Background Gastrointestinal (GI) complaints are the most common categorical presentations in emergency departments (EDs), accounting for approximately 11% of all ED visits in the United States. Many of these GI emergencies do not involve a structural cause and are presumed to be disorders of the gut-brain interaction (DGBIs). DGBIs such as irritable bowel syndrome, functional constipation, and functional dyspepsia affect approximately 40% of the world’s population and pose a major public health concern. Despite this, little is known about patient characteristics, comorbidities, and outcomes of DGBIs in the ED setting. Consequently, many patients with DGBIs undergo repeat ED visits, testing, and opioid exposure, posing a strain on both the patient and the broader healthcare system.

Methods We conducted a prospective, multi-center observational cohort study at four U.S. hospitals, enrolling adults presenting to the ED who were determined by three independent physicians to have recurrent abdominal pain without clear structural etiology. Participants completed standardized surveys assessing pain severity, psychiatric symptoms, substance use, and social determinants of health. Chart review captured clinical management, diagnostic testing, and health care utilization at the index visit, and at 30 days and 12 months post-visit.

Results Analysis is ongoing, and preliminary results from George Washington University Hospital (GWUH) are provided. A total of 95 participants at GWUH were enrolled. The mean age was 36.29 years, 65.3% were female, and 69.5% identified as Black. Unmet social needs were frequently identified in finances (43.2%), food insecurity (37.9%), and housing (29.5%). Past medical history of anxiety and depression were found in 46.3% and 41.1% of study participants, respectively. Moderate- to high-risk cannabis use was present in 40.0% of the participants. Opioids were administered to 20.0% of eligible patients during their ED visit, and 3.2% were discharged with an opiate prescription. Thirty days following the index visit, 12.6% returned to the ED. At 12 months, 25.3% have had at least one additional ED visit.

Conclusions Adults presenting to the ED with recurrent abdominal pain and no structural cause are predominantly young, female, and from minoritized populations. Comorbidities, including anxiety and depression, are common among eligible patients, as well as food insecurity and financial distress. Repeat ED visits, CT scans, and opioid prescriptions are frequent, yet structural causes are rarely identified. Many eligible patients additionally engage in moderate- to high-risk substance use, particularly with cannabis. Identification of key risk factors may inform targeted interventions to improve outcomes in patients experiencing DGBIs.