Rome III criteria in parents' hands: pain-related functional gastrointestinal disorders in community children and associations with somatic complaints and mental health

Mental health comorbidity in youth with atopic dermatitis: A narrative review of possible mechanisms

The presence of atopic dermatitis (AD) in youth has been linked to a variety of mental health concerns including disruptive behavior, symptoms of anxiety and depression, and diagnoses of attention deficit/hyperactivity disorder and autism spectrum disorder. However, the factors accounting for these relationships are not well understood. The current review summarizes possible mechanisms identified in previous research and highlights areas for future investigation. Among the primary mechanisms studied to date, child sleep is the only factor that has been characterized in relative detail, with findings generally supporting the mediating role of sleep problems in the relationship between AD and psychological symptoms. There is substantial evidence suggesting a negative impact of child AD on parent mental health and the impact of parent mental health on child psychological functioning, although the latter has not been assessed specifically in populations of children with AD. There is also preliminary support for other mechanisms, including pruritus and pain, atopic comorbidities, social functioning, and systemic antihistamine use, in the development of mental health concerns in pediatric AD. Furthermore, research suggests the presence of bidirectional relationships between AD and psychological functioning via inflammatory responses to stress and impaired treatment adherence. Overall, significant additional research is needed to better characterize the nature and magnitude of the relationships among these multiple mechanisms and various psychosocial outcomes. Nevertheless, the findings to date support routine screening of psychological health in patients with AD as well as screening for potential risk factors, which may also serve as targets of therapeutic intervention.

The Influence of Caregiver Distress and Child Anxiety in Predicting Child Somatization in Youth with Functional Abdominal Pain Disorders

Pediatric functional abdominal pain disorders (FAPD) are associated with adverse outcomes including increased somatization (e.g., heightened physiological sensations that include gastroenterological and non-gastroenterological symptoms) and increased functional disability. Caregiver distress and child anxiety are separately associated with the adverse outcomes of pediatric FAPD. However, the cumulative role of caregiver (i.e., stress, anxiety, and depression) and child psychological functioning (anxiety) in relation to adverse outcomes associated with FAPD, and particularly somatization, is unclear. Thus, the present investigation sought to examine the role of caregiver distress and child anxiety in relation to pain-related functioning (i.e., somatization, pain intensity, functional disability) in youth with FAPD. Data were gathered as part of a larger study examining a psychological treatment for youth with FAPD. Participants (ages 9–14) with FAPD completed measures of child anxiety, pain, and pain-related functioning. Caregivers completed a measure of caregiver distress (e.g., stress, anxiety, depressive symptoms). Pearson correlations revealed significant positive associations between child anxiety and child functional disability. Additionally, caregiver anxiety, child anxiety, and child somatization were all significantly and positively correlated with one another. Therefore, we assessed whether child anxiety may potentially mediate the relationship between caregiver anxiety and child somatization in this cross-sectional study. The indirect association between caregiver anxiety and child somatization via child anxiety was not significant. Future research including longitudinal designs to further understand the relationship between caregiver anxiety, child anxiety, and child pain-related functioning, would enhance understanding of how these potentially modifiable psychological factors may impact adverse outcomes of FAPD.

The Prevalence, Comorbidity, Management and Costs of Irritable Bowel Syndrome

BACKGROUND

Insufficient data are available on the administrative incidence and prevalence of irritable bowel syndrome (IBS) in Germany, as well as on its comorbidities, diagnostic evaluation, treatment, and costs.

METHODS

We analyzed routine data from a statutory health insurance carrier with approximately eight million insurees. IBS was identified from the ICD-10 codes K58.0, K58.9, and F45.32 (outpatient care by a physician, outpatient and inpatient care in a hospital). The cumulative incidence for the year 2017 was determined by the exclusion of insurees who had carried the diagnosis of IBS in any of the preceding 12 years. The frequencies of comorbid diseases and of diagnostic and therapeutic measures were compared with those of persons in age- and sex- matched control groups without IBS.

RESULTS

In 2017, the administrative incidence of IBS was 0.36%, and its prevalence was 1.34%. Persons with IBS were often documented as having other gastrointes- tinal diseases, headache, back pain, and mental disorders. There was evidence for the insufficient use of ultrasound and colonoscopy and for the excessive use of computed tomography and magnetic resonance imaging for diagnostic evaluation. The costs of medical care for insurees with IBS in the year of their initial diagnosis were higher than those of other insurees without the diagnosis of IBD (€ 3770 vs. € 2788) and rose in each of the eight years preceding the initial diagnosis.

CONCLUSION

Patients with IBS in Germany are likely not receiving sufficient diag- nostic evaluation in conformity with the relevant guidelines. The high prevalence of comorbid mental disorders and other pain syndromes implies that the complaints of patients with IBS need to be more comprehensively evaluated and treated.

Cow's Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children?

The role and prevalence of cow's milk protein allergy (CMA) in functional gastrointestinal disorders remains unclear. The aim of this review is to update knowledge on the relationship between CMA and functional abdominal pain disorders (FAPDs) in children. Cochrane Database and Pubmed were searched from inception using general and specific terms for CMA and functional gastrointestinal disorders. CMA is reported as a predisposing or coexisting factor in a wide range of functional gastrointestinal disorders in infants and children. Pathogenesis of both conditions is complex and multiple mechanisms including dysmotility and hypersensitivity might contribute to the clinical manifestations. Data supporting the possible role of food allergies in the pathogenesis of FAPDs are limited. CMA may predispose to early life inflammation and visceral hypersensitivity, which in turn might manifest as FAPDs. The diagnosis of either CMA or FAPDs and distinction between them is challenging because of nonspecific and overlapping symptoms. Lack of accurate allergy tests in non-IgE (immunoglobulin E) mediated cases is also problematic. Oral food challenge, following an elimination diet, should be performed to diagnose a suspected non-IgE CMA allergy in children with FAPDs. In the management of FAPDs, an elimination diet should be considered for a limited period to verify if the symptoms improve or resolve.

Epidemiology of functional gastrointestinal disorders in children and adolescents: A systematic review

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.

Do Mothers Benefit from a Child-Focused Cognitive Behavioral Treatment (CBT) for Childhood Functional Abdominal Pain? A Randomized Controlled Pilot Trial

While the efficacy of cognitive-behavioral treatment (CBT) approaches for childhood functional abdominal pain (FAP) is well-established for child outcomes, only a few studies have reported on parent-specific outcomes. This randomized controlled pilot trial analyzed effects of a group CBT on maternal variables (i.e., pain-related behavior, worries and self-efficacy, as well as general psychosocial strain). Methods: The sample constituted of 15 mothers in the intervention group (IG) and 14 mothers in the waitlist control group (WLC). Outcome measures were assessed pre-treatment, post-treatment and at three months follow-up. Results: Analyses revealed significant, large changes in maladaptive maternal reactions related to the child's abdominal pain in the IG compared to the WLC-i.e., reduced attention (d = 0.95), medical help-seeking (d = 0.92), worries (d = 1.03), as well as a significant increase in behaviors that encourage the child's self-management (d = 1.03). In addition, maternal self-efficacy in dealing with a child's pain significantly increased in the IG as well (d = 0.92). Treatment effects emerged post-treatment and could be maintained until three months follow-up. There were no effects on general self-efficacy and maternal quality of life. Conclusion: While these results are promising, and underline the efficacy of the CBT approach for both the child and mothers, further studies, including long-term follow-ups, are warranted.

Pain Measurement in Children with Functional Abdominal Pain

Functional abdominal pain (FAP) occurs frequently in pediatric patients. Lacking clear biomarkers, clinicians and researchers must rely on patient reports of pain intensity. Presently, there are challenges affecting our ability to use existing measures of self-reported pediatric pain intensity. This report discusses those challenges, finding that: (a) inter-rater agreement of children's pain intensity is generally low; (b) typically used approaches to measuring outcomes may yield high levels of unreliable reports of improvement;

A cross sectional study between the prevalence of chronic pain and academic pressure in adolescents in China (Shanghai)

Background

The purpose of this study was to investigate the prevalence of four types of chronic pain (headache, abdominal pain, neck and shoulder pain (NSP), and low back pain (LBP)) and to explore the relationship between the prevalence of chronic pain and self-reported academic pressure in high school students in Shanghai, China.

Method

Three thousand students were randomly surveyed on related issues using a questionnaire, and the results were analyzed using a multivariate logistic regression model.

Results

Among the 2849 high school students who completed the questionnaire, the overall prevalence rates of headache, abdominal pain, NSP, and LBP were 30.3, 20.9, 32.8, and 41.1 %, respectively. The students in general experienced a heavy burden of learning, a high level of stress, and sleep deprivation, which were closely related to the four types of chronic pain.

Conclusion

Chronic pain is a common condition in Chinese adolescents and is closely related to self-reported academic pressure.

Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis

Objective

We aimed to review the literature regarding epidemiology of functional abdominal pain disorders in children and to assess its geographic, gender and age distribution including associated risk factors of developing functional abdominal pain.

Methods

The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsychInfo databases were systematically searched up to February 2014. Study selection criteria included: (1) studies of birth cohort, school based or general population samples (2) containing data concerning epidemiology, prevalence or incidence (3) of children aged 4-18 years (4) suffering from functional abdominal pain. Quality of studies was rated by a self-made assessment tool. A random-effect meta-analysis model was used to estimate the prevalence of functional abdominal pain in childhood.

Results

A total of 58 articles, including 196,472 children were included. Worldwide pooled prevalence for functional abdominal pain disorders was 13.5% (95% CI 11.8-15.3), of which irritable bowel syndrome was reported most frequently (8.8%, 95% CI 6.2-11.9). The prevalence across studies ranged widely from 1.6% to 41.2%. Higher pooled prevalence rates were reported in South America (16.8%) and Asia (16.5%) compared to Europe (10.5%). And a higher pooled prevalence was reported when using the Rome III criteria (16.4%, 95% CI 13.5-19.4). Functional abdominal pain disorders are shown to occur significantly more in girls (15.9% vs. 11.5%, pooled OR 1.5) and is associated with the presence of anxiety and depressive disorders, stress and traumatic life events.

Conclusion

Functional abdominal pain disorders are a common problem worldwide with irritable bowel syndrome as most encountered abdominal pain-related functional gastrointestinal disorder. Female gender, psychological disorders, stress and traumatic life events affect prevalence.

Associations between abdominal pain symptom dimensions and depression among adolescents

Background and aims

The prevalence of depression is increased among patients with abdominal pain (AP) and Irritable Bowel Syndrome (IBS), but little is known about this association among adolescents in the general population. Furthermore, there is considerable uncertainty about exactly which dimensions of AP and IBS are associated with depression.

The aims of this study were therefore: (a) to describe the prevalence of AP, IBS and depression in a representative sample of adolescents, (b) to analyze the association of AP and IBS with depression and lastly, (c) to analyze the relationship between depression and specific AP and IBS symptom dimensions, i.e. pain intensity, frequency, duration, and distribution, the presence of co-morbid non-abdominal pain, and the specific bowel systems distinguishing IBS from AP in general.

Materials and methods

Self-reported symptoms of AP (monthly or more frequent), IBS (Rome III 2006 criteria), co-morbid chronic pain and depression (The Short Mood and Feeling Questionnaire sum-score ≥11) were recorded among 961 adolescents (mean age 16.1 y and 48.8% girls), participating in a population based study in 2010–2011. Multiple logistic regression carried out to analyze the association of AP and IBS with depression, adjusting for sex, parental level of education (<college or ≥college) and co-morbid chronic pain. Among the AP cases, the association of different AP dimensions and of the specific bowel symptoms in IBS with depression were analyzed in a stepwise multiple logistic regression model.

Results

Monthly or more frequent AP was reported by 27% of the participants (n = 259) and 8.2% (n = 77) met the Rome III IBS criteria. The prevalence of depression was 11.5% (girls 15.9% and boys 7.3%). The prevalence of depression was higher among both AP and IBS cases compared to in controls (20.5%, 24.7% and 8.1% respectively), but there was no evidence that depression rates differed between the two case groups (IBS: OR = 2.5, 95% CI = 1.6–3.9; AP: OR = 2.4 with 95% CI = 1.3–4.4, after adjusting for sex, parental level of education and co-morbid chronic pain).

In the regression analyses within the AP group, the following symptom dimensions were independently associated with depression: severe abdominal pain intensity (OR = 4.0; CI = 1.5–10.7), widespread abdominal pain (OR = 5.5; CI = 2.6–11.8) and presence of co-morbid chronic pain (OR = 3.3; CI = 1.6–6.8). Sex, parental education, and other abdominal pain symptom dimensions, including bowel symptoms that distinguish IBS from AP, were not independently associated with depression.

Conclusions and implications

The prevalence of depression is considerably increased among adolescents with AP and IBS in the general population, in particular among those reporting severe, widespread abdominal pain, and co-morbid chronic pain. Evaluating these symptom dimensions may be of value for identifying subgroups adolescents with AP and IBS that have greater risk of depression.