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Merianos AL, Mahabee-Gittens EM. Tobacco Smoke Exposure and Gastrointestinal Problems Among US Children. Clin Pediatr (Phila) 2023; 62:1229-1236. [PMID: 36789912 PMCID: PMC10425569 DOI: 10.1177/00099228231154135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This study examined the association between home tobacco smoke exposure (TSE) status and gastrointestinal problems in the past 12 months among US children. We conducted a secondary analysis of the 2018-2019 National Survey of Children's Health cross-sectional data including 20 149 children aged 4 to 10 years. Weighted logistic regression models unadjusted and adjusted for child and family covariates were fitted. Overall, 12.3% of children had home thirdhand smoke (THS) exposure only and 1.8% had home secondhand smoke (SHS) and THS exposure. Unadjusted (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.32-2.20) and adjusted (adjusted odds ratio [AOR] = 1.51, 95% CI = 1.14-1.99) logistic regression results indicated that relative to children with no home TSE, children with home THS exposure only were at increased odds of having frequent or chronic difficulty with gastrointestinal problems over the past 12 months. Interventions are critically needed to promote smoking cessation among household members who live with children in order to reduce levels of SHS and THS in their homes.
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Affiliation(s)
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA
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Vernon-Roberts A, Alexander I, Day AS. Prevalence of Functional Gastrointestinal Disorders (Rome IV Criteria) among a Cohort of New Zealand Children. GASTROINTESTINAL DISORDERS 2023; 5:261-272. [DOI: 10.3390/gidisord5020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Functional gastrointestinal disorders (FGIDs) are characterised by recurring gastrointestinal symptoms that are not secondary to organic disease. FGIDs may cause reduced quality of life, with approximately 22% of children experiencing at least one FGID. This study aimed to assess FGID prevalence among children attending a tertiary care hospital in New Zealand (NZ). Methods: Children aged ≥ four years were prospectively recruited from Christchurch Hospital, NZ. Data were collected on demographics, medical history, gastrointestinal symptoms (Rome IV), and quality of life (EQ-5D-Y). An analysis was carried out using analysis of variance and the chi-squared test of independence. Results: The cohort included 156 children, with a mean age of 9.5 years (SD 3.3), 56% male. According to the Rome IV criteria, 29% experienced at least one FGID, most commonly functional constipation and functional dyspepsia. FGID symptoms were associated with Māori ethnicity (p = 0.012) and parental FGID (p < 0.001). Quality of life was lower in the FGID group in the domain ‘Feeling worried, sad, or unhappy’ (p = 0.002). Conclusion: the association of FGIDs with worse quality of life, in particular relating to worry and sadness, should highlight the importance of providing support to school age children experiencing FGID symptoms.
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Affiliation(s)
- Angharad Vernon-Roberts
- Department of Paediatrics, University of Otago, Christchurch, Christchurch 8011, New Zealand
| | - India Alexander
- Department of Paediatrics, University of Otago, Christchurch, Christchurch 8011, New Zealand
| | - Andrew S. Day
- Department of Paediatrics, University of Otago, Christchurch, Christchurch 8011, New Zealand
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Zia JK, Lenhart A, Yang PL, Heitkemper MM, Baker J, Keefer L, Saps M, Cuff C, Hungria G, Videlock EJ, Chang L. Risk Factors for Abdominal Pain-Related Disorders of Gut-Brain Interaction in Adults and Children: A Systematic Review. Gastroenterology 2022; 163:995-1023.e3. [PMID: 35716771 PMCID: PMC9509486 DOI: 10.1053/j.gastro.2022.06.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Many studies have assessed risk factors of irritable bowel syndrome (IBS) and other abdominal pain-related disorders of gut-brain interaction (AP-DGBI); however, the role of these factors is unclear due to heterogeneous study designs. The aim of this systematic review was to extensively evaluate the literature and determine clinical risk and protective factors for the presence and persistence of AP-DGBI in children and adults. METHODS A PubMed search identified studies investigating potential risk and protective factors for AP-DGBI in adults and children. Inclusion criteria included fully published studies with a control group; exclusion criteria included poor-quality studies (using a validated scale). For each factor, the proportion of studies that found the factor to be a risk factor, protective factor, or neither was summarized. The number of studies, diagnostic criteria, number of subjects, and average study quality rating provided further context. Whenever possible, a meta-analysis generated pooled odds ratios or mean difference. RESULTS The systematic review included 348 studies. Female sex, gastroenteritis, abuse, stress, psychological disorders, somatic symptoms, and poor sleep were consistent risk factors for developing AP-DGBI in adults and children. In adults, additional risk factors included obesity, smoking, and increased use of medical resources. Protective AP-DGBI factors in adults included social support and optimism; no studies for protective factors were found for children. CONCLUSIONS There are multiple risk factors for AP-DGBI in adults and children. These include female sex, gastroenteritis, abuse, stress, poor sleep, obesity, psychological disorders, and somatic symptoms. Additional studies are needed in children, on protective factors, and on factors associated with persistence of AP-DGBI.
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Affiliation(s)
- Jasmine K. Zia
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington
| | - Adrienne Lenhart
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Pei-Lin Yang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Margaret M. Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington
| | - Jason Baker
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan
| | - Laurie Keefer
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Miguel Saps
- Division of Pediatrics Gastroenterology, Hepatology and Nutrition, Miller School of Medicine, University of Miami, Miami, Florida
| | - Callie Cuff
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Gregory Hungria
- Division of Pediatrics Gastroenterology, Hepatology and Nutrition, Miller School of Medicine, University of Miami, Miami, Florida
| | - Elizabeth J. Videlock
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California.
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Vernon-Roberts A, Alexander I, Day AS. Systematic Review of Pediatric Functional Gastrointestinal Disorders (Rome IV Criteria). J Clin Med 2021; 10:5087. [PMID: 34768604 PMCID: PMC8585107 DOI: 10.3390/jcm10215087] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022] Open
Abstract
Functional gastrointestinal disorders (FGID) are common among children and may cause a significant symptom burden. The Rome criteria are symptom-based guidelines for the assessment of FGID among children and adults. The aim of this systematic review was to estimate the prevalence of FGID utilizing the revised Rome IV criteria. Nine health databases were searched. The inclusion criteria were: prospective FGID prevalence data using the Rome IV criteria for children up to 18 years, and the exclusion criteria were: cohorts with known gastrointestinal or organic conditions. The data were presented as a percentage of children experiencing at least one FGID, as well as in individual categories. The searches identified 376 papers, with 20 included in the final analysis, providing a pooled cohort of 18,935 children. The median prevalence of FGID for children aged up to four years was 22.2% (range 5.8-40%), and aged four-eighteen years was 21.8% (range 19-40%). The most common FGID for children aged 0-12 months was infant regurgitation, the most common FGID for those aged 13-48 months were functional constipation and cyclic vomiting, and, for those aged over four years, functional constipation, functional dyspepsia, and irritable bowel syndrome. This reported overall incidence of FGID may be used as a benchmark of normative data among the general population and comparative data for those with comorbid disease.
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Affiliation(s)
- Angharad Vernon-Roberts
- Department of Paediatrics, University of Otago Christchurch, Christchurch 8011, New Zealand; (I.A.); (A.S.D.)
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Höfel L, Draheim N, Haas JP, Ebinger F. [Medical pain care for children and adolescents with chronic pain in Germany : An inventory]. Schmerz 2020; 35:94-102. [PMID: 33112976 DOI: 10.1007/s00482-020-00510-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/13/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022]
Abstract
Chronic pain in children and adolescents is increasing in prevalence, affects the quality of life, predisposes to pain in adulthood and causes numerous contacts to the healthcare system. In contrast, the number of therapeutic offers tailored to the special needs of this age group is insufficient and confusing. The working group on pain in children and adolescents of the German Pain Society therefore documented appropriate facilities in a questionnaire survey carried out using a snowball system. The response rate of 27/109 questionnaires was low. Thus, the results may not be entirely representative. Nevertheless, the heterogeneity of the offers and in total an undersupply became very clear. In order to improve the care situation, joint efforts by the various pediatric subdisciplines dealing with pain, an increase in the number of child pain treatment centers and a better networking are necessary.
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Affiliation(s)
- Lea Höfel
- Zentrum für Schmerztherapie junger Menschen, Kinderklinik Garmisch-Partenkirchen gGmbH, Garmisch-Partenkirchen, Deutschland
| | - Nicole Draheim
- Zentrum für Schmerztherapie junger Menschen, Kinderklinik Garmisch-Partenkirchen gGmbH, Garmisch-Partenkirchen, Deutschland
| | - Johannes-Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Kinderklinik Garmisch-Partenkirchen gGmbH, Garmisch-Partenkirchen, Deutschland
| | - Friedrich Ebinger
- Klinik für Kinder- und Jugendmedizin, St. Vincenz-Krankenhaus, Husener Str. 81, 33098, Paderborn, Deutschland.
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Shulman RJ, Öhman L, Stridsberg M, Cain K, Simrén M, Heitkemper M. Evidence of increased fecal granins in children with irritable bowel syndrome and correlates with symptoms. Neurogastroenterol Motil 2019; 31:e13486. [PMID: 30298961 PMCID: PMC6296885 DOI: 10.1111/nmo.13486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/30/2018] [Accepted: 09/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Granins have been implicated in the pathophysiology of irritable bowel syndrome (IBS) in adults. We sought to determine whether fecal granins are altered in children with IBS and associated with symptoms. METHODS Children (7-12 years of age) with IBS and healthy controls (HC) kept daily pain and stool diaries for 2 weeks. Stool samples were analyzed for chromogranins A and B (CgA, CgB) and secretogranins II and III (SgII, SgIII). Children also completed psychological measures to assess anxiety, depression, somatization, and internalizing symptoms. KEY RESULTS Fecal CgB and SgIII concentrations were higher in all the boys (IBS plus HC, n = 48) than in all the girls (IBS plus HC, n = 75) (P = 0.02 and P = 0.046, respectively). CgA and SgIII were greater in children with IBS (n = 52) vs HC (n = 69) (P = 0.01, P = 0.017, respectively). CgB and SgII did not differ between groups. In children with IBS, the number of pain episodes per week and mean daily pain rating correlated positively with all four granins. The number of stools per day correlated positively with CgB and SgII, and the percent of diarrheal stools (6 or 7 on the Bristol Scale) correlated inversely with all four granins in boys but not in girls. Fecal granins did not correlate with psychological measures. CONCLUSIONS AND INFERENCES As measured by fecal granins, there is evidence of neuroimmune activation in children with IBS. Granins are related to abdominal pain symptoms, stooling frequency, and stool form in children with IBS. Sex influences the fecal concentration of CgB and SgIII.
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Affiliation(s)
- Robert J. Shulman
- Children’s Nutrition Research Center, Baylor College of Medicine, Department of Pediatrics, Houston, TX
| | - Lena Öhman
- University of Gothenburg, Göteborg, Sweden
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The Role of Fiber in the Treatment of Functional Gastrointestinal Disorders in Children. Nutrients 2018; 10:nu10111650. [PMID: 30400292 PMCID: PMC6267171 DOI: 10.3390/nu10111650] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 12/12/2022] Open
Abstract
We reviewed the available evidence on the role of fiber in the treatment of Functional Constipation (FC) and Irritable Bowel Syndrome (IBS) in children. The vast majority of toddlers and preschoolers do not consume enough fiber. Two of the most common reasons for consultation to a pediatric gastroenterology practice include FC and IBS. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines state that the evidence does not support the use of fiber supplements in the treatment of FC in children, and the Rome IV criteria do not recommend an increase in fiber consumption, in children with IBS. Despite this, in general practice, it is commonly recommended that children who experience constipation and IBS to increase their fiber intake. We conducted a systematic review of the available evidence on the role of fiber in the treatment of FC and IBS in children. Thirteen full-text articles with a total of seven hundred and twenty-three pediatric participants were included in this review. Three clinical trials found positive effects of dietary fiber for the management of IBS. Nine out of ten trials found fiber to be either more effective than placebo, or just as effective as laxative treatment. Most studies on the use of fiber for the treatment of FC and IBS have shown its benefit. However, due to the heterogeneity in study design, length of treatment, outcome measures, and amount and type of fiber, we were unable to make a definitive recommendation supporting the use of fiber for the treatment of FC and IBS in children.
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Saps M, Velasco-Benitez CA, Langshaw AH, Ramírez-Hernández CR. Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents: Comparison Between Rome III and Rome IV Criteria. J Pediatr 2018; 199:212-216. [PMID: 29747935 DOI: 10.1016/j.jpeds.2018.03.037] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/24/2018] [Accepted: 03/15/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the prevalence of functional gastrointestinal disorders (FGIDs) in children using Rome IV criteria and to compare the prevalence of FGIDs using Rome IV with Rome III criteria. STUDY DESIGN This was a cross-sectional study using the same methods as our previous study on FGIDs in Colombia. The Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV version was translated into Spanish, followed by reverse translation. Terms were adjusted to children's language by using focus groups of children. School children aged 8-18 years completed the Spanish version of the Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV. Data were compared with Rome III data. RESULTS In total, there were 3567 children (from 6 cities): 1071 preadolescents (8-12 years) and 2496 adolescents (13-18 years). Average age 13.7 ± 2.4 years (56.5% girls). A total of 21.2% of children had at least 1 FGID. Prevalence was significantly lower than Rome III (P = .004). Similar to Rome III, disorders of defecation were the most common, followed by abdominal pain, and disorders of nausea and vomiting. Prevalence of abdominal migraine decreased (P = .000) and functional dyspepsia increased (P = .000). The new diagnoses functional vomiting and functional nausea were present in 0.7% of all children. CONCLUSIONS The application of the Rome IV criteria resulted in a significantly lower prevalence of FGIDs; however, the relative frequency of each subgroup of disorders did not change. New diagnoses of the Rome IV criteria were present in a small percentage of children.
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Affiliation(s)
- Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL.
| | | | - Amber Hamid Langshaw
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL
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9
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Saps M, Langshaw A. An Ounce of Prevention May Be Worth Many Pounds of Cure. J Pediatr 2018; 195:13-15. [PMID: 29336792 DOI: 10.1016/j.jpeds.2017.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/13/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Miguel Saps
- Division of Pediatrics Gastroenterology, Hepatology & Nutrition Department of Pediatrics University of Miami Miller School of Medicine Miami, Florida.
| | - Amber Langshaw
- Division of Pediatrics Gastroenterology, Hepatology & Nutrition Department of Pediatrics University of Miami Miller School of Medicine Miami, Florida
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Abstract
OBJECTIVES The aim of the study was to establish the prevalence of abdominal pain (AP) in school children in Pasto (Colombia) and determine the effect of AP on their daily activities; and compare the prevalence of AP and other gastrointestinal symptoms between school children from Pasto and Chicago. METHODS Fourth- and fifth-grade students from a public school and a private school in Colombia were invited to participate in a prospective study using the same methods and questionnaires (Spanish version) as a previous study conducted in Chicago schools. Children completed weekly confidential surveys for 8 consecutive weeks. RESULTS A total of 332 children participated in the study (40% girls, mean age 9.97 years, median 10, range 8-12 years): public school (288), private school (44). A total of 2425 surveys were analyzed. Out of 2656 possible weekly surveys (332 children × 8 weeks), 91.3% were completed. Overall weekly prevalence of gastrointestinal symptoms: AP (39%), nausea (29.5%), constipation (14%), diarrhea (10.5%), vomiting (9%). Children with AP reported interference with activities: gym (21.9%), school (17.3%), difficulty sleeping (13.7%), and social activities (12.6%). Out of all children, 8.4% sought medical attention for AP during the study period. CONCLUSIONS Gastrointestinal symptoms are common in school-aged children in Colombia and interfere with both daily activities and school attendance. The prevalence of AP, diarrhea, and vomiting found in the present study was similar to published prevalence of American children using similar methods.
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Huguet A, Olthuis J, McGrath PJ, Tougas ME, Hayden JA, Stinson JN, Chambers CT. Systematic review of childhood and adolescent risk and prognostic factors for persistent abdominal pain. Acta Paediatr 2017; 106:545-553. [PMID: 28036098 DOI: 10.1111/apa.13736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 12/02/2016] [Accepted: 12/28/2016] [Indexed: 12/26/2022]
Abstract
This review aimed to identify childhood and adolescence risk and prognostic factors associated with onset and persistence of persistent abdominal pain and related disability and assess quality of the evidence. While findings suggest a possible role for negative emotional symptoms and parental mental health as risk and prognostic factors for onset and persistence of persistent abdominal pain, the evidence is of poor quality overall and nonexistent when it comes to prognostic factors associated with disability. CONCLUSION Further research is needed to increase confidence in existing evidence and to explore new factors. This research will inform prevention.
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Affiliation(s)
- A Huguet
- IWK Health Centre; Halifax NS Canada
- Department of Community Health and Epidemiology; Dalhousie University; Halifax NS Canada
| | - J Olthuis
- Department of Psychology; University of New Brunswick; Federicton NB Canada
| | - PJ McGrath
- IWK Health Centre; Halifax NS Canada
- Department of Community Health and Epidemiology; Dalhousie University; Halifax NS Canada
- Departments of Pediatrics and Psychiatry; Dalhousie University; Halifax NS Canada
| | - ME Tougas
- Department of Psychology & Neuroscience; Dalhousie University; Halifax NS Canada
| | - JA Hayden
- Department of Community Health and Epidemiology; Dalhousie University; Halifax NS Canada
| | - JN Stinson
- Child Health Evaluative Sciences; The Hospital for Sick Children; Toronto ON Canada
| | - CT Chambers
- IWK Health Centre; Halifax NS Canada
- Departments of Pediatrics and Psychiatry; Dalhousie University; Halifax NS Canada
- Department of Psychology & Neuroscience; Dalhousie University; Halifax NS Canada
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Zhang Z, Li M, Chen F, Li L, Liu J, Li Z, Ji R, Zuo X, Li Y. Probe-Based Confocal Laser Endomicroscopy for Imaging TRAIL-Expressing Mesenchymal Stem Cells to Monitor Colon Xenograft Tumors In Vivo. PLoS One 2016; 11:e0162700. [PMID: 27617958 PMCID: PMC5019474 DOI: 10.1371/journal.pone.0162700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/27/2016] [Indexed: 12/13/2022] Open
Abstract
Introduction Mesenchymal stem cells (MSCs) can serve as vehicles for therapeutic genes. However, little is known about MSC behavior in vivo. Here, we demonstrated that probe-based confocal laser endomicroscopy (pCLE) can be used to track MSCs in vivo and individually monitor tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) gene expression within carcinomas. Methods Isolated BALB/c nu/nu mice MSCs (MSCs) were characterized and engineered to co-express the TRAIL and enhanced green fluorescent protein (EGFP) genes. The number of MSCs co-expressing EGFP and TRAIL (TRAIL-MSCs) at tumor sites was quantified with pCLE in vivo, while their presence was confirmed using immunofluorescence (IF) and quantitative polymerase chain reaction (qPCR). The therapeutic effects of TRAIL-MSCs were evaluated by measuring the volumes and weights of subcutaneous HT29-derived xenograft tumors. Results Intravital imaging of the subcutaneous xenograft tumors revealed that BALB/c mice treated with TRAIL-MSCs exhibited specific cellular signals, whereas no specific signals were observed in the control mice. The findings from the pCLE images were consistent with the IF and qPCR results. Conclusion The pCLE results indicated that endomicroscopy could effectively quantify injected MSCs that homed to subcutaneous xenograft tumor sites in vivo and correlated well with the therapeutic effects of the TRAIL gene. By applying pCLE for the in vivo monitoring of cellular trafficking, stem cell-based anticancer gene therapeutic approaches might be feasible and attractive options for individualized clinical treatments.
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Affiliation(s)
- Zhen Zhang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Ming Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Feixue Chen
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Lixiang Li
- Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Jun Liu
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Rui Ji
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiuli Zuo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yanqing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- * E-mail:
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Carlson MJ, Moore CE, Tsai CM, Shulman RJ, Chumpitazi BP. Child and parent perceived food-induced gastrointestinal symptoms and quality of life in children with functional gastrointestinal disorders. J Acad Nutr Diet 2014; 114:403-413. [PMID: 24360501 PMCID: PMC4267718 DOI: 10.1016/j.jand.2013.10.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 10/02/2013] [Indexed: 12/17/2022]
Abstract
It is unknown whether children with functional gastrointestinal (GI) disorders identify specific foods that exacerbate their GI symptoms. The objectives of this study were to determine the perceived role of food on GI symptoms and to determine the impact of food-induced symptoms on quality of life (QOL) in children with functional GI disorders. Between August and November 2010, 25 children ages 11 to 17 years old with functional GI disorders and a parent completed a food symptom association questionnaire and validated questionnaires assessing FGID symptoms and QOL. In addition, children completed a 24-hour food recall, participated in focus groups to identify problematic foods and any coping strategies, and discussed how their QOL was affected. Statistical analyses were conducted using χ2, t test, Mann-Whitney U test, Wilcoxon signed rank, and Spearman's ρ. Children identified a median of 11 (range=2 to 25) foods as exacerbating a GI symptom, with the most commonly identified foods being spicy foods, cow's milk, and pizza. Several coping strategies were identified, including consuming smaller portions, modifying foods, and avoiding a median of 8 (range=1 to 20) foods. Children reported that food-induced symptoms interfered with school performance, sports, and social activities. Although the parent's assessment of their child's QOL negatively correlated with the number of perceived symptom-inducing foods in their child, this relationship was not found in the children. Findings suggest that specific foods are perceived to exacerbate GI symptoms in children with functional GI disorders. In addition, despite use of several coping strategies, food-induced symptoms can adversely impact children's QOL in several important areas.
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Warschburger P, Hänig J, Friedt M, Posovszky C, Schier M, Calvano C. Health-related quality of life in children with abdominal pain due to functional or organic gastrointestinal disorders. J Pediatr Psychol 2013; 39:45-54. [PMID: 24055816 DOI: 10.1093/jpepsy/jst070] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Comparing health-related quality of life (HRQOL) in children suffering from functional and organic gastrointestinal disorders and to identify predictors for HRQOL. METHODS Children with functional (n = 70) and organic (n = 100) gastrointestinal disorders, aged 8-18 years and referred to a pediatric gastroenterologist, completed questionnaires assessing pain severity, coping, and HRQOL. RESULTS The sample reported low HRQOL scores, even significantly lower compared with reference values of chronically ill children, derived from normative data of KINDL-R, a generic QOL questionnaire. HRQOL was not significantly associated with age, gender, duration of pain, and diagnosis (functional gastrointestinal disorder vs. organic gastrointestinal disorder). Pain severity and catastrophizing were significantly associated with HRQOL, with catastrophizing fully mediating the relationship between pain and HRQOL. CONCLUSION The emotional burden associated with chronic abdominal pain-regardless of its cause-is enormous. Interventions should target the children's coping strategies, as catastrophizing seems to be the causal link between pain and HRQOL.
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Affiliation(s)
- Petra Warschburger
- Counseling Psychology, Department of Psychology, Potsdam University, Karl- Liebknecht- Str. 24/25, 14476 Potsdam, Germany.
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Williams AE, Heitkemper M, Self MM, Czyzewski DI, Shulman RJ. Endogenous inhibition of somatic pain is impaired in girls with irritable bowel syndrome compared with healthy girls. THE JOURNAL OF PAIN 2013; 14:921-30. [PMID: 23685184 PMCID: PMC3759538 DOI: 10.1016/j.jpain.2013.03.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/27/2013] [Accepted: 03/11/2013] [Indexed: 12/17/2022]
Abstract
UNLABELLED Endogenous pain inhibition is often deficient in adults with chronic pain conditions including irritable bowel syndrome (IBS). It is unclear whether deficiencies in pain inhibition are present in young children with IBS. The present study compared endogenous pain inhibition, somatic pain threshold, and psychosocial distress in young girls with IBS versus controls. Girls with IBS did not show significant endogenous pain inhibition of heat pain threshold during a cold-pressor task in contrast to controls, who had significant pain inhibition. Girls with IBS did not differ from peers on measures of somatic pain but had more symptoms of depression, somatization, and anxiety than controls. When psychological variables were included as covariates, the difference in pain inhibition was no longer significant, although poor achieved power limits interpretation of these results. Higher-order cognitive processes including psychological variables may be contributing to observed pain inhibition. In girls with IBS, pain inhibition was positively related to the number of days without a bowel movement. To our knowledge, this is the first study to demonstrate deficiencies of endogenous pain inhibition in young children with IBS. Findings have implications for better understanding of onset and maintenance of IBS and other chronic pain conditions. PERSPECTIVE This study found that young girls with IBS have deficient endogenous pain inhibition compared to healthy girls, which is consistent with the literature on adults. This information can facilitate clinicians in identification of risk factors for onset/maintenance of IBS and other chronic pain conditions.
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Affiliation(s)
- Amy E Williams
- Department of Psychiatry & Behavioral Neurosciences, Loyola University Medical Center, Maywood, Illinois.
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16
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Bonilla S, Saps M. Early life events predispose the onset of childhood functional gastrointestinal disorders. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2013; 78:82-91. [PMID: 23578567 DOI: 10.1016/j.rgmx.2013.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 02/08/2013] [Accepted: 02/14/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) are common digestive conditions characterized by chronic or recurrent symptoms in the absence of a clearly recognized gastrointestinal etiology. The biopsychosocial model, the most accepted concept explaining chronic pain conditions, proposes that the interplay of multiple factors such as genetic susceptibility, early life experiences, sociocultural issues, and coping mechanisms affect children at different stages of their lives leading to the development of different pain phenotypes and pain behaviors. Early life events including gastrointestinal inflammation, trauma, and stress may result in maladaptive responses that could lead to the development of chronic pain conditions such as FGIDs. AIMS In this review, we discuss novel findings from studies regarding the long-term effect of early life events and their relationship with childhood chronic abdominal pain and FGIDs. METHODS A bibliographic search of the PubMed database was conducted for articles published over the last 20 years using the keywords: "Functional gastrointestinal disorders", "chronic abdominal pain", "chronic pain", "gastrointestinal inflammation", and "early life events". Forty-three articles were chosen for review. RESULTS Based on the current evidence, events that take place early in life predispose children to the development of chronic abdominal pain and FGIDs. Conditions that have been studied include cow's milk protein hypersensitivity, pyloric stenosis, gastrointestinal infections, and Henoch-Schonlein purpura, among others. CONCLUSIONS Early events may play an important role in the complex pathogenesis of functional gastrointestinal conditions. Timely intervention may have a critical impact on the prevention of this group of chronic incapacitating conditions.
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Affiliation(s)
- S Bonilla
- Division of Pediatric Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA.
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Jarrett M, Heitkemper M, Czyzewski D, Zeltzer L, Shulman RJ. Autonomic nervous system function in young children with functional abdominal pain or irritable bowel syndrome. THE JOURNAL OF PAIN 2012; 13:477-84. [PMID: 22520688 DOI: 10.1016/j.jpain.2012.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 02/16/2012] [Accepted: 02/21/2012] [Indexed: 02/08/2023]
Abstract
UNLABELLED Adults with irritable bowel syndrome (IBS) have been reported to have alterations in autonomic nervous system function as measured by vagal activity via heart rate variability. Whether the same is true for children is unknown. We compared young children 7 to 10 years of age with functional abdominal pain (FAP) or IBS to healthy children (HC) and explored the relationship of vagal activity and sympathovagal balance to psychological distress and stool type. Children completed questionnaires, kept a 2-week pain/stool diary, and wore a 24-hour Holter monitor to assess vagal activity. Group comparisons on vagal activity were controlled for age and body mass index. Indicators of vagal activity and sympathovagal balance did not differ between FAP/IBS children (70 girls, 30 boys) and HC (44 girls, 18 boys). Psychological distress measures were generally higher in FAP/IBS than HC, primarily in girls. Exploratory analyses suggest a potential negative correlation between vagal activity and psychological distress in FAP/IBS girls but not boys. In contrast to reports in women, no differences were found in vagal activity between FAP/IBS and HC. Preliminary findings suggest that in girls with FAP/IBS there is an inverse relationship between vagal activity and psychological distress. PERSPECTIVE The results from this study suggest a possible relationship between emotional state and vagal activity in prepubertal girls (but not boys) with FAP/IBS. Age and/or duration of symptoms may explain our contrasting findings versus adults with IBS.
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Affiliation(s)
- Monica Jarrett
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington, USA
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18
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Saulnier DM, Riehle K, Mistretta TA, Diaz MA, Mandal D, Raza S, Weidler EM, Qin X, Coarfa C, Milosavljevic A, Petrosino JF, Highlander S, Gibbs R, Lynch SV, Shulman RJ, Versalovic J. Gastrointestinal microbiome signatures of pediatric patients with irritable bowel syndrome. Gastroenterology 2011; 141:1782-91. [PMID: 21741921 PMCID: PMC3417828 DOI: 10.1053/j.gastro.2011.06.072] [Citation(s) in RCA: 485] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 06/15/2011] [Accepted: 06/24/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The intestinal microbiomes of healthy children and pediatric patients with irritable bowel syndrome (IBS) are not well defined. Studies in adults have indicated that the gastrointestinal microbiota could be involved in IBS. METHODS We analyzed 71 samples from 22 children with IBS (pediatric Rome III criteria) and 22 healthy children, ages 7-12 years, by 16S ribosomal RNA gene sequencing, with an average of 54,287 reads/stool sample (average 454 read length = 503 bases). Data were analyzed using phylogenetic-based clustering (Unifrac), or an operational taxonomic unit (OTU) approach using a supervised machine learning tool (randomForest). Most samples were also hybridized to a microarray that can detect 8741 bacterial taxa (16S rRNA PhyloChip). RESULTS Microbiomes associated with pediatric IBS were characterized by a significantly greater percentage of the class γ-proteobacteria (0.07% vs 0.89% of total bacteria, respectively; P < .05); 1 prominent component of this group was Haemophilus parainfluenzae. Differences highlighted by 454 sequencing were confirmed by high-resolution PhyloChip analysis. Using supervised learning techniques, we were able to classify different subtypes of IBS with a success rate of 98.5%, using limited sets of discriminant bacterial species. A novel Ruminococcus-like microbe was associated with IBS, indicating the potential utility of microbe discovery for gastrointestinal disorders. A greater frequency of pain correlated with an increased abundance of several bacterial taxa from the genus Alistipes. CONCLUSIONS Using 16S metagenomics by PhyloChip DNA hybridization and deep 454 pyrosequencing, we associated specific microbiome signatures with pediatric IBS. These findings indicate the important association between gastrointestinal microbes and IBS in children; these approaches might be used in diagnosis of functional bowel disorders in pediatric patients.
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Affiliation(s)
- Delphine M. Saulnier
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX,NIZO, Ede, The Netherlands
| | - Kevin Riehle
- Department of Molecular & Human Genetics, and Baylor College of Medicine, Houston, TX,Bioinformatics Research Laboratory, Baylor College of Medicine, Houston, TX
| | - Toni-Ann Mistretta
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Maria-Alejandra Diaz
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Debasmita Mandal
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Sabeen Raza
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Children's Nutrition Research Center, Houston, TX
| | - Xiang Qin
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Cristian Coarfa
- Department of Molecular & Human Genetics, and Baylor College of Medicine, Houston, TX,Bioinformatics Research Laboratory, Baylor College of Medicine, Houston, TX
| | - Aleksandar Milosavljevic
- Department of Molecular & Human Genetics, and Baylor College of Medicine, Houston, TX,Bioinformatics Research Laboratory, Baylor College of Medicine, Houston, TX
| | - Joseph F. Petrosino
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX,Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX
| | - Sarah Highlander
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Richard Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Susan V. Lynch
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX,Children's Nutrition Research Center, Houston, TX
| | - James Versalovic
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX,Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX,Department of Molecular & Human Genetics, and Baylor College of Medicine, Houston, TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX,Department of Pathology, Texas Children's Hospital, Houston, TX
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[Hypnotherapeutic treatment approaches in children and adolescents suffering from functional abdominal pain]. Prax Kinderpsychol Kinderpsychiatr 2011; 60:386-400. [PMID: 21751534 DOI: 10.13109/prkk.2011.60.5.386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Functional abdominal pain significantly impairs day-to-day function. It is one of the most frequent somatic complaints among children and adolescents. For most of those affected, despite some indication of their possible presence, physiological factors fail to explain the symptoms adequately. The increased level of psychological symptoms suggests that the focus should be on behavioural and psychological aspects. Brief hypnotherapeutic treatment methods show encouraging results. A review of the current literature; potential mechanisms of effective intervention and their practical applicability are discussed.
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Francavilla R, Miniello V, Magistà AM, De Canio A, Bucci N, Gagliardi F, Lionetti E, Castellaneta S, Polimeno L, Peccarisi L, Indrio F, Cavallo L. A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics 2010; 126:e1445-52. [PMID: 21078735 DOI: 10.1542/peds.2010-0467] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Our aim was to determine whether Lactobacillus rhamnosus GG (LGG) relieves symptoms in children with recurrent abdominal pain. PATIENTS AND METHODS A total of 141 children with irritable bowel syndrome (IBS) or functional pain were enrolled in 9 primary care sites and a referral center. Children entered a randomized, double-blind, placebo-controlled trial and received LGG or placebo for 8 weeks and entered follow-up for 8 weeks. The primary outcome was overall pain at the end of the intervention period. At entry and at the end of the trial, children underwent a double-sugar intestinal permeability test. RESULTS Compared with baseline, LGG, but not placebo, caused a significant reduction of both frequency (P < .01) and severity (P < .01) of abdominal pain. These differences still were significant at the end of follow-up (P < .02 and P < .001, respectively). At week 12, treatment success was achieved in 48 children in the LGG group compared with 37 children in the placebo group (P < .03); this difference still was present at the end of follow-up (P < .03). At entry, 59% of the children had abnormal results from the intestinal permeability test; LGG, but not placebo, determined a significant decrease in the number of patients with abnormal results from the intestinal permeability testing (P < .03). These effects mainly were in children with IBS. CONCLUSIONS LGG significantly reduces the frequency and severity of abdominal pain in children with IBS; this effect is sustained and may be secondary to improvement of the gut barrier.
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Affiliation(s)
- Ruggiero Francavilla
- Department of Developmental Biomedicine, Gastroenterology Section, University of Bari, Bari, Italy.
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Ammoury RF, Pfefferkorn MDR, Croffie JM. Functional gastrointestinal disorders: past and present. World J Pediatr 2009; 5:103-12. [PMID: 19718531 DOI: 10.1007/s12519-009-0021-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 02/03/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic abdominal pain is a common complaint in childhood and adolescence. Despite decades of clinical observations and research, it still poses a challenge to pediatric health care professionals. The aim of this review is to highlight the epidemiology of pediatric chronic abdominal pain and to describe the pathogenesis of this disorder, its clinical manifestations, evaluation and therapeutic options. DATA SOURCES Articles on chronic abdominal pain in the recent years from PubMed, MEDLINE, and reference textbooks were reviewed. RESULTS Chronic abdominal pain, a functional gastrointestinal disorder (FGID), is a multifactorial condition that results from a complex interaction between psychosocial and physiologic factors via the brain-gut axis. A thorough history coupled with a complete physical examination and normal screening studies rule out an organic cause in 95% of the cases. It is highly important for the physician to establish a trusting relationship with the child and parents because successful treatment including modification of physical and psychological stress factors, dietary changes, and drug therapy depends greatly on education, reassurance and active psychological support. CONCLUSIONS FGIDs are a cause of great anxiety, distress and morbidity in children as well as adults. As our understanding of these conditions improves, our therapeutic interventions will progress not only to overcome them but also to intervene early in the disease course so as to limit long-term impact.
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Affiliation(s)
- Rana Fayez Ammoury
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine, Indianapolis, IN, USA.
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22
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Shulman RJ, Eakin MN, Czyzewski DI, Jarrett M, Ou CN. Increased gastrointestinal permeability and gut inflammation in children with functional abdominal pain and irritable bowel syndrome. J Pediatr 2008; 153:646-50. [PMID: 18538790 PMCID: PMC2614282 DOI: 10.1016/j.jpeds.2008.04.062] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 04/03/2008] [Accepted: 04/24/2008] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine gastrointestinal (GI) permeability and fecal calprotectin concentration in children 7 to 10 years of age with functional abdominal pain and irritable bowel syndrome (FAP/IBS) versus control subjects and ascertain potential relationships with pain symptoms and stooling. STUDY DESIGN GI permeability and fecal calprotectin concentration were measured. Children kept a 2-week diary of pain episodes and stooling pattern. RESULTS Proximal GI permeability was greater in the FAP/IBS group (n = 93) compared with control subjects (n = 52) (0.59 +/- 0.50 vs 0.36 +/- 0.26, respectively; mean +/- SD; P < .001) as was colonic permeability (1.01 +/- 0.67 vs 0.81 +/- 0.43, respectively; P < .05). Gastric and small intestinal permeability were similar. Fecal calprotectin concentration was greater in children with FAP/IBS compared with control children (65.5 +/- 75.4 microg/g stool vs 43.2 +/- 39.4, respectively; P < .01). Fecal calprotectin concentration correlated with pain interference with activities (P = .01, r(2) = 0.36). There was no correlation between GI permeability and pain related symptoms. Neither permeability nor fecal calprotectin correlated with stool form. CONCLUSIONS Children with FAP/IBS have evidence of increased GI permeability and low-grade GI inflammation, with the latter relating to the degree to which pain interferes with activities.
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Affiliation(s)
- Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Wilmington, DE,Children’s Nutrition Research Center, Wilmington, DE
| | | | - Danita I. Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Wilmington, DE
| | - Monica Jarrett
- Menninger Department of Psychiatry and Behavioral Sciences, University of Washington, Department of Biobehavioral Nursing and Health Systems, Seattle, Washington
| | - Ching-Nan Ou
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Wilmington, DE
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23
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Czyzewski DI, Eakin MN, Lane MM, Jarrett M, Shulman RJ, M D. Recurrent Abdominal Pain in Primary and Tertiary Care: Differences and Similarities. CHILDRENS HEALTH CARE 2007; 36:137-153. [PMID: 20357915 DOI: 10.1080/02739610701334970] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Masters KS. Recurrent Abdominal Pain, Medical Intervention, and Biofeedback: What Happened to the Biopsychosocial Model? Appl Psychophysiol Biofeedback 2006; 31:155-65. [PMID: 16868844 DOI: 10.1007/s10484-006-9016-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Recurrent abdominal pain (RAP) is a significant and common problem among pediatric populations. Based on results from randomized controlled trials there are no established efficacious treatments for this disorder. Biofeedback (BFB) and other psychological treatments offer logically appealing alternatives or adjuncts to medical interventions and there is some evidence to support their use. This paper presents a typical case of RAP that exemplifies how the lack of integration of the biopsychosocial model may result in less than optimal treatment. Specifically, it demonstrates that the patient was exposed to potentially risky treatments that lack evidence to support their use and were not beneficial. Although there was evidence of psychological involvement early in the treatment, this was only attended to following numerous medical trials and exploratory surgery over three years. The patient was finally referred for BFB and during a course of seven sessions over five months that variously included heart rate variability and skin temperature feedback along with extensive home practice of paced breathing and hand warming the patient achieved significant symptom reduction and improved coping abilities. This case vividly illustrates the need for multidisciplinary collaboration and full implementation and integration of the biopsychosocial model of health and illness.
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Affiliation(s)
- Kevin S Masters
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, USA.
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