ArticleNeurogastroenterology and motility2026
Development and Validation of the Food Expectation Questionnaire (FEX-Q): An Image-Based Instrument to Assess Food-Related Perceptions and Symptom Expectations.
Article in Neurogastroenterology and motility, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFood-related gastrointestinal (GI) symptoms are highly prevalent in patients with IBS. Although dietary components may trigger symptoms through luminal mechanisms, cognitive expectations may also shape symptom perception within the gut-brain axis. No validated instrument exists to measure food-related symptom expectations. We developed and validated the Food Expectation Questionnaire (FEX-Q).
methodsThe FEX-Q was developed using a stepwise process including patient input, face-to-face validation, and an online validation. The finalized questionnaire presents food images rated on six visual analogue scale items, with food-related GI symptom expectation as the core measure, alongside taste preference, willingness to eat, perceived healthiness, and perceived fat and carbohydrate content. Adults with IBS and non-IBS controls completed the FEX-Q together with validated questionnaires assessing GI symptoms, psychological distress, food-related quality of life, and food avoidance.
resultsFace-to-face validation supported food recognition, item comprehension, and response processes, resulting in the final 44-image version. In the online survey including 134 patients with IBS and 126 non-IBS controls, the FEX-Q demonstrated known-groups validity with higher symptom expectation scores in IBS than in non-IBS controls (50.1 vs. 18.4). Validity of the nutrient-perception items was supported by correlations between perceived and calculated fat (r = 0.78) and carbohydrate content (r = 0.59). Convergent validity was demonstrated through significant associations with GI symptom severity (r = 0.42) and food-related quality of life (r = -0.39). Split-half reliability was high (r = 0.88).
conclusionThe FEX-Q is a promising instrument for assessing food-related symptom expectations and perceptions. It may facilitate future mechanistic research into food-related symptom generation and inform personalized dietary management in IBS.
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