead R. Pharmacological Challenges in Short Gut Syndrome and Pain Management: A Case Series and Review of Literature. Journal of pain & palliative care pharmacotherapy 2025. link 9 Atkins M, Huynh D, Madva EN, Kuo B, Zar-Kessler C, Burton-Murray H et al.. Transitions of care for adolescents with disorders of gut-brain interaction. Journal of pediatric gastroenterology and nutrition 2024. link 10 Ballou S, Vasant DH, Guadagnoli L, Reed B, Chiarioni G, Ten Cate L et al.. A primer for the gastroenterology provider on psychosocial assessment of patients with disorders of gut-brain interaction. Neurogastroenterology and motility 2024. link 11 Larsson A, Ericson U, Jönsson D, Miari M, Athanasiadis P, Baldanzi G et al.. New connections of medication use and polypharmacy with the gut microbiota composition and functional potential in a large population. Scientific reports 2024. link 12 Zhan Q, Wang R, Thakur K, Feng JY, Zhu YY, Zhang JG et al.. Unveiling of dietary and gut-microbiota derived B vitamins: Metabolism patterns and their synergistic functions in gut-brain homeostasis. Critical reviews in food science and nutrition 2024. link 13 Sasegbon A, Luo Y, Keefer LA, Vasant DH. The consequences of limited training in disorders of gut-brain interaction: Results from a national survey of gastroenterology trainees in the United Kingdom. Neurogastroenterology and motility 2023. link 14 Liao X, Lan Y, Wang W, Zhang J, Shao R, Yin Z et al.. Vitamin D influences gut microbiota and acetate production in zebrafish (. Gut microbes 2023. link 15 Aggeletopoulou I, Tsounis EP, Mouzaki A, Triantos C. Exploring the Role of Vitamin D and the Vitamin D Receptor in the Composition of the Gut Microbiota. Frontiers in bioscience (Landmark edition) 2023. link 16 Luo Y, Dixon RE, Shah BJ, Keefer LA. Gastroenterology Trainees' Attitudes and Knowledge towards Patients with Disorders of Gut-Brain Interaction. Neurogastroenterology and motility 2022. link 17 Drossman DA, Chang L, Deutsch JK, Ford AC, Halpert A, Kroenke K et al.. A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology 2021. link 18 Ellis JL, Karl JP, Oliverio AM, Fu X, Soares JW, Wolfe BE et al.. Dietary vitamin K is remodeled by gut microbiota and influences community composition. Gut microbes 2021. link 19 Khine WWT, Zhang Y, Goie GJY, Wong MS, Liong M, Lee YY et al.. Gut microbiome of pre-adolescent children of two ethnicities residing in three distant cities. Scientific reports 2019. link 20 Ningappa M, Higgs BW, Weeks DE, Ashokkumar C, Duerr RH, Sun Q et al.. NOD2 gene polymorphism rs2066844 associates with need for combined liver-intestine transplantation in children with short-gut syndrome. The American journal of gastroenterology 2011. link 21 . Lactobacillus sporogenes. Alternative medicine review : a journal of clinical therapeutic 2002. link 22 Fukatsu K, Kudsk KA, Zarzaur BL, Sabek O, Wilcox HG, Johnson CD. Increased ICAM-1 and beta2 integrin expression in parenterally fed mice after a gut ischemic insult. Shock (Augusta, Ga.) 2002. link 23 Camilleri M. Enteric nervous system disorders: genetic and molecular insights for the neurogastroenterologist. Neurogastroenterology and motility 2001. link 24 Modlin IM, Tang LH. Approaches to the diagnosis of gut neuroendocrine tumors: the last word (today). Gastroenterology 1997. link

Gut-associated lymphadenopathy