Disorders of Gut-Brain Interaction in Juvenile Fibromyalgia Syndrome: Prevalence, Clinical Characteristics, and Management in a Single-Center Cohort Study

Abstract

Objective: Patients with juvenile fibromyalgia syndrome (JFS) often report gastrointestinal (GI) symptoms. Disorders of gut-brain interaction (DGBI) are common in adult fibromyalgia, but data in JFS are limited. We evaluated the prevalence and clinical impact of DGBI in JFS and explored their association with disease severity. Methods: This observational study included patients with JFS followed at the Gaslini Institute between March 2024 and October 2025. At each visit, the Widespread Pain Index (WPI) and JFS-related symptoms (fatigue, headache, morning tiredness, and neuropsychiatric features) were assessed using self-reported measures. Patients completed a questionnaire for GI symptoms at each visit, and DGBI diagnoses were established by a pediatric gastroenterologist according to the Rome IV criteria. Results: Sixty-three patients (55 female, 87%; mean age at enrollment 16.9 [SD 2.6] years) were included, and 219 questionnaires were collected. Forty-eight patients (76%) had ≥ 1 DGBI, which included functional dyspepsia (63%), irritable bowel syndrome (38%), and functional constipation (15%). Thirty-eight percent of patients with JFS reported limitations in daily activities due to GI symptoms. BMI (kg/m 2 ) was significantly lower in patients with DGBI (BMI Z -score 0.0 [IQR −0.6 to 1.8] vs 2.1 [IQR 0.7 to 3.3]; P = 0.01). In multivariate analysis, a higher WPI was independently associated with DGBI (odds ratio 1.19, 95% CI 1.03-1.37; P = 0.02). Conclusion: DGBI are very common in JFS and may significantly affect patients' functional capacity. Their presence is associated with more severe and widespread musculoskeletal pain, underscoring the importance of a multidisciplinary approach in the management of JFS.