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

OBJECTIVE: Patients with Juvenile Fibromyalgia Syndrome (JFS) often report gastrointestinal 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 JFSrelated symptoms (fatigue, headache, morning tiredness, and neuropsychiatric features) were assessed using self-reported measures. Patients completed a questionnaire for gastrointestinal symptoms at each visit, and DGBI diagnoses were established by a paediatric gastroenterologist according to Rome IV criteria. RESULTS: Sixty-three patients (55 females, 87%; mean age at enrolment 16.9 ± 2.6 years) were included, and 219 questionnaires were collected. Forty-eight patients (76%) had at least one DGBI: 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 gastrointestinal symptoms. Body mass index (BMI) 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 (OR 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.