Disorders of Gut–Brain Interaction and Psychological Comorbidity in Singapore: Insights From the Rome IV Global Epidemiology Study

Background/Aims: Disorders of gut-brain interaction (DGBI) affect 40% of the global population, yet data from Asia, including urbanized Singapore, remain limited. We aim to estimate prevalence, characterize psychological comorbidities, and assess burden using Rome IV criteria. Methods: As part of the Rome Foundation Global Epidemiology Study, we conducted a cross-sectional, internet-based survey of 2047 nationally representative Singaporean adults (January-March 2018). The Rome IV Diagnostic Questionnaire identified 22 DGBI; participants with physician-diagnosed organic disease were excluded. Psychological comorbidities were assessed with Patient Health Questionnaire-4 (PHQ-4 [anxiety/depression]) and Patient Health Questionnaire-12 (PHQ-12 [somatization]), and quality of life with Patient-Reported Outcomes Measurement Information System Global-10. Multivariable logistic regression identified factors associated with DGBI and psychological comorbidity. Results: DGBI prevalence was 31.1% (95% CI, 29.1-33.2), lower than the pooled global prevalence (40%). Functional bowel disorders predominated (25.3%), with constipation-related conditions (irritable bowel syndrome with constipation and functional constipation) affecting 9.9%. DGBI were more common in younger adults and women, but not education-related. Participants with multi-region DGBI reported higher somatization and anxiety/depression scores, poorer physical and mental health, and greater healthcare use. Regression showed younger age (per-year OR, 0.978; 95% CI, 0.970-0.986), female sex (OR, 0.667; 95% CI, 0.546-0.813), and higher somatization and anxiety scores independently associated with DGBI. Among those with DGBI, psychological comorbidity was independently associated with female sex, polypharmacy, and multi-region involvement. Conclusions: In Singapore, DGBI are common but less prevalent than global estimates. Constipation-related disorders and psychological comorbidities contribute substantially to symptom burden and healthcare use, particularly in women and younger adults. Findings support integrated, culturally tailored care pathways to guide regional practice and public health policy.