Disorders of Gut–Brain Interaction in Infants

DGBIs encompass a broad spectrum of conditions. Their causes are multifactorial. DGBIs describe a group of disorders that manifest as gastrointestinal symptoms and are associated with various interacting factors, including disturbances in gut motility, heightened sensitivity of the digestive system, changes in the intestinal mucosa, immune system and microbiota, and altered signal processing in the central nervous system (CNS). The role of psychosocial factors, such as stress, is also discussed in the context of communication between the gut and the brain (the gut–brain axis).¹

In early life, both the digestive system and the CNS are still immature and susceptible to disorders, the manifestations of which may be influenced by additional early environmental conditions and may ultimately have a negative impact on quality of life.¹ Given the complexity of the topic, this article focuses on the latest developments relating to the most common gastrointestinal disorders in infancy. Depending on the anatomical site, a distinction is made between DGBIs of the upper and lower gastrointestinal (GI) tract.

Reflux or regurgitation – commonly referred to as burping and spitting-up – is frequent and physiological. As long as infants are growing, thriving and have no additional complications, the occasional passage of gastric contents into the oesophagus, with or without regurgitation and vomiting, is not a cause for concern.² For this reason, regurgitation in healthy infants is no longer listed as a disorder in the Rome V publication.³

Functional constipation affects infants who, over the course of one month, have two or fewer defecations per week, with hard and possibly even painful bowel movements. Other abnormalities in stooling behaviour, such as marked straining or stool withholding, may also occur.⁴ With a prevalence of approximately 20 percent, infantile colic – more recently referred to as “infant distress syndrome”–occurs within the first six months of life.^4,5 In infants aged five months or younger, it is characterised by persistent, recurrent episodes of crying and fussing without an identifiable cause, which cannot be resolved by caregivers.

Education, including information on the self-limiting nature of DGBIs, and support for parents are important components of treatment. Depending on the medical history and clinical diagnosis, treatment should be individualized and may include dietary and, where appropriate, pharmacological measures. In infants who are not, or not exclusively, breastfed, the use of so-called special formulas may be considered–following medical consultation and after exclusion of pathological causes. These formulas are safe and practical and may help provide more rapid relief of symptoms. Their composition is specifically tailored to infants’ needs. Synbiotic comfort formulas containing beta-palmitate and hydrolysate may help regulate digestion and soften stools, while anti-reflux formulas effectively reduce the frequency of reflux.

DGBIs are common in infancy, are highly relevant in clinical practice and often present challenges for affected families. Comprehensive counselling, clear and understandable information, and reassurance for parents play a central role. In infants who are not, or not exclusively, breastfed, a targeted, temporary nutritional intervention may be used to relieve symptoms rapidly and thereby improve quality of life.

References:

¹ Drossman et al. Gastroenterology 2026;170:1083–1098.
² Rosen R et al. JPGN. 2018;66: 516–554.
³ Rosen et al. Gastroenterology 2026;170:1347–1366.
⁴ Di Lorenzo et al. Gastroenterology 2026;170:1367–1387.
⁵ Toca et al. Arch Argent Pediatr 2022;120(5):346–353.