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Petropoulos A, Anesiadou S, Michou M, Lymperatou A, Roma E, Chrousos G, Pervanidou P. Functional Gastrointestinal Symptoms in Children with Autism and ADHD: Profiles of Hair and Salivary Cortisol, Serum Leptin Concentrations and Externalizing/Internalizing Problems. Nutrients 2024; 16:1538. [PMID: 38794776 PMCID: PMC11124526 DOI: 10.3390/nu16101538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Functional Gastrointestinal Disorders (FGIDs) present a higher prevalence in individuals with Neurodevelopmental Disorders (NDDs). The Stress System and the Gut-Brain axis (GBA) may mediate these relations. We aimed to assess the prevalence and profile of FGIDs in a clinical sample of children with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) compared to typically developing children (TD) as well as to investigate possible relations between stress-related biomarkers and internalizing/externalizing problems in children with NDDS. METHODS In total, 120 children, aged between 4 and 12 years old, formed three groups (N = 40, each): ADHD, ASD and TD. Salivary cortisol, hair cortisol and serum leptin were measured. RESULTS The ASD group had more FGID problems than the TD group (p = 0.001). The ADHD and ASD groups had higher total internalizing/externalizing problems than the TD group (p < 0.0001, p < 0.0001, p = 0.005, respectively). Children with FGIDs showed more total, internalizing and externalizing problems compared to children without FGIDs (p < 0.0001, p < 0.0001, p = 0.041, respectively). The ADHD group showed lower AUCg values (p < 0.0001), while the hair cortisol was higher for the TD group (p < 0.0001). CONCLUSION In conclusion, children with NDDs had more FGID symptoms and present higher internalizing and externalizing problems. Children with ADHD and FGIDs had more internalizing problems compared to those without FGIDs. No differences in stress-related biomarkers were shown to differentiate children with NDDs with and without FGIDs. Future prospective studies including a greater number of children may elucidate the biological pathways linking these comorbidities.
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Affiliation(s)
- Andreas Petropoulos
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.P.); (S.A.); (A.L.)
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
| | - Sophia Anesiadou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.P.); (S.A.); (A.L.)
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
| | - Maria Michou
- Human Ecology Laboratory, Department of Home Economics and Ecology, Harokopio University, 17676 Athens, Greece;
| | - Aikaterini Lymperatou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.P.); (S.A.); (A.L.)
- Postgraduate Program “The Science of Stress and Stress Promotion”, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece
| | - Eleftheria Roma
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
| | - George Chrousos
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (A.P.); (S.A.); (A.L.)
- School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (E.R.); (G.C.)
- Postgraduate Program “The Science of Stress and Stress Promotion”, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece
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Peña-Galo EM, Wurzelmann D, Alcedo J, Peña R, Cortes L, Morgan D. Enduring association between irritable bowel syndrome and war trauma during the Nicaragua civil war period: A population-based study. World J Gastroenterol 2023; 29:5953-5961. [PMID: 38130999 PMCID: PMC10731151 DOI: 10.3748/wjg.v29.i45.5953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/13/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Psychosocial and physical trauma are known risk factors for irritable bowel syndrome (IBS), including in war veterans, whereas war exposure in civilians is unclear. Nicaragua experienced two wars, 1970-1990: The Sandinistas Revolution (1970s) and The Contra War (1980s). Our aim was to investigate the role of exposure to war trauma in the subsequent development of IBS in the context of an established health surveillance system (11000 households). AIM To investigate in a civilian population the relationship between exposure to war trauma and events and the subsequent development of IBS in the context of an established public health and demographic surveillance system in western Nicaragua. METHODS We conducted a nested population-based, cross-sectional study focused on functional gastrointestinal disorders based on Rome II criteria. 1617 adults were randomly selected. The Spanish Rome II Modular Questionnaire and Harvard Trauma Questionnaire were validated in Nicaragua. War exposure was assessed with 10 measures of direct and indirect war trauma and post-war effects. Multiple exposures were defined by ≥ 3 measures. RESULTS The prevalence of IBS was 15.2% [Female (F) 17.1%, Male (M) 12.0%], war exposure 19.3% (F 9.3%, M 36.7%), and post-traumatic stress disorder (PTSD) 5.6% (F 6.4%, M 4.3%). Significant associations with IBS in the civilian population were observed (adjusted by gender, age, socioeconomic status, education): physical and psychological abuse [adjusted odds ratio (aOR): 2.25; 95% confidence interval: 1.1-4.5], witnessed execution (aOR: 2.4; 1.1-5.2), family member death (aOR: 2.2; 1.2-4.2), and multiple exposures (aOR: 2.7; 1.4-5.1). PTSD was independently associated with IBS (aOR: 2.6; 1.2-5.7). CONCLUSION An enduring association was observed in the Nicaragua civilian population between specific civil war-related events and subsequent IBS. Civilian populations in regions with extended armed conflict may warrant provider education and targeted interventions for patients.
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Affiliation(s)
- Edgar M Peña-Galo
- Department of Digestive Diseases, Miguel Servet University Hospital, Zaragoza 50009, Aragon, Spain
- Aragon Health Research Institute, IIS Aragon, Zaragoza 50009, Aragon, Spain
| | - Daniel Wurzelmann
- Department of Mental Health, Carolina Partners, Durham, NC 27707, United States
| | - Javier Alcedo
- Department of Digestive Diseases, Miguel Servet University Hospital, Zaragoza 50009, Aragon, Spain
- Aragon Health Research Institute, IIS Aragon, Zaragoza 50009, Aragon, Spain
| | - Rodolfo Peña
- Department of Data Analysis, CIDE (Research, Development and Epidemiology Center), Tegucigalpa 11101, Francisco Morazán, Honduras
| | - Loreto Cortes
- School of Medicine, National Autonomous University of Nicaragua, Leon 21000, Leon, Nicaragua
| | - Douglas Morgan
- Department of Gastroenterology and Hepatology, UAB University of Alabama Birmingham, Birmingham, AL 35233, United States
- School of Medcine, The University of North Carolina, Chapel Hill, NC 9500, United States
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Drossman DA, Tack J. Rome Foundation Clinical Diagnostic Criteria for Disorders of Gut-Brain Interaction. Gastroenterology 2022; 162:675-679. [PMID: 34808139 DOI: 10.1053/j.gastro.2021.11.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Douglas A Drossman
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina; Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, Chapel Hill, North Carolina; Rome Foundation, Raleigh, North Carolina USA
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium; Rome Foundation, Raleigh North Carolina
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Masui D, Nikaki K, Sawada A, Sonmez S, Yazaki E, Sifrim D. Belching in children: Prevalence and association with gastroesophageal reflux disease. Neurogastroenterol Motil 2022; 34:e14194. [PMID: 34190371 DOI: 10.1111/nmo.14194] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/24/2021] [Accepted: 05/13/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Excessive belching is frequently reported in adult patients with gastro-oesophageal reflux disease (GORD) and dyspepsia. Although postprandial gastric belching (GB) is considered a physiological mechanism for gastric venting, supra-gastric belching (SGB) is considered a distinct behavioural disorder. We aimed to define the prevalence of different types of belching and its association with reflux disease in paediatric patients. METHODS We retrospectively analysed reflux monitoring studies from 287 patients (median age: 7.0 years; interquartile range 3.0-11.3 years) with a suspicion of GORD. Based on oesophageal acid exposure time (AET) patients were divided in 3 groups: (a) physiological AET, (b) borderline AET and (c) pathological AET. MII-pH studies were manually edited and reflux disease parameters were measured together with quantification of GB and SGB. KEY RESULTS Two hundred one children (70.0%) had physiological AET (median: 0.8; interquartile range 0.3-1.6), 52 (18.1%) had borderline AET (median: 4.2; interquartile range 3.4-5.3) and 34 (11.9%) had pathologic AET (median: 10.7; interquartile range 9.1-14.2). Gastric belching was observed in all studies. Gastric belching related reflux was more frequently observed in patients with borderline and pathological AET (p < 0.001). This was more common in older children. SGB were observed in only 7 (2.4%) children (age range: 8-17years) in our population and all patients had Physiological AET. Only 3 (1%) patients had pathological number of SGB (>13/24 h). CONCLUSIONS AND INFERENCES Gastric belching related reflux is observed in children with increased AET. SGB is very rare in the paediatric population.
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Affiliation(s)
- Daisuke Masui
- Barts and The London School of Medicine and Dentistry, Upper GI Physiology Unit Royal London Hospital, Wingate Institute of Neurogastroenterology, Blizard Institute, Queen Mary University of London, London, UK.,Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kornilia Nikaki
- Barts and The London School of Medicine and Dentistry, Upper GI Physiology Unit Royal London Hospital, Wingate Institute of Neurogastroenterology, Blizard Institute, Queen Mary University of London, London, UK
| | - Akinari Sawada
- Barts and The London School of Medicine and Dentistry, Upper GI Physiology Unit Royal London Hospital, Wingate Institute of Neurogastroenterology, Blizard Institute, Queen Mary University of London, London, UK.,Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shirley Sonmez
- Barts and The London School of Medicine and Dentistry, Upper GI Physiology Unit Royal London Hospital, Wingate Institute of Neurogastroenterology, Blizard Institute, Queen Mary University of London, London, UK
| | - Etsuro Yazaki
- Barts and The London School of Medicine and Dentistry, Upper GI Physiology Unit Royal London Hospital, Wingate Institute of Neurogastroenterology, Blizard Institute, Queen Mary University of London, London, UK
| | - Daniel Sifrim
- Barts and The London School of Medicine and Dentistry, Upper GI Physiology Unit Royal London Hospital, Wingate Institute of Neurogastroenterology, Blizard Institute, Queen Mary University of London, London, UK
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Functional Abdominal Pain Disorders and Constipation in Children on Gluten-Free Diet. Clin Gastroenterol Hepatol 2021; 19:2551-2558. [PMID: 32890754 DOI: 10.1016/j.cgh.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/06/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We studied the prevalence of functional abdominal pain disorders (FAPDs) and functional constipation (FC) in a large prospective cohort of children with celiac disease on a strict gluten-free diet (GFD). METHODS We performed a prospective cohort study, from 2016 through 2018, in a tertiary care center in Italy, of 417 patients (37% male; mean age, 13.7 y) with a diagnosis of celiac disease (European Society for Paediatric Gastroenterology Hepatology, and Nutrition criteria) who had been on a strict GFD for more than 1 year and had negative results from serologic tests after being on the GFD. Parents and children (>10 y) were asked to fill in a questionnaire on pediatric gastrointestinal symptoms, according to Rome IV criteria. Patients' closest siblings (or cousins) who had negative results from serologic test for celiac disease were used as controls (n = 373; 39% male; mean age, 13.5 y). RESULTS We found a higher prevalence of FAPDs among patients with celiac disease (11.5%) than controls (6.7%) (P < .05); the relative risk (RR) was 1.8 (95% CI, 1.1-3.0). Irritable bowel syndrome (IBS) and FC defined by the Rome IV criteria were more prevalent in patients with celiac disease (7.2% for IBS and 19.9% for FC) than controls (3.2% for IBS and 10.5% for FC) (P < .05 and P < .001, respectively); the RR for IBS was 2.3 (95% CI, 1.1-4.6) and the RR for functional constipation was 2.1 (95% CI, 1.4-3.2). We found no differences in the prevalence of other subtypes of FAPDs. A logistic regression showed that younger age (P < .05) and a higher level of anti-transglutaminase IgA at diagnosis (P < .04) were associated with FAPDs (in particular for IBS) irrespective of GFD duration. CONCLUSIONS Celiac disease is associated with an increased risk of IBS and FC. Strategies are needed to manage IBS and FC in patients with celiac disease.
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Dutta RA, Ely SL, Cunningham NR. The Utility of an Anxiety Screening Measure in Youth With Functional Abdominal Pain Disorders and Clinical Characteristics Associated With Presence of Anxiety. Clin J Pain 2021; 37:616-622. [PMID: 34108362 PMCID: PMC8479873 DOI: 10.1097/ajp.0000000000000952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/23/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Anxiety is common in youth with functional abdominal pain disorders (FAPD) and is related to increased pain-related impairment. However, it is unknown if self-reported anxiety on a clinical screener represents a true anxiety disorder diagnosis in youth with FAPD. Further, little is known about clinical characteristics in youth with FAPD and comorbid anxiety (ANX). Therefore, we evaluated whether the clinical cutoff on the Screen for Anxiety and Related Disorders (SCARED) corresponded with the presence of an anxiety disorder. We predicted a more clinically complex profile (eg, increased pain-related impairment, psychological problems, and family risk factors) in youth with FAPD+ANX compared with youth with FAPD alone. MATERIALS AND METHODS Participants completed measures of anxiety, functional disability, pain intensity, pain catastrophizing, and mood, and underwent a semistructured diagnostic interview to assess for psychological disorders. Caregivers completed family characteristics and caregiver distress measures. Analyses of group differences were conducted using χ2 and multivariate tests. RESULTS The SCARED appears to be a good proxy for an anxiety disorder in youth with FAPD, particularly for generalized anxiety disorder and social anxiety disorder. Youth with FAPD+ANX reported higher rates of pain-related disability and depressive symptoms compared with those with FAPD alone, but other clinical characteristics and family risk factors were comparable across groups. DISCUSSION Findings support the use of the SCARED as a proxy for an anxiety disorder diagnosis in youth with FAPD and suggest youth with FAPD+ANX may have a more complex clinical profile categorized by greater mental health and health-related impairment as compared with youth with FAPD alone.
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Affiliation(s)
- Richa Aggarwal Dutta
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19107
| | - Samantha L. Ely
- Department of Family Medicine, Michigan State University, 15 Michigan Street NE, Grand Rapids, Michigan 49503
| | - Natoshia R. Cunningham
- Department of Family Medicine, Michigan State University, 15 Michigan Street NE, Grand Rapids, Michigan 49503
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Zhong B, Liu Q. Medical Insights from Posts About Irritable Bowel Syndrome by Adolescent Patients and Their Parents: Topic Modeling and Social Network Analysis. J Med Internet Res 2021; 23:e26867. [PMID: 34106078 PMCID: PMC8262600 DOI: 10.2196/26867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/14/2021] [Accepted: 05/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Adolescents with irritable bowel syndrome (IBS) are increasingly seeking and sharing information about their symptoms in web-based health care forums. Their posts and those from their parents contain critical insights that can be used by patients, physicians, and caregivers to manage IBS symptoms. Objective The aim of this study is to examine the posts from adolescent patients and their parents in a health forum, IBS Group, to better understand the key challenges, concerns, and issues of interest to young patients with IBS and their caregivers. Methods Using topic modeling and social network analysis, in this study, we analyzed all the messages (over 750 topics and 3400 replies) posted on the IBS Group forum from 2010-2019 by adolescents with IBS aged 13-17 years and parents having children with IBS. We first detected 6 major topics in the posts by adolescent patients and parents on teenagers’ IBS symptoms and the interaction between the topics. Social network analysis was then performed to gain insights into the nature of web-based interaction patterns among patients and caregivers. Results Using the Latent Dirichlet Allocation algorithm and a latent Dirichlet allocation visualization tool, this study revealed 6 leading topics of concern in adolescents with IBS: school life, treatment or diet, symptoms, boys’ ties to doctors, social or friend issues, and girls’ ties to doctors. The top 6 topics in the parents’ discussions were school life, girls’ issues, boys’ issues, diet choice, symptoms, and stress. The analyses show that the adolescent patients themselves are most concerned about the effect of IBS on their everyday activities and social lives. For parents having daughters with IBS, their top concerns were related to the girls’ school performance and how much help they received at school. For their sons, the parents were more concerned about the pain and suffering that their sons had to endure. Both parents and adolescents gained social support from the web-based platform. Topic modeling shows that IBS affects teenagers the most in the areas of pain and school life. Furthermore, the issues raised by parents suggest that girls are bothered more by school performance over pain, whereas boys show exactly the opposite: pain is of greater concern than school performance. Conclusions This study represents the first attempt to leverage both machine learning approaches and social network analysis to identify top IBS concerns from the perspectives of adolescent patients and caregivers in the same health forum. Young patients with IBS must face the challenges of social influences and anxiety associated with this health disorder in addition to physical pain and other symptoms. Boys and girls are affected differently by pain and school performance and view the IBS impacts differently from the parents.
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Affiliation(s)
- Bu Zhong
- Donald P. Bellisario College of Communications, Pennsylvania State University, University Park, PA, United States
| | - Qian Liu
- School of Journalism and Communication, National Media Experimental Teaching Demonstration Center, Jinan University, Guangzhou, Guangdong Province, China
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Diagnostic Accuracy of the Rome IV Criteria for the Diagnosis of Functional Gastrointestinal Disorders in Children. J Pediatr Gastroenterol Nutr 2021; 72:538-541. [PMID: 33394887 DOI: 10.1097/mpg.0000000000003030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT The diagnosis of functional gastrointestinal disorders (FGIDs) centers on symptoms-based criteria (Rome criteria). The last edition of the criteria was published in 2016. Still, few data on its validity support its use in children. We conducted a study aimed at determining the diagnostic accuracy of the Rome IV criteria through the application of questionnaires (Questionnaire of Pediatric Gastrointestinal Symptoms-Rome IV QPGS-IV) to diagnose FGIDs in children. We hypothesized that the Rome IV criteria has adequate diagnostic accuracy supporting its use for diagnosing FGIDs in children. METHODS School children ages 10 to 18 years from Cali (Colombia) completed the Spanish version of the QPGS-IV. Children with FGIDs were matched with a group of children without FGIDs. Both groups had a medical consultation with a blinded experienced pediatric gastroenterologist (criterion standard) who provided his diagnosis. The questionnaire-based diagnoses were compared with the consultation's diagnoses. RESULTS Of 487 schoolchildren surveyed with the QPGS-IV, 97 (20.8%) had FGIDs. Eighty-nine with FGIDs were matched with 92 children without FGIDs (mean age 13.1 years [±1.3]). We found a higher prevalence of FGIDs during the medical visit than using the self-report QPGS-IV (66.3% vs 49.2%, P = 0.001), mainly in abdominal pain disorders (19.3% vs 10.5%, P = 0.013). The Rome IV diagnostic criteria using the QPGS-IV had a sensitivity of 75% (95% confidence interval, 59-79) and 90% specificity (95% confidence interval, 83-98). Positive predictive value is 85.8%, and negative predictive value is 79.9%. CONCLUSION Our study suggests that the QPGS-IV has adequate diagnostic accuracy.
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Mehta V, Mehta A, Patel S, Irastorza L, Rizvi SA, Abomoelak B, Mehta N, Mehta D. Efficacy of Short Course of Preksha Dhyana for Functional Abdominal Pain Disorder in a Busy Pediatric Clinic. Front Pediatr 2021; 9:646686. [PMID: 34113586 PMCID: PMC8185299 DOI: 10.3389/fped.2021.646686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Mind body techniques such as meditation improve symptoms in children and adults with IBS. Typical courses, however, are lengthy and difficult to administer. We report our experience with a short course of Preksha Dhyana (PD), a child-friendly focused meditation with yoga. Method: Physicians deliver focused meditation while medical assistants taught yoga. Three sessions were administered biweekly with recommendations for daily practice. Pain severity Likert scores were compared with a treatment as usual (TAU) historical control. Anxiety scores were compared from baseline in the PD group. Results: Thirty PD patients aged 9-17 (20 female) and 52 consecutive TAU group aged 5-17 (33 female) were reviewed. The biweekly sessions had high (71%) completion rates. Utilization rates of PD were similar to TAU despite added sessions. The PD group had an average time of follow-up of 8.9 ± 9.4 vs. 6.0 ± 3.9 months in the TAU group (p = 0.522). Changes in pain scores from baseline showed improvement in the PD group, 0.67 ± 0.13 vs. TAU 1.39 ± 0.11 (p = 0.0003). In the PD group, anxiety scores improved significantly from baseline (0.5 vs. 1, P < 0.001). Pain improved in 93% (28/30) and resolved in 47% (14/30). Conclusion: A short course of PD was successfully embedded in a busy pediatric office without additional staffing. The approach proved cost-effective without increasing overall healthcare utilization and showed significant benefits over TAU. Pending RCT confirmation, this offers a cost-effective method to incorporate mind-body techniques into a pediatric office practice.
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Affiliation(s)
- Vijay Mehta
- Department of Pediatric Gastroenterology and Nutrition, Orlando Health-Arnold Palmer Hospital for Children, Orlando, FL, United States
| | - Akshay Mehta
- Department of Pediatric Gastroenterology and Nutrition, Orlando Health-Arnold Palmer Hospital for Children, Orlando, FL, United States
| | - Samit Patel
- Pediatric Gastroenterology and Nutrition of Tampa Bay, Tampa Bay, FL, United States
| | - Laura Irastorza
- Department of Pediatric Gastroenterology and Nutrition, Orlando Health-Arnold Palmer Hospital for Children, Orlando, FL, United States
| | - Syed Ahsan Rizvi
- Department of Pediatric Gastroenterology and Nutrition, Orlando Health-Arnold Palmer Hospital for Children, Orlando, FL, United States
| | - Bassam Abomoelak
- Department of Pediatric Gastroenterology and Nutrition, Orlando Health-Arnold Palmer Hospital for Children, Orlando, FL, United States
| | - Naina Mehta
- Department of Pediatric Neurology, Orlando Health-Arnold Palmer Hospital for Children, Orlando, FL, United States
| | - Devendra Mehta
- Department of Pediatric Gastroenterology and Nutrition, Orlando Health-Arnold Palmer Hospital for Children, Orlando, FL, United States
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Singh M, Singh V, Schurman JV, Colombo JM, Friesen CA. The relationship between mucosal inflammatory cells, specific symptoms, and psychological functioning in youth with irritable bowel syndrome. Sci Rep 2020; 10:11988. [PMID: 32686762 PMCID: PMC7371888 DOI: 10.1038/s41598-020-68961-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/29/2020] [Indexed: 12/11/2022] Open
Abstract
Both mucosal inflammation and psychologic dysfunction have been implicated in irritable bowel syndrome (IBS). While some relationships between inflammation (mast cells and eosinophils) and depression have been reported in adults with IBS, relationships between inflammation and psychologic function have not been studied in children and adolescents. The aims of the current study were to: (1) assess densities of colonic mast cells, eosinophils, and TH17 cells in youth with IBS; and, (2) explore relationships between these cells and specific IBS symptoms and psychologic functioning. Utilizing previously obtained biopsies from the descending and rectosigmoid colons, densities were determined for mast cells, eosinophils, and TH17 cells, respectively, in 37 youth with IBS and 10 controls. In IBS patients, densities were assessed in relation to specific IBS symptoms and in relation to self-report anxiety and depression scores. In both the descending and rectosigmoid colons, densities of mast cells, eosinophils, and TH17 cells were higher in IBS patients as compared to controls. In IBS patients, rectosigmoid mast cell density was higher in those reporting pain relief with defecation. Also, in IBS patients, rectosigmoid eosinophilia was associated with higher anxiety scores and eosinophil density correlated with depression scores. In the descending colon, eosinophil and mast cell densities both correlated with depression scores. In conclusion, mucosal inflammation (mast cells and eosinophils) is associated with pain relief with defecation and with anxiety and depression in youth with IBS.
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Affiliation(s)
- Meenal Singh
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Vivekanand Singh
- Department of Pathology, The University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
| | - Jennifer V Schurman
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Jennifer M Colombo
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Craig A Friesen
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Tosto M, D’Andrea P, Salamone I, Pellegrino S, Costa S, Lucanto MC, Pallio S, Magazzu’ G, Guandalini S. Functional constipation masked as irritable bowel syndrome. BMC Gastroenterol 2020; 20:86. [PMID: 32252644 PMCID: PMC7132980 DOI: 10.1186/s12876-020-01244-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/27/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Rome IV criteria for functional gastrointestinal disorders state that children suspected of having Irritable Bowel Syndrome (IBS) with Constipation (IBS-C) should be preliminarily treated for constipation. We aimed at verifying if functional constipation may indeed lead to an erroneous diagnosis of IBS with diarrhea (IBS-D) or IBS with mixed pattern of diarrhea and constipation (IBS-M). METHODS We prospectively enrolled in an unblinded fashion 10 and 16 consecutive children referred to our center who met Rome IV criteria for a diagnosis of IBS-D and IBS-M, respectively. Patients who fulfilled criteria for suspect "occult constipation" were then given a bowel cleaning regimen with Polyethylene glycol 3350, re-evaluated at 2 months and followed up for at least 6 months. Sixteen additional patients with IBS with Constipation (IBS-C) referred in the same period served as control. The endpoints were: 1) a decrease of more than 50% in abdominal pain intensity and frequency scores; and 2) for patients with IBS-D and IBS-M: resolution of diarrhea. RESULTS The endpoints were met by 8 (80%) and 14 (87%) of the patients with IBS-D and IBS-M, respectively, with decrease of abdominal pain and resolution of "diarrhea". The response was not significantly different from that observed in 15 (93%) of the IBS-C control group. CONCLUSION Acknowledging the limitations of the small number of patients and of the uncontrolled nature of the study, we suggest that a possibly large number of patients labeled as IBS-D or IBS-M may actually simply present functional constipation and should be managed as such.
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Affiliation(s)
- Monica Tosto
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | | | - Ignazio Salamone
- Oncological Radiology Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino Hospital, University of Messina, Messina, Italy
| | - Salvatore Pellegrino
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Stefano Costa
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Maria Cristina Lucanto
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Socrate Pallio
- Digestive Diseases Endoscopy Unit, Policlinico G. Martino Hospital, University of Messina, Messina, Italy
| | - Giuseppe Magazzu’
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Policlinico G. Martino Hospital, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
- Adult and Pediatric Pathology Department G. Barresi, University of Messina, Messina, Italy
| | - Stefano Guandalini
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, USA
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Mediterranean Diet Adherence is Associated with Lower Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents. Nutrients 2019; 11:nu11061283. [PMID: 31174310 PMCID: PMC6628326 DOI: 10.3390/nu11061283] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022] Open
Abstract
Dietary patterns may have a role in the prevention of functional gastrointestinal disorders (FGIDs). The current study aimed at examining the association between FGIDs and adherence to the Mediterranean diet (MD) among elementary school children (ESC), as well as high school students (HSS). In a prospective cohort study, data from 1116 subjects (387 ESC and 448 HSS) aged 6–18 years were collected. FGID identification was based on the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-RIII). Adherence to the MD was assessed using the KIDMED Index. Full data were available on 835/1116 questionnaires. Based on Rome III criteria, 184/835 participants (22%) were identified with FGID (122 (66%) with functional constipation (FC)). The prevalence of FGIDs (p = 0.001) was significantly higher in HSS (13–18 years). The KIDMED score in the cohort was 5.7 ± 2.5. Subjects with FGIDs demonstrated a lower KIDMED score compared to the non-FGID group, both in the cohort, as well as in the ESC and HSS subgroups (FGID vs. non-FGID: p = 0.001, p = 0.007, and p = 0.032, respectively). Multivariate analysis highlighted the KIDMED score as a significant predictor of FGIDs and FC after controlling for the age subgroups. We conclude that good adherence to the MD is associated to lower prevalence of FGIDs, while adolescents display a significantly higher prevalence of FGIDs compared to children.
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13
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Eltorki M, Bhattacharjee A, Khan M, Martin E, Shyleyko R, Freedman SB. Treatment failure in children diagnosed with constipation in a paediatric emergency department in relation to Rome III criteria. Paediatr Child Health 2019; 24:185-192. [PMID: 31110460 DOI: 10.1093/pch/pxy121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/29/2018] [Indexed: 11/14/2022] Open
Abstract
Objective To determine if treatment failure varies based on ROME III classification and adherence to guideline congruent therapy among children diagnosed in an emergency department with functional constipation. Methods Children aged 1 month to 18 years who were diagnosed with constipation in a paediatric emergency department underwent chart review and 7-day phone follow-up to complete the ROME III questionnaire, confirm treatments administered, and assess treatment failure. Participants were classified according to the ROME III criteria as having functional constipation (FC) or irritable bowel syndrome - constipation (IBS-C) subtype. The primary outcome was treatment failure defined as ≥ 2 of the following: 1) presenting symptom persistence; 2) < 1 bowel movement every other day; 3) pain/difficulty passing stools; and 4) abdominal pain between bowel movements. Results Five hundred and thirteen children completed follow-up; 40% (204/513) had FC, 23% (118/513) IBS-C, and 37% (191/513) did not meet either criteria. Treatment failure rates in children who received guideline congruent treatment were 28% (38/135) among those classified as FC and 43% (37/86) among those with IBS-C; P=0.02, a difference of 15% (95% confidence interval [CI]: 0.02, 0.27). On regression analysis, ROME III classification was not an independent predictor of treatment failure (odds ratio [OR]: 1.56 [95% CI: 0.97, 2.51]). At 7-day follow up, pain in between bowel movements was present in 22% (44/204) in FC patients versus 45% (53/118) of IBS-C patients; P=0.001. Conclusions Treatment failure rates in children who receive guideline congruent therapy are higher among those with IBS-C, however, after adjustment for known confounders the relationship was not statistically significant.
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Affiliation(s)
- Mohamed Eltorki
- Division of Pediatric Emergency Medicine, McMaster Children's Hospital, McMaster University, Hamilton, Ontario
| | - Amrita Bhattacharjee
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Maida Khan
- Faculty of Nursing, University of Calgary, Calgary, Alberta
| | - Elise Martin
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Robert Shyleyko
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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14
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Zvizdic Z, Jonuzi A, Djuran A, Vranic S. Gastric Necrosis and Perforation Following Massive Gastric Dilatation in an Adolescent Girl: A Rare Cause of Acute Abdomen. Front Surg 2019; 6:3. [PMID: 30761307 PMCID: PMC6363666 DOI: 10.3389/fsurg.2019.00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/14/2019] [Indexed: 01/30/2023] Open
Abstract
Gastric necrosis with perforation is a rare and potentially life-threatening condition in childhood beyond the neonatal period. We report a case of gastric necrosis and perforation of a portion of the great curvature due to a massive gastric dilatation caused by pathological aerophagia in a 13-years-old, mentally impaired adolescent girl. Despite the successful surgical treatment, the patient's condition rapidly deteriorated post-operatively and she died due to the multisystem organ failure and multiple infections. In addition, we surveyed the literature on this rare condition and assessed the preventive actions to reduce this life-treating condition.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Aleksandra Djuran
- Department of Pathology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, Qatar University, Doha, Qatar
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15
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Cunningham NR, Moorman E, Brown CM, Mallon D, Chundi PK, Mara CA, Pentiuk S, Lynch-Jordan AM, Dykes DMH, Elfers J, Farrell MK. Integrating Psychological Screening Into Medical Care for Youth With Abdominal Pain. Pediatrics 2018; 142:peds.2017-2876. [PMID: 30045930 DOI: 10.1542/peds.2017-2876] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pediatric functional abdominal pain disorders are common, costly, and disabling. Clinical anxiety is highly prevalent and is associated with increased pain and functional disability. Thus, a psychological screening process is recommended but is infrequently used in current practice. METHODS A screening process for patient-reported anxiety (Screen for Child Anxiety and Related Disorders), functional disability (Functional Disability Inventory), and pain levels was implemented in a large gastroenterology division within a major medical center. Quality improvement methods and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients ages 8 to 18 with abdominal pain. RESULTS Screening rates increased from <1% to >80%. A total of 1291 patients who reported having abdominal pain completed the screening during the first 6 months. Clinically significant anxiety (43.1%), at least moderate disability (45%), and elevated pain (61.5%) were common in children with abdominal pain. The presence of clinically significant anxiety corresponded with higher pain and pain-related disability. Twenty-one percent of youth had clinical elevations in all 3 areas. In such instances, medical providers received an automated prompt to tailor care, including to consider a psychological referral. After the project implementation, psychological referral rates increased from 8.3 per 1000 patients to 15.2 per 1000 patients. CONCLUSIONS Systematic screening for anxiety, pain, and pain-related disability as a routine part of medical care can be reliably implemented with clinically meaningful results. Future directions include examining the role of anxiety over the long-term and reducing clinician burden.
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Affiliation(s)
- Natoshia R Cunningham
- Divisions of Behavioral Medicine and Clinical Psychology, .,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Erin Moorman
- Divisions of Behavioral Medicine and Clinical Psychology
| | - Courtney M Brown
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,General and Community Pediatrics, and.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Daniel Mallon
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Gastroenterology, Hepatology and Nutrition, and
| | - Pavan K Chundi
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Constance A Mara
- Divisions of Behavioral Medicine and Clinical Psychology.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Scott Pentiuk
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Gastroenterology, Hepatology and Nutrition, and
| | - Anne M Lynch-Jordan
- Divisions of Behavioral Medicine and Clinical Psychology.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Dana M H Dykes
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Gastroenterology, Hepatology and Nutrition, and
| | | | - Michael K Farrell
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Gastroenterology, Hepatology and Nutrition, and
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16
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Sudha MR, Jayanthi N, Aasin M, Dhanashri R, Anirudh T. Efficacy of Bacillus coagulans Unique IS2 in treatment of irritable bowel syndrome in children: a double blind, randomised placebo controlled study. Benef Microbes 2018; 9:563-572. [DOI: 10.3920/bm2017.0129] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The efficacy of the probiotic strain, Bacillus coagulans Unique IS2 in the treatment of Irritable Bowel Syndrome (IBS) was evaluated in children. A total of 141 children of either sex in the age group 4-12 years, diagnosed with IBS according to the Rome III criteria, participated in the double-blind randomised controlled trial. Children received either B. coagulans Unique IS2 chewable tablets or placebo once daily for eight weeks followed by a two week follow-up period. Reduction in pain intensity as well as other symptoms associated with Irritable Bowel Syndrome like abdominal discomfort, bloating, distension, sense of incomplete evacuation, straining at stool, urgency of bowel movement, passage of gas and mucus, and bowel habit satisfaction were assessed. B. coagulans Unique IS2 treated group showed a greater reduction in pain scores as evaluated by a weekly pain intensity scale. There was a significant reduction (P<0.0001) in pain intensity in the probiotic treated group (7.6±0.98) as compared to the placebo group (4.2±1.41) by the end of the treatment period (8 weeks). There was also a significant improvement in stool consistency as well as reduction in abdominal discomfort, bloating, staining, urgency, incomplete evacuation and passage of gas. Bowel habit satisfaction and global assessment of relief was also observed in the B. coagulans Unique IS2 treated group as compared to the placebo group. This study demonstrates the efficacy of B. coagulans Unique IS2 in reducing the symptoms of Irritable Bowel Syndrome in children in the age group of 4-12 years.
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Affiliation(s)
- M. Ratna Sudha
- Centre for Research & Development, Unique Biotech Ltd., Plot No. 2, Phase-II, Alexandria Knowledge Park, Hyderabad, Telangana 500078, India
| | - N. Jayanthi
- Centre for Research & Development, Unique Biotech Ltd., Plot No. 2, Phase-II, Alexandria Knowledge Park, Hyderabad, Telangana 500078, India
| | - M. Aasin
- Integrity Healthcare Services, Kailas Business Park, Vikhroli, Mumbai 400079, India
| | - R.D. Dhanashri
- Angel Child Care, S Mistry Road, Antop Hill, Mumbai 400037, India
| | - T. Anirudh
- Life Veda Treatment and Research Centre, Pandurang Budhkar Marg, Worli, Mumbai 400030, India
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Demographic and Clinical Correlates of Mucosal Disaccharidase Deficiencies in Children With Functional Dyspepsia. J Pediatr Gastroenterol Nutr 2018; 66 Suppl 3:S52-S55. [PMID: 29762379 PMCID: PMC5957288 DOI: 10.1097/mpg.0000000000001859] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A subset of children with functional gastrointestinal disorders (FGIDs), which includes functional dyspepsia, may have duodenal disaccharidase deficiencies. OBJECTIVES To determine the frequency, demographics, and clinical characteristics associated with duodenal disaccharidase deficiencies in children with functional dyspepsia. METHODS Children ages 4 to 18 years undergoing esophagogastroduodenoscopy (EGD) evaluation for dyspepsia were enrolled in either a retrospective (study 1) or prospective (study 2) evaluation. Those with histologic abnormalities were excluded. Duodenal biopsies were obtained for disaccharidase enzyme analysis. In the retrospective study, both demographic and clinical characteristics were obtained via chart review. In the prospective study, parents completed the Rome II Questionnaire on Gastrointestinal Symptoms before the EGD. RESULTS One hundred and twenty-nine children (n = 101, study 1; n = 28, study 2) were included. Mean age was 11.2 ± 3.8 (SD) years in study 1 and 10.6 ± 3.2 years in study 2. Forty-eight (47.5%) of subjects in study 1 and 13 (46.4%) of subjects in study 2 had at least 1 disaccharidase deficiency identified. All of those with a disaccharidase deficiency in both studies had lactase deficiency with 8 (7.9%) and 5 (17.9%) of those in studies 1 and 2, respectively, having an additional disaccharidase deficiency. The second most common disaccharidase deficiency pattern was that of pan-disaccharidase deficiency (PDD) in both studies. In study 1 (where both race and ethnicity were captured), self-identified Hispanic (vs non-Hispanic, P < 0.05) and non-white (vs white, P < 0.01) children were more likely to have lactase deficiency. Age, sex, and type of gastrointestinal symptom were not associated with presence or absence of a disaccharidase deficiency. CONCLUSIONS Approximately half of children with functional dyspepsia undergoing EGD were identified as having a disaccharidase deficiency (predominantly lactase deficiency). Race/ethnicity may be associated with the likelihood of identifying a disaccharidase deficiency. Other clinical characteristics were not able to distinguish those with versus without a disaccharidase deficiency.
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18
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Di Nardo G, Cremon C, Frediani S, Lucarelli S, Villa MP, Stanghellini V, La Torre G, Martemucci L, Barbara G. Allergic Proctocolitis Is a Risk Factor for Functional Gastrointestinal Disorders in Children. J Pediatr 2018; 195:128-133.e1. [PMID: 29352590 DOI: 10.1016/j.jpeds.2017.10.073] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/23/2017] [Accepted: 10/30/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To test the hypothesis that allergic proctocolitis, a cause of self-limiting rectal bleeding in infants, can predispose to the development of functional gastrointestinal disorders (FGIDs) later in childhood. STUDY DESIGN We studied a cohort of 80 consecutive patients diagnosed with allergic proctocolitis. Their sibling or matched children presenting to the same hospital for minor trauma served as controls. Parents of the patients with allergic proctocolitis and controls participated in a telephone interview every 12 months until the child was at least 4 years old. At that time, they were asked to complete the parental Questionnaire on Pediatric Gastrointestinal Symptoms, Rome III version. RESULTS Sixteen of the 160 subjects (10.0%) included in the study met the Rome III criteria for FGIDs. Among the 80 patients with allergic proctocolitis, 12 (15.0%) reported FGIDs, compared with 4 of 80 (5.0%) controls (P = .035). After adjustment for age and sex, the OR for FGIDs in allergic proctocolitis group was 4.39 (95% CI, 1.03-18.68). FGIDs were significantly associated with iron deficiency anemia, duration of hematochezia, and younger age at presentation. In a multivariate analysis, only the duration of hematochezia was significantly associated with the development of FGIDs (OR, 3.14; 95% CI,1.72-5.74). CONCLUSIONS We have identified allergic proctocolitis as a new risk factor for the development of FGIDs in children. Our data suggest that not only infection, but also a transient early-life allergic inflammatory trigger may induce persistent digestive symptoms, supporting the existence of "postinflammatory" FGIDs.
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Affiliation(s)
- Giovanni Di Nardo
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy; Pediatric Gastroenterology Unit, International Hospital Salvator Mundi, Rome, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Simone Frediani
- Pediatric Gastroenterology Unit, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Sandra Lucarelli
- Pediatric Gastroenterology Unit, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Maria Pia Villa
- Pediatric Unit, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Vincenzo Stanghellini
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luigi Martemucci
- Pediatric Gastroenterology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
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Edwards T, Friesen C, Schurman JV. Classification of pediatric functional gastrointestinal disorders related to abdominal pain using Rome III vs. Rome IV criterions. BMC Gastroenterol 2018; 18:41. [PMID: 29549882 PMCID: PMC5857312 DOI: 10.1186/s12876-018-0769-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The primary purpose of this study was to compare Rome III and IV evaluation criteria for irritable bowel syndrome (IBS), functional dyspepsia (FD), and an overlap syndrome consisting of both IBS and FD by assessing the frequency of each diagnosis in a population of children with chronic abdominal pain. Frequencies of Rome IV FD subtypes of postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) were determined and FD/IBS overlap symptom associations were also assessed. METHODS We conducted a cross-sectional retrospective chart review of 106 pediatric patients who had completed standardized medical histories as part of their evaluation for chronic abdominal pain. The patients ranged from eight to 17 years of age and reported having abdominal pain at least weekly for 8 weeks. Patients whose evaluation revealed gastrointestinal disease were excluded. The patients' diagnoses were determined by a single pediatric gastroenterologist utilizing the specific criteria for Rome III and IV, respectively. RESULTS Patients were significantly more likely to be diagnosed with FD (84.9% vs. 52.8%), IBS (69.8% vs. 34%), and FD/IBS overlap (58.5% vs. 17.9%) by Rome IV criteria, as compared to Rome III criteria. With regard to Rome IV FD subtypes, 81.1% fulfilled criteria for PDS, 11.1% fulfilled criteria for EPS, 6.7% fulfilled criteria for both, and 1.1% did not fulfill criteria for either. Finally, we found an increased frequency of diarrhea and pain with eating in the overlap group compared to the non-overlap group of Rome III, while only an increased frequency of diarrhea was found in the overlap group compared to the non-overlap group of Rome IV. CONCLUSIONS Our data demonstrate that utilizing Rome IV criteria, as compared to Rome III, results in an increase in the diagnosis of FD, a two-fold increase in the diagnosis of IBS, and a three-fold increase in the diagnosis of FD/IBS overlap. Rome IV criteria appears to result in greater heterogeneity within diagnostic categories. It is important to determine whether Rome IV diagnoses are predictive of treatment response, and if so, whether assessing symptom variability within a diagnosis will enhance the ability to select patients for a particular treatment.
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Affiliation(s)
- Trent Edwards
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Craig Friesen
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
| | - Jennifer V. Schurman
- Division of Developmental and Behavioral Sciences, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
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20
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Schurman JV, Karazsia BT, Friesen CA. Examination of competing diagnostic models of functional gastrointestinal disorders related to pain in children. Neurogastroenterol Motil 2017; 29. [PMID: 28656703 DOI: 10.1111/nmo.13126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There have been no empirical validations of the Rome III or Rome IV criteria in children. The aim of the current study was to examine whether symptoms naturally occur in a pattern consistent with Rome III and/or Rome IV pediatric criteria for functional dyspepsia (FD) and irritable bowel syndrome (IBS). METHODS We conducted a retrospective cohort study of 250 children, ages 8-17 years, presenting to an abdominal pain clinic with pain of at least 8 weeks duration. We evaluated patterns of gastrointestinal (GI) and non-gastrointestinal (non-GI) symptoms which had been collected in a standardized fashion as part of routine clinical care. Confirmatory factor analyses were used to compare pre-existing models of symptoms clusters, namely Rome III and Rome IV criteria for IBS and FD in children and adolescents. Factor intercorrelations also were examined to determine whether IBS symptoms and non-GI somatic complaints correlate uniquely with FD symptom clusters. KEY RESULTS Both models demonstrated good fit with observed data [3-factor: χ2 (101, n=250)110.75, P<.05, TLI=.99, CFI=.99; 4-factor: χ2 (98, n=250)117.54, P<.05, TLI=.96, CFI=.97]. Fit indices and intercorrelations favored the more parsimonious 3-factor solution (3-factor: AIC=4654.91, BIC=4778.17; 4-factor: AIC=4757.16, BIC=4890.97) consistent with pediatric Rome III criteria that conceptualizes FD as a single diagnostic category. FD demonstrated significant overlap with IBS (.42), while non-GI-specific symptoms correlated significantly with FD (.64), but not IBS (.14) symptoms. CONCLUSIONS & INFERENCES GI symptoms in children presenting for initial evaluation of chronic functional abdominal pain occur in a pattern consistent with Rome III and IV pediatric criteria. Rome III offers a more parsimonious model. The presence of FD symptoms is strongly, and uniquely, associated with non-GI symptoms.
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Affiliation(s)
- J V Schurman
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas, MO, 64108, USA
| | - B T Karazsia
- Department of Psychology, 930 College Mall, The College of Wooster, Wooster, OH, 44691, USA
| | - C A Friesen
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, 64108, USA
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Prevalence and Impact of Functional Abdominal Pain Disorders in Children With Inflammatory Bowel Diseases (IBD-FAPD). J Pediatr Gastroenterol Nutr 2017; 65:212-217. [PMID: 27906801 DOI: 10.1097/mpg.0000000000001479] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We sought to describe the prevalence of the overlap of functional abdominal pain disorders (FAPDs) in children with inflammatory bowel diseases (IBDs), a condition we have designated as IBD-FAPD. We also aimed to describe the psychological profile of this group, and to assess predictors of disease and the impact of IBD-FAPD on quality of life. METHODS This cross-sectional prospective study included patients ages 8 to 18 years with a diagnosis of IBD. Disease activity was assessed by physician's global assessment, laboratory studies, and abbreviated Pediatric Crohn's Disease Activity Index or Pediatric Ulcerative Colitis Activity Index scoring. Age-appropriate validated questionnaires were used to diagnose FAPDs according to the Rome III criteria, depression, anxiety symptoms, and quality of life. RESULTS There were 128 patients recruited. Eighty-one (63%) completed questionnaires (36 girls; 45 boys; mean age 14.4 ± 2.6 years) (62 Crohn disease, 19 ulcerative colitis). The prevalence of IBD-FAPD in clinical remission was 26% (17 Crohn disease, 4 ulcerative colitis; 95% confidence interval: 20.6%-79.4%), with significantly more girls having IBD-FAPD (P = 0.038). Anxiety symptoms were in 14.3% of patients with IBD-FAPD (P = 0.06) and depression in 23.8% (P = 0.006). The average Pediatric Quality of Life Inventory Gastrointestinal Symptoms score for the IBD-FAPD group was significantly lower than those without FAPDs (71 vs 86.5, P = 0.008). CONCLUSIONS In our cohort, the prevalence of IBD-FAPD was 26%. This is the first study to assess all FAPDs using the Rome III criteria and to demonstrate increased anxiety, depression, and worse quality of life in children with IBD-FAPD. The identification of patients predisposed to IBD-FAPD may allow implementing strategies that could improve symptoms and quality of life.
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Boronat AC, Ferreira-Maia AP, Matijasevich A, Wang YP. Epidemiology of functional gastrointestinal disorders in children and adolescents: A systematic review. World J Gastroenterol 2017; 23:3915-3927. [PMID: 28638232 PMCID: PMC5467078 DOI: 10.3748/wjg.v23.i21.3915] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the prevalence of functional gastrointestinal disorders (FGIDs) in children and adolescents.
METHODS PubMed, EMBASE, and Scopus databases were searched for original articles from inception to September 2016. The literature search was made in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For inclusion, each study had to report epidemiological data on FGIDs in children between 4 and 18 years old and contain standardized outcome based on Rome II, III or IV criteria. The overall quality of included epidemiological studies was evaluated in accordance with Loney’s proposal for prevalence studies of health literature. Two reviewers assessed each study for data inclusion and extraction. Discrepancies were reconciled through discussion with seniors.
RESULTS A total of 659 articles were identified from the databases and 16 through manual search. A total of 43 articles fulfilled the eligibility criteria for full-text reading, with 26 remaining to be included in the final analysis. All studies were written in English and published between 2005 and 2016. Eight (30.8%) articles were performed in North America, five (19.2%) in Latin America, five (19.2%) in Europe, seven (27%) in Asia, and one (3.8%) in Africa. Sample size varied between 114 and 99416 subjects, totaling 132600 individuals. Fourteen (53.9%) studies recruited their target samples from schools, 11 (42.3%) from healthcare settings and the remaining one (3.8%) from online panel community. The overall FGID prevalence rates for student samples ranged from 9.9% to 29% to as high as 87% in clinical samples. Cyclic vomiting, irritable bowel syndrome and functional constipation were the most researched conditions, with a prevalence ranging from 0.2% to 6.2%, 0% to 45.1% and 0.5% to 86.9%, respectively. The qualitative appraisal revealed that most of the studies showed average or below average generalizability.
CONCLUSION The heterogeneity of the studies on FGIDs must be improved in order to allow comparison. Improvements should include appropriate sampling of representative population, comparable study setting, and consistent data collection.
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Childhood Bladder and Bowel Dysfunction Questionnaire: Development, Feasibility, and Aspects of Validity and Reliability. J Pediatr Gastroenterol Nutr 2017; 64:911-917. [PMID: 28248210 DOI: 10.1097/mpg.0000000000001461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was to develop a questionnaire evaluating the frequency of symptoms over time of concomitant childhood bladder and bowel dysfunctions (CBBDs) in 5- to 12-year-old children and to assess its feasibility and aspects of validity and reliability. METHODS The Childhood Bladder and Bowel Dysfunction Questionnaire (CBBDQ) was developed in phases according to COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) in cooperation with epidemiologists, pediatricians, physiotherapists (phases 1 and 5), and professional translators (phase 5): selection of items (Delphi-method), content validity (pilot), feasibility (interviews), structural validity and internal consistency (field testing), and guideline-based translation (Dutch-English). Participants were parents of children, ages 5 to 12 years (phases 2-4). RESULTS Parents of 1333 children (mean age 7.8 years [standard deviation 2.1]) were included. Most common were urinary incontinence (35.9%), enuresis (29.7%), and constipation/fecal incontinence (30.1%). Concomitant CBBD was seen in 74.2% of 1229 children. Originally, a 27-item CBBDQ was developed. After the pilot (48 parents) a 23-item version remained for evaluation of feasibility aspects by interviewing 56 parents. Based on 1229 completed questionnaires during field testing, the CBBDQ reduced to 18 items. Cronbach α values were 0.74 and 0.71 for bladder and bowel subscales, respectively. Feasibility and aspects of validity and reliability were satisfactory. A definitive and accepted English version of the CBBDQ is available. CONCLUSIONS When completed by parents, the 18-item evaluative CBBDQ appears feasible, content, and structurally valid with good internal consistency for the bladder and bowel subscales. The Dutch and English versions will be introduced clinically and subjected to further psychometric evaluation.
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Saps M, van Tilburg MAL, Lavigne JV, Miranda A, Benninga MA, Taminiau JA, Di Lorenzo C. Recommendations for pharmacological clinical trials in children with irritable bowel syndrome: the Rome foundation pediatric subcommittee on clinical trials. Neurogastroenterol Motil 2016; 28:1619-1631. [PMID: 27477090 DOI: 10.1111/nmo.12896] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/30/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is little published evidence of efficacy for the most commonly used treatments. Thus, there is an urgent need to conduct clinical trials on existing and novel therapies. PURPOSE In order to address these issues the Rome Foundation and members of the Pediatric Committee of the European Medicines Agency formed a subcommittee on clinical trials to develop guidelines for the design of clinical trials in children with irritable bowel syndrome (IBS). The following recommendations are based on evidence from published data when available and expert opinion. KEY RECOMMENDATIONS The subcommittee recommends randomized, double-blind, placebo-controlled, parallel-group, clinical trials to assess the efficacy of new drugs. The combined endpoints for abdominal pain are a decrease in intensity of at least 30% compared with baseline and to meet or exceed the Reliable Change Index (RCI) for the sample. Stool consistency is measured with the Bristol Stool Scale Form (BSFS). The subcommittee recommends as entry criteria for abdominal pain a weekly average of worst abdominal pain in past 24 h of at least 3.0 on a 0-10 point scale or at least 30 mm in 100 mm Visual Analog Scale. For stool endpoints the committee recommends an average stool consistency lower than 3 in the BSFS during the run-in period for clinical trials on IBS-C and an average stool consistency greater than 5 in the BSFS during the run-in period for clinical trials on IBS-D. Changes in stool consistency are the primary endpoints for both IBS with diarrhea (IBS-D) and IBS with constipation (IBS-C).
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Affiliation(s)
- M Saps
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.
| | - M A L van Tilburg
- Division of Gastroenterology and Hepatology, Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA
| | - J V Lavigne
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Mary Ann and J. Milburn Smith Child Health Research Program, Chicago, IL, USA.,Children's Hospital of Chicago Research Center, Chicago, IL, USA
| | - A Miranda
- Division of Pediatric Gastroenterology Hepatology & Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - J A Taminiau
- Member of the Pediatric Committee (PDCO) European Medicines Agency, London, UK
| | - C Di Lorenzo
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
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Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents. J Pediatr 2016; 177:39-43.e3. [PMID: 27156185 DOI: 10.1016/j.jpeds.2016.04.008] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/23/2016] [Accepted: 04/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the prevalence of functional gastrointestinal (GI) disorders (FGIDs) in children and adolescents in a representative community sample of the US. STUDY DESIGN The study recruited a general population sample of mothers (n = 949) of children and adolescents aged 4-18 years. Child and adolescent GI symptoms were assessed using parental report through online questionnaires, including the Questionnaire on Pediatric Gastrointestinal Symptoms and the PedsQL4.0 Generic Core Scale. Parental GI symptoms, and demographic characteristics were also assessed. The data was used to determine prevalence of FGIDs. RESULTS Using Rome III criteria by parental report, 23.1% of children and adolescents qualified for at least 1 FGID. Functional constipation and abdominal migraine were the most common FGIDs. All 10 child/adolescent FGIDs occurred, except rumination. Significant prevalence differences were not found between sexes, except in functional constipation, which was more prevalent in males than females (P = .022). There were no significant prevalence differences between racial or ethnic groups. Children who met criteria for an FGID had lower quality of life (median = 76.4) than children who did not (median = 89.6; P < .001). Children were more likely to qualify for a FGID if their parent also qualified for a FGID (P < .01). CONCLUSIONS FGIDs are common in children and adolescents in the US. There are no significant differences in FGIDs between sex, race, or ethnic groups, except in functional constipation. There is overlap between parental and child FGID symptoms. Children with a FGID report a lower quality of life than healthy children.
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Gulewitsch M, Weimer K, Enck P, Schwille-Kiuntke J, Hautzinger M, Schlarb A. Stress reactivity in childhood functional abdominal pain or irritable bowel syndrome. Eur J Pain 2016; 21:166-177. [DOI: 10.1002/ejp.914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 12/17/2022]
Affiliation(s)
- M.D. Gulewitsch
- Department of Psychology, Clinical Psychology and Psychotherapy; University of Tübingen; Germany
| | - K. Weimer
- Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy; University Hospital Tübingen; Germany
| | - P. Enck
- Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy; University Hospital Tübingen; Germany
| | - J. Schwille-Kiuntke
- Department of Internal Medicine VI/Psychosomatic Medicine and Psychotherapy; University Hospital Tübingen; Germany
| | - M. Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy; University of Tübingen; Germany
| | - A.A. Schlarb
- Department of Psychology, Clinical Psychology and Psychotherapy; University of Tübingen; Germany
- Faculty of Psychology and Sports Science, Clinical Psychology and Psychotherapy for Children and Adolescents; University of Bielefeld; Germany
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Ferreira-Maia AP, Matijasevich A, Wang YP. Epidemiology of functional gastrointestinal disorders in infants and toddlers: A systematic review. World J Gastroenterol 2016; 22:6547-6558. [PMID: 27605889 PMCID: PMC4968134 DOI: 10.3748/wjg.v22.i28.6547] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/26/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the functional gastrointestinal disorders (FGID) prevalence in infants and toddlers.
METHODS: PubMed, EMBASE, and Scopus were searched for original articles from inception to February 2016. The literature search was made in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). For inclusion, each study had to report epidemiological data of FGID on children up to 4 years old and contain standardized outcome Rome II or III criteria. The overall quality of included epidemiological studies was evaluated in accordance to Loney’s proposal for prevalence studies of health literature. Two reviewers assessed each study for inclusion and extracted data. Discrepancies were reconciled through discussion.
RESULTS: It was identified a total of 101 articles through the databases and two through the manual search. A total of 28 articles fulfilled the eligibility criteria. After reading the full articles, 13 of them were included in the present review. Twelve studies were written in English and one in Chinese, and published between 2004 and 2015. Eight articles (61.5%) were performed in Europe, three (23.1%) in America and two (15.4%) in Asia. Sample size varied between 45 and 9660 subjects. Cross-sectional frequency was reported in majority of studies (k = 9) and four studies prospectively followed the subjects. 27.1% to 38% of participants have met any of Rome’s criteria for gastrointestinal syndromes, of those 20.8% presented two or more FGID. Infant regurgitation and functional constipation were the most common FGID, ranging from less than 1% to 25.9% and less than 1% to 31%, respectively. Most included studies were of moderate to poor data quality with respect to absence of confidential interval for prevalence rate and inadequate sampling methods.
CONCLUSION: The scarcity and heterogeneity of FGID data call for the necessity of well-designed epidemiological research in different levels of pediatric practice and refinement of diagnostic.
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Devanarayana NM, Rajindrajith S, Benninga MA. Abdominal migraine in children: association between gastric motility parameters and clinical characteristics. BMC Gastroenterol 2016; 16:26. [PMID: 26924750 PMCID: PMC4770524 DOI: 10.1186/s12876-016-0435-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/17/2016] [Indexed: 12/12/2022] Open
Abstract
Background Approximately 0.2–1 % of children suffers from abdominal migraine (AM). Pathophysiology of AM has not been adequately studied. This study evaluated gastric motility in children with AM. Methods Seventeen children (6 boys), within an age range of 4–15 years, referred to a tertiary care paediatric unit, North Colombo Teaching Hospital Ragama, Sri Lanka, from 2007 to 2012, were screened. Those fulfilling Rome III criteria for AM were recruited after obtaining parental consent. None had clinical or laboratory evidence of organic disorders. Twenty healthy children (8 boys), with an age range of 4–14 years, were recruited as controls. Liquid gastric emptying rate (GE) and antral motility parameters were assessed using an ultrasound method. Results Average GE (41.6 % vs. 66.2 %, in controls), amplitude of antral contractions (A) (57.9 % vs. 89.0 %) and antral motility index (MI) (5.0 vs. 8.3) were lower and fasting antral area (1.8 cm2 vs. 0.6 cm2) was higher in children with AM (p < 0.01). No significant difference in the frequency of antral contractions (F) (8.8/3 min vs. 9.3/3 min, p = 0.08) was found between the two groups. Scores obtained for severity of abdominal pain had a negative correlation with A (r = −0.55, p = 0.03). Average duration of abdominal pain episodes correlated with GE (r = −0.58, p = 0.02). Negative correlations were observed between duration of AM and A (r = −0.55), F (r = −0.52), and MI (r = −0.57) (p < 0.05). Conclusions GE and antral motility parameters were significantly lower in children with AM. A significant correlation was found between symptoms and gastric motility. These findings suggest a possible role of abnormal gastric motility in the pathogenesis of AM.
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Affiliation(s)
- Niranga Manjuri Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka.
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Gastrointestinal Symptoms of Patients with Fabry Disease. Gastroenterol Res Pract 2015; 2016:9712831. [PMID: 26880903 PMCID: PMC4736195 DOI: 10.1155/2016/9712831] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/10/2015] [Accepted: 09/13/2015] [Indexed: 11/21/2022] Open
Abstract
In order to characterize gastrointestinal (GI) symptoms of 50 patients with Fabry disease (FD) (22 M; age range: 4–70 y; 35 adults and 15 children), validated questionnaires of GI symptoms were used to diagnose the functional gastrointestinal disorders (FGIDs) of the patients with GI symptoms (33/50 (66%); 25/35 adults and 8/15 children) according to Rome III criteria. In 16/25 of these adults and 2/8 of these children, the symptoms mimicked FGID. The adult subgroup included patients with unspecified functional bowel disorder (n = 9), functional bloating (n = 7), and IBS (n = 5), and the child subgroup included patients with abdominal migraine (n = 1) and IBS (n = 1). Among the 25 adults, 14 reported feeling full after a regular-size meal, and 12 complained of abdominal bloating/distension. All of the children with GI symptoms complained of low abdominal pain associated with changes in the form of the stool/improvements with defecation. In conclusion, according to Rome III criteria, the most frequent diagnoses of FGID among the adults with FD were unspecified functional bowel disorder, followed by functional bloating and IBS. The most frequent GI symptom in the children in our population was IBS-like abdominal pain, while the adults exhibited a full feeling following a regular-size meal and abdominal bloating/distension.
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Abstract
To compare disability and emotional health in individuals with irritable bowel syndrome (IBS), fibromyalgia, or both, patients completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III, childhood Functional Disability Inventory (FDI), and the Behavior Assessment System for Children, Second Edition. Patients' (age range 8-18 years, 19 IBS, 12 fibromyalgia, and 12 both) FDI scores showed greater disability than scores from historically healthy patients. Fibromyalgia (FDI 22.5 ± 12.7, P = 0.018) and patients with both (FDI 26.2 ± 13.8, P = 0.001) averaged greater disability than those with IBS (FDI 10.6 ± 7.9). Disability was correlated with anxiety and depression symptoms. Disability and psychological symptoms are important when evaluating individuals with fibromyalgia and IBS.
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Farahmand F, Abedi A, Esmaeili-Dooki MR, Jalilian R, Tabari SM. Pelvic Floor Muscle Exercise for Paediatric Functional Constipation. J Clin Diagn Res 2015; 9:SC16-7. [PMID: 26284199 DOI: 10.7860/jcdr/2015/12726.6036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 03/29/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Functional constipation (FC) is one of the most common gastrointestinal problems among children. This study was designed to investigate the effectiveness of pelvic floor muscle exercise on treatment of FC. MATERIALS AND METHODS In this study which was conducted in Children's Medical Center, children with a diagnosis of FC (aged 4-18 y) who did not respond to medical treatment, performed sessions of pelvic floor muscle exercise at home twice a day for 8 wk. Frequency of defecation, overall improvement of constipation, stool withholding, painful defecation and stool consistency were measured at the final week of the intervention compared to baseline. RESULTS Forty children (16 males, 24 females mean age 5.6±1.03 y) completed the 8-wk exercise program. Subjective overall improvement of the symptoms was present in 36 patients (90%). The changes in stool frequency, stool diameter and consistency were statistically significant. However, there were no statistically significant differences in the stool withholding, fecal impaction, fecal incontinence and painful defecation. CONCLUSION Pelvic floor muscle exercise is an effective non-pharmacologic treatment for Paediatric FC.
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Affiliation(s)
- Fatemeh Farahmand
- Faculty, Department of Paediatric, Gastroenterology, Children Medical Center, Tehran University of Medical Sciences , Tehran, Iran
| | - Aidin Abedi
- Faculty, Department of Paediatric, Tehran University of Medical Sciences , Tehran, Iran
| | - Mohammad Reza Esmaeili-Dooki
- Faculty, Department of Paediatric, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences , Babol, IR Iran
| | - Rozita Jalilian
- Faculty, Department of Paediatric, Tehran University of Medical Sciences , Tehran, Iran
| | - Sanaz Mehrabani Tabari
- Faculty, Department of Paediatric, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences , Babol, IR Iran
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Park R, Mikami S, LeClair J, Bollom A, Lembo C, Sethi S, Lembo A, Jones M, Cheng V, Friedlander E, Nurko S. Inpatient burden of childhood functional GI disorders in the USA: an analysis of national trends in the USA from 1997 to 2009. Neurogastroenterol Motil 2015; 27:684-92. [PMID: 25809794 PMCID: PMC5549670 DOI: 10.1111/nmo.12542] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) are among the most common outpatient diagnoses in pediatric primary care and gastroenterology. There is limited data on the inpatient burden of childhood FGIDs in the USA. The aim of this study was to evaluate the inpatient admission rate, length of stay (LoS), and associated costs related to FGIDs from 1997 to 2009. METHODS We analyzed the Kids' Inpatient Sample Database (KID) for all subjects in which constipation (ICD-9 codes: 564.0-564.09), abdominal pain (ICD-9 codes: 789.0-789.09), irritable bowel syndrome (IBS) (ICD-9 code: 564.1), abdominal migraine (ICD-9 code: 346.80 and 346.81) dyspepsia (ICD-9 code: 536.8), or fecal incontinence (ICD-codes: 787.6-787.63) was the primary discharge diagnosis from 1997 to 2009. The KID is the largest publicly available all-payer inpatient database in the USA, containing data from 2 to 3 million pediatric hospital stays yearly. KEY RESULTS From 1997 to 2009, the number of discharges with a FGID primary diagnosis increased slightly from 6,348,537 to 6,393,803. The total mean cost per discharge increased significantly from $6115 to $18,058 despite the LoS remaining relatively stable. Constipation and abdominal pain were the most common FGID discharge diagnoses. Abdominal pain and abdominal migraine discharges were most frequent in the 10-14 year age group. Constipation and fecal incontinence discharges were most frequent in the 5-9 year age group. IBS discharge was most common for the 15-17 year age group. CONCLUSIONS & INFERENCES Hospitalizations and associated costs in childhood FGIDs have increased in number and cost in the USA from 1997 to 2009. Further studies to determine optimal methods to avoid unnecessary hospitalizations and potentially harmful diagnostic testing are indicated.
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Affiliation(s)
- Richard Park
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sage Mikami
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jack LeClair
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Andrea Bollom
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Cara Lembo
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Saurabh Sethi
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Anthony Lembo
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Mike Jones
- Macquarie University, Sydney, New South Wales, Australia
| | - Vivian Cheng
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Elizabeth Friedlander
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA
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Pensabene L, Talarico V, Concolino D, Ciliberto D, Campanozzi A, Gentile T, Rutigliano V, Salvatore S, Staiano A, Di Lorenzo C. Postinfectious functional gastrointestinal disorders in children: a multicenter prospective study. J Pediatr 2015; 166:903-7.e1. [PMID: 25661403 DOI: 10.1016/j.jpeds.2014.12.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/01/2014] [Accepted: 12/17/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To prospectively investigate the occurrence of postinfectious functional gastrointestinal disorders (FGIDs), diagnosed according to the Rome III criteria, in children with acute diarrhea of different infectious etiology. STUDY DESIGN This was a prospective cohort multicenter study. Children 4-17 years of age presenting with acute diarrhea who tested positive for an enteric infection were recruited within 1 month from the episode and matched with control subjects of similar age and sex. Symptoms were evaluated with a validated questionnaire for FGIDs at the time of enrollment in the study and after 3 and 6 months. RESULTS A total of 64 patients (36 boys; median age 5.3 years; age range 4.1-14.1 years) were recruited, 32 subjects in each arm. Infections included rotavirus (56.8%), salmonella (30%), adenovirus (6.6%), norovirus (3.3%), and Giardia lamblia (3.3%). FGIDs were significantly more common in exposed patients compared with controls within 1 month from acute diarrhea (40.6% vs 12.5% [P = .02, relative risk (RR) = 1.9]), 3 months (53% vs 15.6% [P = .003, RR = 2.2]), and 6 months (46.8% vs 15.6% [P = .01, RR = 1.9]) later. No correlation was found between different etiologies, age, or sex, and any type of FGIDs. Among exposed children, abdominal pain-related FGIDs were significantly more frequent compared with controls after 6 months from infection (P = .04, RR = 1.7). CONCLUSION This prospective cohort multicenter study supports postinfectious FGIDs as a true entity in children. There seems to be a significant increase in abdominal pain-related FGIDs after acute diarrhea in children within 1 month and 3 and 6 months later.
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Affiliation(s)
- Licia Pensabene
- Department of Pediatrics, University Magna Graecia, Catanzaro, Italy.
| | | | - Daniela Concolino
- Department of Pediatrics, University Magna Graecia, Catanzaro, Italy
| | | | | | - Teresa Gentile
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | | | | | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples, Naples, Italy
| | - Carlo Di Lorenzo
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
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Li F, Ma J, Geng S, Wang J, Liu J, Zhang J, Sheng X. Fecal calprotectin concentrations in healthy children aged 1-18 months. PLoS One 2015; 10:e0119574. [PMID: 25742018 PMCID: PMC4351193 DOI: 10.1371/journal.pone.0119574] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/15/2015] [Indexed: 12/13/2022] Open
Abstract
Objective Fecal calprotectin (FC) is an established biomarker of gut inflammation. The aim of this study was to evaluate FC concentrations in healthy children between 1 and 18 months of age. Methods Healthy children aged 1-18 months were enrolled in this study at the Department of Children's Health Care in Shanghai, China. Children’s stool samples were collected and analyzed, and FC concentration was determined using a commercially available enzyme-linked immunosorbent assay (ELISA). The children's weights and lengths were measured. Parents were asked to complete a brief questionnaire regarding several clinical and sociodemographic factors. Results The FC concentrations were unevenly distributed; the median FC concentration was 174.3 μg/g (range: 6.0-1097.7 μg/g) or 2.241 log10 μg/g (range: 0.775-3.041 log10 μg/g) for all 288 children. The children were divided into several age groups: 1-3 months, 3-6 months, 6-9 months, 9-12 months and 12-18 months. The median FC concentrations for these age groups were 375.2 μg/g (2.574 log10 μg/g), 217.9 μg/g (2.338 log10 μg/g), 127.7 μg/g (2.106 log10 μg/g), 96.1 μg/g (1.983 log10 μg/g) and 104.2 μg/g (2.016 log10 μg/g), respectively. A significant correlation between age and FC concentration was found (r=-0.490, p<0.001). A simple correlation analysis of weight-for-length Z-scores or weight-for-age Z-scores vs. FC concentrations showed that these variables were negatively correlated (Spearman’s rho=-0.287, p<0.001; Spearman’s rho=-0.243, p<0.001, respectively). Conclusions The FC levels of children aged 1-18 months exhibit a downward trend with increasing age and are greater than the normal levels observed in healthy adults. In healthy children aged <6 months, FC levels are high. In children aged 6-18 months, FC concentrations are relatively low but are still higher than those of children aged >4 years.
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Affiliation(s)
- Feng Li
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingqiu Ma
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanshan Geng
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junli Wang
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinrong Liu
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyang Sheng
- Department of Children and Adolescents Health Care, MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
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van Tilburg MAL, Hyman PE, Walker L, Rouster A, Palsson OS, Kim SM, Whitehead WE. Prevalence of functional gastrointestinal disorders in infants and toddlers. J Pediatr 2015; 166:684-9. [PMID: 25557967 DOI: 10.1016/j.jpeds.2014.11.039] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/18/2014] [Accepted: 11/18/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine the prevalence of gastrointestinal symptoms suggestive of an infant/toddler functional gastrointestinal disorder (FGID) as reported by parents in a representative community sample. STUDY DESIGN Mothers (n = 320) of children aged 0-3 years old were recruited in the US and completed a questionnaire about their child's and their own gastrointestinal symptoms. RESULTS By Rome criteria, 27% of infants/toddlers qualified for FGIDs. Infant regurgitation was the most common disorder in infants and functional constipation in toddlers. No age, sex, or race differences were found in FGID diagnoses. Compared with those who did not meet Rome criteria, toddlers with FGID had lower quality of life (M = 80.1 vs M = 90.3, P < .001), increased medical visits (M = 0.38 vs 0.14; P < .05), mental health visits (M = 0.29 vs 0.06; P < .05), and hospital stays (M = 0.35 vs 0.06; P < .01). A child was more likely to suffer from hard stools if the parent also reported hard stools (P = .02), but similar association was not found with loose stools. CONCLUSIONS FGIDs are common in infants and toddlers and can be identified in the general population. They do not vary with sex and race. Quality of life is reduced in those with FGIDs. More research is needed into these largely neglected conditions as it may improve the lives of a significant number of young children.
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Affiliation(s)
- Miranda A L van Tilburg
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC.
| | - Paul E Hyman
- Department of Pediatrics, Louisiana State University School of Medicine, New Orleans, LA
| | - Lynne Walker
- Division of Adolescent Medicine and Behavioral Science, Vanderbilt University, Nashville, TN
| | - Audra Rouster
- Department of Pediatrics, Louisiana State University School of Medicine, New Orleans, LA
| | - Olafur S Palsson
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | - Sung Min Kim
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | - William E Whitehead
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
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Arbuckle RA, Carson RT, Abetz-Webb L, Hyams J, Di Lorenzo C, Lewis BE, Gargon E, Kurtz C, Shiff SJ, Johnston JM. Measuring the symptoms of pediatric constipation and irritable bowel syndrome with constipation: expert commentary and literature review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2015; 7:343-64. [PMID: 24965712 DOI: 10.1007/s40271-014-0070-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Symptom measurement in pediatric chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) trials requires appropriately developed clinical outcome assessments (COAs). METHODS Literature was reviewed to identify symptom COAs meeting regulatory standards. Searches were conducted in Pubmed/Medline, EMBASE, and PsychINFO. Title/abstracts were reviewed to identify qualitative studies and those using COAs to measure pediatric CIC/IBS symptoms. Pediatric functional gastrointestinal experts provided input on relevant symptom-concepts to measure. RESULTS Review of 1,105 abstracts identified 1 relevant qualitative article and 113 articles including COAs. Symptoms most frequently measured in CIC studies were frequency of bowel movements, fecal incontinence/encopresis, abdominal pain, stool consistency, and painful defecation. Symptoms most frequently measured in IBS were abdominal pain, abdominal distention/bloating, stool consistency, frequency of bowel movements, and gas. Evidence of development/validity of COAs was limited. Expert feedback was broadly consistent with the literature. CONCLUSION Findings demonstrate consistency in the literature on key CIC/IBS symptoms to measure in pediatric trials, but existing COAs do not meet regulatory standards.
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Urinary tract infection in infancy is a risk factor for chronic abdominal pain in childhood. J Pediatr Gastroenterol Nutr 2015; 60:214-6. [PMID: 25625577 DOI: 10.1097/mpg.0000000000000599] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Adverse early life events are key factors for development of functional gastrointestinal disorders (FGIDs). Urinary tract infection (UTI) is associated with chronic pelvic pain in adults, a finding that has been recapitulated in murine models, but the relation between UTI and chronic pelvic and abdominal pain has not been studied in children. We hypothesized that UTI in infancy increases the risk of FGIDs and chronic abdominal pain (CAP) in childhood. METHODS The present study included children, ages 4 to 18 years, with a single UTI in the first year of life and their siblings with no history of UTI. Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III) by telephone. Children meeting QPGS-III criteria for FGIDs but with pain less than once weekly were considered to have CAP. RESULTS A total of 57 patients with UTI and 58 sibling controls were identified. Mean age at UTI was 4.8 months, and mean time since UTI was 9.3 years. At the time of survey, mean age of patients was 9.7 years (5-16 years, 40% boys) and that of controls was 9.6 years (range 4-17 years, 57% boys). FGIDs were diagnosed in 6 of 57 (11%) patients, and 1 of 58 (2%) controls (P = 0.06). CAP was identified in 10 of 57 (18%) patients and 2 of 58 (3%) controls (P = 0.02). Predominant sex (female), infecting organism (E coli), and treatment (third-generation cephalosporin) were similar in patients with UTI with and without CAP. CONCLUSIONS We show for the first time that UTI is associated with CAP in childhood. We speculate that pelvic organ sensory convergence explains our findings.
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Korterink JJ, Rutten JMTM, Venmans L, Benninga MA, Tabbers MM. Pharmacologic treatment in pediatric functional abdominal pain disorders: a systematic review. J Pediatr 2015; 166:424-31.e6. [PMID: 25449223 DOI: 10.1016/j.jpeds.2014.09.067] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/25/2014] [Accepted: 09/30/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically review literature assessing efficacy and safety of pharmacologic treatments in children with abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). STUDY DESIGN MEDLINE and Cochrane Database were searched for systematic reviews and randomized controlled trials investigating efficacy and safety of pharmacologic agents in children aged 4-18 years with AP-FGIDs. Quality of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS We included 6 studies with 275 children (aged 4.5-18 years) evaluating antispasmodic, antidepressant, antireflux, antihistaminic, and laxative agents. Overall quality of evidence was very low. Compared with placebo, some evidence was found for peppermint oil in improving symptoms (OR 3.3 (95% CI 0.9-12.0) and for cyproheptadine in reducing pain frequency (relative risk [RR] 2.43, 95% CI 1.17-5.04) and pain intensity (RR 3.03, 95% CI 1.29-7.11). Compared with placebo, amitriptyline showed 15% improvement in overall quality of life score (P = .007) and famotidine only provides benefit in global symptom improvement (OR 11.0; 95% CI 1.6-75.5; P = .02). Polyethylene glycol with tegaserod significantly decreased pain intensity compared with polyethylene glycol only (RR 3.60, 95% CI 1.54-8.40). No serious adverse effects were reported. No studies were found concerning antidiarrheal agents, antibiotics, pain medication, anti-emetics, or antimigraine agents. CONCLUSIONS Because of the lack of high-quality, placebo-controlled trials of pharmacologic treatment for pediatric AP-FGIDs, there is no evidence to support routine use of any pharmacologic therapy. Peppermint oil, cyproheptadine, and famotidine might be potential interventions, but well-designed randomized controlled trials are needed.
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Affiliation(s)
- Judith J Korterink
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Juliette M T M Rutten
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Leonie Venmans
- Pediatric Association of The Netherlands, Utrecht, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
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Altamimi EM, Al-Safadi MH. Abdominal Pain-Predominant Functional Gastrointestinal Disorders in Jordanian School Children. Gastroenterology Res 2014; 7:137-142. [PMID: 27785284 PMCID: PMC5040537 DOI: 10.14740/gr627w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 12/12/2022] Open
Abstract
Background Recurrent abdominal pain (RAP) is a common complaint in children. Significant portion of them are of functional origin. This study aimed to assess the prevalence of abdominal pain-predominant functional gastrointestinal disorder (FGID) and its types in Jordanian school children. Methods This is a school-based survey at south Jordan. Information using the self-reporting form of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-RIII) - the official Arabic translation - was collected. Classes from academic years (grades) 6 - 8 were selected. SPSS Statistical Package Version 17 (IBM, Armonk, NY, USA) was used. Categorical data were analyzed using Fisher’s exact test, and continuous data were analyzed using t-test. P < 0.05 was considered significant. Results Five hundred questionnaires were distributed, and 454 returned answered (91%). Two hundred twenty-nine (50.8%) were males. The average age of participants was 12.7 years (11 - 15 years). One hundred sixteen (25.7%) had abdominal pain-predominant FGID. Seventy-nine (68%) of them were females. Forty-seven (10.6%) had irritable bowel syndrome (IBS). Thirty-six (8%), 17 (3.8%), 11 (2.4%) and five (1.1%) had abdominal migraine, functional abdominal pain, functional abdominal pain syndrome and functional dyspepsia, respectively. Conclusion Abdominal pain-predominant FGID has become a major health issue in Jordanian children. One of four children between the ages of 11 and 15 years exhibits at least one abdominal pain-predominant FGID. The most common form of abdominal pain-predominant FGID in our children was IBS. Females are affected more often than males. Intestinal and extra-intestinal symptoms are seen regularly with abdominal pain-predominant FGIDs.
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Abstract
OBJECTIVES Functional gastrointestinal disorders (FGIDs) are common. The diagnosis of FGIDs is based on the Rome criteria, a symptom-based diagnostic classification established by expert consensus. There is little evidence of validity for the pediatric Rome III criteria. The construct validity of the criteria, an overarching term that incorporates other forms of validity, has never been assessed. We assessed the construct validity of the Rome III criteria. METHODS Children from 2 schools in Colombia completed the Questionnaire on Pediatric Gastrointestinal Symptoms at baseline and weekly questionnaires of somatic symptoms and disability for 8 weeks (presence and intensity of gastrointestinal symptoms, nongastrointestinal symptoms, impact on daily activities). A total of 255 children completed at least 6 weekly surveys (2041 surveys). RESULTS At baseline, 27.8% children were diagnosed as having an FGID. Prevalence of nausea (Δ 7.8%, 95% confidence interval [CI] 4.46-11.14), constipation (Δ 4.39%, 95% CI 1.79-6.99), diarrhea (Δ 6.69%, 95% CI 3.25-10.13), headache (Δ 7.4%, 95% CI 3.51-11.09), chest pain (Δ 9.04%, 95% CI 5.20-12.88), and limb pain (Δ 4.07%, 95% CI 1.76-6.37) and intensity of nausea (Δ 0.23, 95% CI 0.127-0.333), diarrhea (Δ 0.30, 95% CI 0.211-0.389), abdominal pain (Δ 0.18, 95% CI 0.069-0.291), headache (Δ 0.17, 95% CI 0.091-0.249), and limb pain (Δ 0.30, 95% CI 0.084-0.516) were higher in children with FGIDs (P < 0.001). Children with FGIDs had greater interference with daily activities (P < 0.001). CONCLUSIONS Children with a Rome III diagnosis had significantly more gastrointestinal and nongastrointestinal complaints, and greater intensity of symptoms and disability than children without an FGID diagnosis. The study suggests that the Rome III pediatric criteria have adequate construct validity.
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Halb C, Pomerleau M, Faure C. Multichannel intraesophageal impedance pattern of children with aerophagia. Neurogastroenterol Motil 2014; 26:1010-4. [PMID: 24796405 DOI: 10.1111/nmo.12355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/04/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Childhood aerophagia is defined by the Rome III criteria as two or more of the following symptoms; air swallowing, abdominal distension due to intraluminal air, or repetitive belching and/or flatus. The aim of this study was to determine the multichannel intraesophageal impedance (MII) pattern in children suffering from aerophagia. METHODS We compared the MII tracings of five children with aerophagia according to Rome III criteria (three girls, median age 7 years) to five controls (three girls, median age 8 years). Controls underwent MII for symptoms of gastro-esophageal reflux, and had normal findings. Liquid swallows (LS), air swallows (AS), mixed swallows (MS) and supragastric belching (SGB) were recorded. Meals were excluded from the analysis. All MII parameters were separately analyzed in the upright and recumbent position. All data are reported as median number of events per hour. KEY RESULTS There was no difference in the total number of LS and MS between the two groups. However, the total number of AS in patients was significantly higher than in controls (26/h vs 5.5/h, p < 0.05) but only in the upright position (46/h vs 8.2 in control group, p < 0.05). SGB was noted only in patients with aerophagia (2.6/h vs 0/h, p < 0.01). CONCLUSIONS & INFERENCES Children suffering from aerophagia have a specific MII pattern with an increased frequency of air swallows in the upright position and supragastric belching. MII may be used as a tool to confirm diagnosis of aerophagia in children.
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Affiliation(s)
- C Halb
- Division of Pediatric Gastroenterology, Department of Pediatrics, CHU Ste-Justine, Montréal, QC, Canada
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Holtman GA, Lisman-van Leeuwen Y, Kollen BJ, Escher JC, Kindermann A, Rheenen PFV, Berger MY. Challenges in diagnostic accuracy studies in primary care: the fecal calprotectin example. BMC FAMILY PRACTICE 2013; 14:179. [PMID: 24274463 PMCID: PMC4222604 DOI: 10.1186/1471-2296-14-179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/21/2013] [Indexed: 01/02/2023]
Abstract
Background Low disease prevalence and lack of uniform reference standards in primary care induce methodological challenges for investigating the diagnostic accuracy of a test. We present a study design that copes with these methodological challenges and discuss the methodological implications of our choices, using a quality assessment tool for diagnostic accuracy studies (QUADAS-2). Design The study investigates the diagnostic value of fecal calprotectin for detecting inflammatory bowel disease in children presenting with chronic gastrointestinal symptoms in primary care. It is a prospective cohort study including two cohorts of children: one cohort will be recruited in primary care and the other in secondary/tertiary care. Test results of fecal calprotectin will be compared to one of the two reference standards for inflammatory bowel disease: endoscopy with histopathological examination of mucosal biopsies or assessment of clinical symptoms at 1-year follow-up. Discussion According to QUADAS-2 the use of two reference standards and the recruitment of patients in two populations may cause differential verification bias and spectrum bias, respectively. The clinical relevance of this potential bias and methods to adjust for this are presented. This study illustrates the importance of awareness of the different kinds of bias that result from choices in the design phase of a diagnostic study in a low prevalence setting. This approach is exemplary for other diagnostic research in primary care.
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Affiliation(s)
- Gea A Holtman
- Department of General Practice, FA21, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD Groningen, The Netherlands.
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Chang SJ, Chiang IN, Lin CD, Hsieh CH, Yang SSD. Obese children at higher risk for having overactive bladder symptoms: A community-based study. Neurourol Urodyn 2013; 34:123-7. [DOI: 10.1002/nau.22532] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 10/23/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Shang-Jen Chang
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
| | - I-Ni Chiang
- Department of Urology; National Taiwan University Hospital; Taipei Taiwan
| | - Chia-Da Lin
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
| | - Cheng-Hsing Hsieh
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
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Rome III criteria in parents' hands: pain-related functional gastrointestinal disorders in community children and associations with somatic complaints and mental health. Eur J Gastroenterol Hepatol 2013; 25:1223-9. [PMID: 24002016 DOI: 10.1097/meg.0b013e328364b55d] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine (a) the prevalence of Rome III abdominal pain-related functional gastrointestinal disorders in a western community sample of children, (b) their associations with sociodemographic factors, and (c) whether children fulfilling Rome III abdominal pain diagnoses show higher rates of psychological distress and somatization. METHODS Data were collected from parents of 6-10-year-old children who were recruited from 22 public grammar schools in Germany. A total of 1537 questionnaires were included in the analysis. Abdominal pain-related functional gastrointestinal disorders were diagnosed on the basis of questionnaire responses by Rome III criteria. Further, somatic complaints as well as emotional and behavioral problems were assessed. RESULTS In total, 7.7% of children aged 6-10 years fulfilled the criteria for at least one Rome III abdominal pain-related functional gastrointestinal disorder according to their parents. The most prevalent diagnoses were irritable bowel syndrome (4.9%) and functional abdominal pain (2.0%). Assigned diagnoses were not associated with sociodemographic factors. We could confirm that abdominal pain-related functional disorders, especially irritable bowel syndrome, were strongly associated with somatization and emotional problems in community. CONCLUSION Rome III abdominal pain-related functional gastrointestinal disorders are a common health problem in children and are, even in community, strongly associated with other somatic complaints and psychological distress.
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Rosen JM, Adams PN, Saps M. Umbilical hernia repair increases the rate of functional gastrointestinal disorders in children. J Pediatr 2013; 163:1065-8. [PMID: 23759426 DOI: 10.1016/j.jpeds.2013.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/28/2013] [Accepted: 04/22/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To hypothesize that hernia repair would not change the incidence of functional gastrointestinal disorders (FGIDs) due to the benign and limited nature of the procedure. STUDY DESIGN This cohort study assessed a randomized selection of children aged 4-18 years who underwent hernia repair more than 4 years prior at Ann and Robert H. Lurie Children's Hospital of Chicago. Controls were siblings who had not undergone surgery previously. Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version by telephone for subjects and controls. The primary outcome was the presence of FGIDs. RESULTS Fifty children with hernia repair and 43 sibling controls were identified. At the time of survey, subjects with hernia repair were average age 12.9 years (range 5-18 years, 60% male) and controls were average age 12.2 years (range 4-18 years, 49% male). Average age at surgical repair was 5.2 years (median 5.2 years, range 0.2-10.4 years) and average time since surgical repair was 7.8 years (range 4.8-13.7 years). FGIDs were diagnosed in 10/50 (20%) cases of hernia repair and 2/43 (5%) controls (P = .033, Fisher 2-tailed test). CONCLUSIONS Umbilical hernia repair increases the likelihood of FGIDs in childhood. Additional studies are needed to identify aspects of surgery that may be associated with development of FGIDs.
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Affiliation(s)
- John M Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Sherwood NE, Levy RL, Langer SL, Senso MM, Crain AL, Hayes MG, Anderson JD, Seburg EM, Jeffery RW. Healthy Homes/Healthy Kids: a randomized trial of a pediatric primary care-based obesity prevention intervention for at-risk 5-10 year olds. Contemp Clin Trials 2013; 36:228-43. [PMID: 23816490 DOI: 10.1016/j.cct.2013.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/21/2013] [Accepted: 06/22/2013] [Indexed: 12/28/2022]
Abstract
Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a Contact Control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The Contact Control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.
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Affiliation(s)
- Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, MN 55440-1524, USA.
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Fernandes VPI, Lima MCL, Camargo EE, Collares EF, Bustorff-Silva JM, Lomazi EA. Gastric emptying of water in children with severe functional fecal retention. Braz J Med Biol Res 2013; 46:293-8. [PMID: 23532267 PMCID: PMC3854375 DOI: 10.1590/1414-431x20132448] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 01/14/2013] [Indexed: 01/18/2023] Open
Abstract
The objective of this study was to evaluate gastric emptying (GE) in pediatric
patients with functional constipation. GE delay has been reported in adults with
functional constipation. Gastric emptying studies were performed in 22 children
with chronic constipation, fecal retention and fecal incontinence, while
presenting fecal retention and after resuming regular bowel movements. Patients
(18 boys, median age: 10 years; range: 7.2 to 12.7 years) were evaluated in a
tertiary pediatric gastroenterology clinic. Gastric half-emptying time of water
(reference range: 12 ± 3 min) was measured using a radionuclide technique
immediately after first patient evaluation, when they presented fecal impaction
(GE1), and when they achieved regular bowel movements
(GE2), 12 ± 5 weeks after GE1. At study admission, 21
patients had reported dyspeptic symptoms, which were completely relieved after
resuming regular bowel movements. Medians (and interquartile ranges) for
GE1 and GE2 were not significantly different [27.0
(16) and 27.5 (21) min, respectively (P = 0.10)]. Delayed GE seems to be a
common feature among children with chronic constipation and fecal retention.
Resuming satisfactory bowel function and improvement in dyspeptic symptoms did
not result in normalization of GE data.
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Affiliation(s)
- V P I Fernandes
- Gastroenterologia Pediátrica, Departamento de Pediatria, Universidade Estadual de Campinas, Campinas, SP, Brasil.
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Borg HC, Holmdahl G, Gustavsson K, Doroszkiewicz M, Sillén U. Longitudinal study of bowel function in children with anorectal malformations. J Pediatr Surg 2013; 48:597-606. [PMID: 23480919 DOI: 10.1016/j.jpedsurg.2012.10.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 09/18/2012] [Accepted: 10/22/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE Longitudinal follow-up of changes in bowel function in children with anorectal malformations (ARMs) with or without spinal cord pathology and neurogenic bladder dysfunction (NBD) as they grow. Another purpose was to identify predictors influencing bowel functional outcome. MATERIAL AND METHODS The study included 41 patients with ARM, excluding perineal fistula (21 boys and 20 girls). Bowel function was evaluated at ages 5, 10 and 15 years using a structured questionnaire and a three-week registration of number and time of bowel movements, episodes of fecal leakage and soiling. Additional bowel treatment with enemas and stool softeners and use of diapers were recorded. A group of 52 healthy boys and girls was used as control. RESULTS A successive improvement in functional outcome with age in children with ARM and normal spinal cord was seen with respect to continence, soiling and constipation. Continence was achieved earlier in girls than in boys (at 10 years: girls 80%, boys 36%). Soiling and constipation decreased with age both in grade and frequency (at 10 years low grade soiling: girls 53%, boys 64%). Boys with spinal cord malformation with NBD in combination with prostatic/bladder neck fistula (PRF/BNF) and sacral agenesis had the worst functional outcome with minimal possibility of improvement over time. Functional outcome in girls with NBD and tethered cord did not differ significantly from those without NBD and with a normal spinal cord. Psychosocial co-morbidity, neuropsychiatric disorders, developmental delay and megarectosigmoid were also risk factors impeding the functional outcome. CONCLUSION In the present study there was a successive improvement in bowel function during childhood and adolescence in ARM children, but they did not achieve the level of healthy children. NBD, spinal cord malformation, sacral malformation and PRF all were negative predictive factors for bowel score at 5 years.
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Affiliation(s)
- Helena C Borg
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Abdominal pain and functional gastrointestinal disorders in children with celiac disease. J Pediatr 2013; 162:505-9. [PMID: 23058293 DOI: 10.1016/j.jpeds.2012.08.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 07/17/2012] [Accepted: 08/23/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess whether patients with celiac disease (CD) are more likely than controls to develop abdominal pain (AP) and AP-associated functional gastrointestinal disorders (FGID) in long-term follow-up. STUDY DESIGN In a retrospective study, data on children (3-22 years old) with CD diagnosed between 2000 and 2010 were obtained. Parents were contacted by telephone at least 6 months after the diagnosis of CD and invited to participate in the study. Consenting parents completed: (1) a telephone questionnaire on the presence of gastrointestinal symptoms; and (2) the parent report version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III for cases and selected controls. RESULTS Forty-nine cases (mean 11.3 years, 20 male participants) and 48 controls (mean 11.1 years, 24 male participants) were enrolled. Twelve children in the CD group (24.5%) and 7 children in the control group (14.6%) had AP at the time of the study (P = .3). Nine children in the CD group (18.3%) and 4 children in the control group (8.3%) met criteria for an AP-associated FGID according to the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (P = .23). CONCLUSION It was found that children with CD and controls have a similar risk of AP and AP-FGIDs. Methodologic limitations prevent generalization of results, but large prospective studies should confirm the findings.
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Abraham S, Kellow JE. Do the digestive tract symptoms in eating disorder patients represent functional gastrointestinal disorders? BMC Gastroenterol 2013; 13:38. [PMID: 23448363 PMCID: PMC3606125 DOI: 10.1186/1471-230x-13-38] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 02/25/2013] [Indexed: 12/28/2022] Open
Abstract
Background Gastrointestinal (GI) symptoms are common in patients with eating disorders. The aim of this study was to determine, using factor analysis, whether these GI symptom factors (clusters) in eating disorder patients hold true to the Rome II classification of functional gastrointestinal disorders (FGIDs). Methods Inpatients in a specialised eating disorder unit completed the Rome II questionnaire. Data from 185 patients were analysed using factor analysis of 17 questions cited as present in 30% to 70% of the patients. Results Five factors emerged accounting for 68% of the variance and these were termed: ‘oesophageal discomfort’, ‘bowel dysfunction’, ‘abdominal discomfort’, ‘pelvic floor dysfunction’, and ‘self-induced vomiting’. These factors are significantly related to the Rome II FGID categories of functional oesophageal, bowel and anorectal disorders, and to the specific FGIDs of IBS, functional abdominal bloating, functional constipation and pelvic floor dyssynergia. Both heartburn and chest pain were included in the oesophageal discomfort factor. The ‘pelvic floor dysfunction’ factor was distinct from functional constipation. Conclusions The GI symptoms common in eating disorder patients very likely represent the same FGIDs that occur in non-ED patients. Symptoms of pelvic floor dysfunction in the absence of functional constipation, however, are prominent in eating disorder patients. Further investigation of the items comprising the ‘pelvic floor dysfunction’ factor in other patient populations may yield useful results.
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Affiliation(s)
- Suzanne Abraham
- Department of Obstetrics and Gynaecology and the Northside Clinic, Sydney Medical School, Royal North Shore Hospital, Sydney, Australia.
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