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Chogle A, El-Chammas K, Santucci N, Grimm M, Dorfman L, Graham K, Kelly DR, Dranove JE, Rosen R, Nurko S, Croffie J, Balakrishnan K, Chiou EH, Zhang L, Simpson P, Karrento K. A multicenter registry study on percutaneous electrical nerve field stimulation for pediatric disorders of gut-brain interaction. J Pediatr Gastroenterol Nutr 2024; 78:817-826. [PMID: 38451058 DOI: 10.1002/jpn3.12174] [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] [Received: 08/02/2023] [Revised: 01/02/2024] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Percutaneous electrical nerve field stimulation (PENFS) has demonstrated promise in single-center trials for pediatric abdominal pain-related disorders of gut-brain interaction (DGBI). Our aim was to explore efficacy of PENFS as standard therapy for DGBI in a registry involving multiple pediatric gastroenterology referral centers. METHODS This was a multicenter, prospective open-label registry of children (8-18 years) undergoing PENFS for DGBI at seven tertiary care gastroenterology clinics. DGBI subtypes were classified by Rome IV criteria. Parents and patients completed Abdominal Pain Index (API), Nausea Severity Scale (NSS), and Functional Disability Inventory (FDI) questionnaires before, during therapy and at follow-up visits up to 1 year later. RESULTS A total of 292 subjects were included. Majority (74%) were female with median (interquartile range [IQR]) age 16.3 (14.0, 17.7) years. Most (68%) met criteria for functional dyspepsia and 61% had failed ≥4 pharmacologic therapies. API, NSS, and FDI scores showed significant declines within 3 weeks of therapy, persisting long-term in a subset. Baseline (n = 288) median (IQR) child-reported API scores decreased from 2.68 (1.84, 3.58) to 1.99 (1.13, 3.27) at 3 weeks (p < 0.001) and 1.81 (0.85, 3.20) at 3 months (n = 75; p < 0.001). NSS scores similarly improved from baseline, persisting at three (n = 74; p < 0.001) and 6 months later (n = 55; p < 0.001). FDI scores displayed similar reductions at 3 months (n = 76; p = 0.01) but not beyond. Parent-reported scores were consistent with child reports. CONCLUSIONS This large, comprehensive, multicenter registry highlights efficacy of PENFS for gastrointestinal symptoms and functionality for pediatric DGBI.
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Affiliation(s)
- Ashish Chogle
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Orange County, Orange, California, USA
| | - Khalil El-Chammas
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Neha Santucci
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Monica Grimm
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lev Dorfman
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kahleb Graham
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel R Kelly
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Jason E Dranove
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Rachel Rosen
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Joseph Croffie
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keshawadhana Balakrishnan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Eric H Chiou
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Liyun Zhang
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katja Karrento
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Tarbell SE, Olufs EL, Fischer PR, Chelimsky G, Numan MT, Medow M, Abdallah H, Ahrens S, Boris JR, Butler IJ, Chelimsky TC, Coleby C, Fortunato JE, Gavin R, Gilden J, Gonik R, Klaas K, Marsillio L, Marriott E, Pace LA, Pianosi P, Simpson P, Stewart J, Van Waning N, Weese-Mayer DE. Assessment of comorbid symptoms in pediatric autonomic dysfunction. Clin Auton Res 2023; 33:843-858. [PMID: 37733160 DOI: 10.1007/s10286-023-00984-4] [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: 08/07/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Pediatric patients with autonomic dysfunction and orthostatic intolerance (OI) often present with co-existing symptoms and signs that might or might not directly relate to the autonomic nervous system. Our objective was to identify validated screening instruments to characterize these comorbidities and their impact on youth functioning. METHODS The Pediatric Assembly of the American Autonomic Society reviewed the current state of practice for identifying symptom comorbidities in youth with OI. The assembly includes physicians, physician-scientists, scientists, advanced practice providers, psychologists, and a statistician with expertise in pediatric disorders of OI. A total of 26 representatives from the various specialties engaged in iterative meetings to: (1) identify and then develop consensus on the symptoms to be assessed, (2) establish committees to review the literature for screening measures by member expertise, and (3) delineate the specific criteria for systematically evaluating the measures and for making measure recommendations by symptom domains. RESULTS We review the measures evaluated and recommend one measure per system/concern so that assessment results from unrelated clinical centers are comparable. We have created a repository to apprise investigators of validated, vetted assessment tools to enhance comparisons across cohorts of youth with autonomic dysfunction and OI. CONCLUSION This effort can facilitate collaboration among clinical settings to advance the science and clinical treatment of these youth. This effort is essential to improving management of these vulnerable patients as well as to comparing research findings from different centers.
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Affiliation(s)
- Sally E Tarbell
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Erin L Olufs
- Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Philip R Fischer
- Mayo Clinic, Rochester, MN, USA
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE
- Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE
| | - Gisela Chelimsky
- Children's Hospital of Richmond, Richmond, VA, USA
- Virginia Commonwealth University Health, Richmond, VA, USA
| | | | | | | | | | | | - Ian J Butler
- University of Texas McGovern Medical School, Houston, TX, USA
| | | | | | - John E Fortunato
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Raewyn Gavin
- Starship Children's Hospital, Auckland, New Zealand
| | - Janice Gilden
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Renato Gonik
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Lauren Marsillio
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
- Stanley Manne Research Institute, Chicago, IL, USA
| | - Erin Marriott
- American Family Children's Hospital, Madison, WI, USA
| | | | - Paul Pianosi
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | | | - Debra E Weese-Mayer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
- Stanley Manne Research Institute, Chicago, IL, USA
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Santucci NR, Sahay R, El-Chammas KI, Graham K, Wheatley M, Vandenbrink M, Hardy J, Fei L. Percutaneous electrical nerve field stimulation compared to standard medical therapy in adolescents with functional abdominal pain disorders. FRONTIERS IN PAIN RESEARCH 2023; 4:1251932. [PMID: 37795388 PMCID: PMC10545961 DOI: 10.3389/fpain.2023.1251932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Standard medical therapy (SMT) in children with functional abdominal pain disorders (FAPD) includes cyproheptadine and amitriptyline. While percutaneous electrical nerve field stimulation (PENFS) has shown benefit, no study has compared outcomes of PENFS to SMT. We aimed to examine changes in abdominal pain, nausea and disability before and after treatment and compare outcomes between treatments. Methods The records of FAPD patients ages 11-21 years, treated with 4 weeks of PENFS, cyproheptadine or amitriptyline were reviewed. Outcomes were evaluated using validated questionnaires [Abdominal Pain Index (API), Nausea Severity Scale (NSS), and the Functional Disability Inventory (FDI)] at baseline and follow-up within 3 months (FU). Result Of 101 patients, 48% received PENFS, 31% cyproheptadine and 21% received amitriptyline. Median ages were 17 (15-19), 16 (15-18) and 15 (11-16) years respectively and the majority were females (75%, 90% and 52% respectively). In the PENFS group, API (p = 0.001), NSS (p = 0.059) and FDI (p = 0.048) were significantly lower at FU. API (p = 0.034) but not NSS and FDI (p > 0.05) decreased significantly at FU in the amitriptyline group. API, NSS and FDI did not change significantly with cyproheptadine at FU (p > 0.05). FU API scores were lower in PENFS vs. cyproheptadine (p = 0.04) but not vs. amitriptyline (p = 0.64). The FDI scores were significantly lower in the amitriptyline vs. cyproheptadine group (p = 0.03). Conclusion Therapy with PENFS showed improvements in abdominal pain, nausea and disability while amitriptyline showed improvements in abdominal pain within 3 months of treatment. PENFS was more effective than cyproheptadine in improving abdominal pain. Amitriptyline improved disability scores more than cyproheptadine and showed promise for treatment. PENFS may be a good non-pharmacologic alternative for FAPD.
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Affiliation(s)
- Neha R. Santucci
- Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Rashmi Sahay
- Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Khalil I. El-Chammas
- Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Kahleb Graham
- Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Mikaela Wheatley
- Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | | | - Jennifer Hardy
- Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Lin Fei
- Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
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Ulfah M, Wahyuni TD, Wicaksana AL. The Effect of Aromatherapy on Hemodialysis-Related Nausea: A Case Report. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.10743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND: After hemodialysis, complications may occur and one of them that problematic is hemodialysis-related nausea. Information is still unclear about aromatherapy concerning nausea-related to hemodialysis. This study aimed to describe the effect of aromatherapy on nausea after hemodialysis procedures.
CASE PRESENTATION: A 51-year-old female, undergoing routine hemodialysis, experienced severe hemodialysis-related nausea. Her nausea occurred a day after dialysis and existed for 3–4 days and this repeated as a cycle that affected her appetite, food intake, and general condition. The daily measurements of nausea used the visual analog scale and the nausea severity scale before and after the intervention. In addition, a manual book with a packet containing nausea education, protocol of intervention, and monitoring sheets, was provided. For two weeks, the application of two drops of lavender aromatherapy was given on a humid cotton swab and inhaled for 5 min. In addition, education explained oral hygiene using warm water when waking up in the morning and before eating food. There was a decrease in the intensity of nausea from severe to none based on daily measurements and from severe nausea (score: 21) to moderate nausea (score: 10) after the 2-weeks intervention. Thus, the patient could enjoy eating without any uncomfortable feeling of nausea.
CONCLUSION: Lavender aromatherapy was demonstrated as a complementary therapy in overcoming nausea after dialysis among CKD patients. This report could provide a novel therapeutic modality for hemodialysis patients suffering hemodialysis-related nausea.
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Somarajan S, Muszynski ND, Olson JD, Russell AC, Walker LS, Acra SA, Bradshaw LA. Multichannel magnetogastrogram: a clinical marker for pediatric chronic nausea. Am J Physiol Gastrointest Liver Physiol 2022; 323:G562-G570. [PMID: 36255075 PMCID: PMC9678406 DOI: 10.1152/ajpgi.00158.2022] [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] [Received: 06/24/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 01/31/2023]
Abstract
Chronic nausea is a widespread functional disease in children with numerous comorbidities. High-resolution electrogastrogram (HR-EGG) has shown sufficient sensitivity as a noninvasive clinical marker to objectively detect distinct gastric slow wave properties in children with functional nausea. We hypothesized that the increased precision of magnetogastrogram (MGG) slow wave recordings could provide supplementary information not evident on HR-EGG. We evaluated simultaneous pre- and postprandial MGG and HR-EGG recordings in pediatric patients with chronic nausea and healthy asymptomatic subjects, while also measuring nausea intensity and nausea severity. We found significant reductions in postprandial dominant frequency and normogastric power, and higher levels of postprandial bradygastric power in patients with nausea in both MGG and HR-EGG. MGG also detected significantly lower preprandial normogastric power in patients. A significant difference in the mean preprandial gastric slow wave propagation direction was observed in patients as compared with controls in both MGG (control: 180 ± 61°, patient: 34 ±72°; P < 0.05) and HR-EGG (control: 240 ± 39°, patient: 180 ± 46°; P < 0.05). Patients also showed a significant change in the mean slow wave direction between pre- and postprandial periods in MGG (P < 0.05). No statistical differences were observed in propagation speed between healthy subjects and patients in either MGG or HR-EGG pre/postprandial periods. The use of MGG and/or HR-EGG represents an opportunity to assess noninvasively the effects of chronic nausea on gastric slow wave activity. MGG data may offer the opportunity for further refinement of the more portable and economical HR-EGG in future machine-learning approaches for functional nausea.NEW & NOTEWORTHY Pediatric chronic nausea is a difficult-to-measure subjective complaint that requires objective diagnosis, clinical assessment, and individualized treatment plans. Our study demonstrates that multichannel MGG used in conjunction with custom HR-EGG detects key pathological signatures of functional nausea in children. This quantifiable measure may allow more personalized diagnosis and treatment in addition to minimizing the cost and potential radiation associated with current diagnostic approaches.
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Affiliation(s)
- Suseela Somarajan
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicole D Muszynski
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee
| | - Joseph D Olson
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra C Russell
- Division of Pediatric Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynn S Walker
- Division of Adolescent Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sari A Acra
- Division of Pediatric Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leonard A Bradshaw
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee
- Department of Physics, Lipscomb University, Nashville, Tennessee
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Somarajan S, Muszynski ND, Olson JD, Comstock A, Russell AC, Walker LS, Acra SA, Bradshaw LA. The effect of chronic nausea on gastric slow wave spatiotemporal dynamics in children. Neurogastroenterol Motil 2021; 33:e14035. [PMID: 33217123 PMCID: PMC8193999 DOI: 10.1111/nmo.14035] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/10/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic nausea in adolescents with functional gastrointestinal disorders is an increasingly reported but poorly understood symptom that negatively affects quality of life. Functional gastrointestinal disorders are known to correlate closely with slow wave rhythm disturbances. The ability to characterize gastric electrophysiologic perturbations in functional nausea patients could provide potential diagnostic and therapeutic tools for nausea patients. METHODS We used high-resolution electrogastrograms (HR-EGG) to measure gastric slow wave parameters in pediatric chronic nausea patients and healthy subjects both pre- and postprandial. We computed the dominant frequency, percentage power distribution, gastric slow wave propagation direction, and speed from HR-EGG. KEY RESULTS We observed significant differences in the dominant frequency and power distributed in normal and bradyarrhythmia frequency ranges when comparing patients and healthy subjects. Propagation patterns in healthy subjects were predominantly anterograde, while patients exhibited a variety of abnormalities including retrograde, anterograde, and disrupted patterns. There was a significant difference in the preprandial mean slow wave direction between healthy subjects (222° ± 22°) and patients (103° ± 66°; p ˂ 0.01), although the postprandial mean direction between healthy subjects and patients was similar (p = 0.73). No significant difference in slow wave propagation speed was found between patients and healthy subjects in either pre- (p = 0.21) or postprandial periods (p = 0.75). CONCLUSIONS AND INFERENCES The spatiotemporal characterization of gastric slow wave activity using HR-EGG distinguishes symptomatic chronic nausea patients from healthy subjects. This characterization may in turn inform and direct clinical decision-making and lead to further insight into its pathophysiology.
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Affiliation(s)
- Suseela Somarajan
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Physics & Astronomy, Vanderbilt University, TN, USA
| | - Nicole D. Muszynski
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Physics & Astronomy, Vanderbilt University, TN, USA
| | - Joseph D. Olson
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew Comstock
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Physics, Lipscomb University, Nashville, TN, USA
| | - Alexandra C. Russell
- Division of Pediatric Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lynn S. Walker
- Division of Adolescent Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sari A. Acra
- Division of Pediatric Gastroenterology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leonard A. Bradshaw
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Physics & Astronomy, Vanderbilt University, TN, USA,Department of Physics, Lipscomb University, Nashville, TN, USA
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Cole MAT, Qu’d D, Wild MG, Russell AC, Caillet AR, Stone AL. "My Body Hates Me": A Qualitative Analysis of the Experience of Functional Nausea in Adolescent Girls and Their Mothers. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E83. [PMID: 32722617 PMCID: PMC7466061 DOI: 10.3390/children7080083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022]
Abstract
Nausea is a somatic sensation typically associated with the need to vomit in order to remove a toxin from the body. When nausea occurs in the absence of a specific structural cause or toxin, it is classified as a functional gastrointestinal disorder (FGID). Functional nausea was newly recognized in 2016 as a FGID in children and little is known about its prevalence, course or patient experiences. Nausea co-occurring with functional abdominal pain in childhood has been associated with long-term risk for anxiety and ongoing somatic symptoms into young adulthood. However, few studies have focused uniquely on the experience and impact of nausea on youth. The present study aimed to qualitatively understand the experiences of adolescent girls with functional nausea and their parents. Five mother-daughter dyads were recruited from a specialized pediatric gastroenterology clinic focused on nausea and completed semi-structured interviews. Interviews were transcribed and coded using interpretive phenomenological analysis (IPA). Four main themes emerged: nausea interference, body frustration, misunderstanding of symptoms, and maternal helplessness and guilt. These themes were similar to prior studies on the experiences of youth with chronic pain but also indicated unique challenges due to nausea, such as significant food restriction and subsequent weight loss.
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Affiliation(s)
- Michelle A. T. Cole
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN 37212, USA;
| | - Dima Qu’d
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, USA;
| | - Marcus G. Wild
- Department of Psychology, Vanderbilt University, Nashville, TN 37212, USA;
| | - Alexandra C. Russell
- Division of Pediatric Gastroenterology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (A.C.R.); (A.R.C.)
| | - Aimee R. Caillet
- Division of Pediatric Gastroenterology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (A.C.R.); (A.R.C.)
| | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37212, USA;
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Friesen C, Singh M, Singh V, Schurman JV. A cross-sectional study of nausea in functional abdominal pain: relation to mucosal mast cells and psychological functioning. BMC Gastroenterol 2020; 20:144. [PMID: 32393272 PMCID: PMC7216423 DOI: 10.1186/s12876-020-01291-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 04/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background Nausea is a common symptom in youth with chronic abdominal pain. The aims of the current study were to assess: 1) the frequency of nausea in patients with functional dyspepsia (FD) and irritable bowel syndrome (IBS), respectively, as defined by Rome IV criteria; and, 2) relationships between nausea and mucosal inflammation as defined by antral and duodenal eosinophil and mast cell densities. A secondary aim was to assess relationships between nausea and other gastrointestinal symptoms, non-gastrointestinal somatic symptoms, and psychological dysfunction. Methods Records from patients with pain associated functional gastrointestinal disorders were retrospectively reviewed for gastrointestinal and somatic symptoms and anxiety, depression, and somatizations scores as assessed by the Behavior Assessment System for Children (BASC-2). In addition, previous gastric and mucosal biopsies were assessed for mast cell and eosinophil densities, respectively. Results 250 patients, ages 8 to 17 years, were assessed. Nausea was reported by 78% and was equally prevalent in those with FD alone, those with IBS alone, and those with both FD and IBS. Nausea was associated with increased mean (21.4 vs. 17.5) and peak (26.2 vs. 22.9) duodenal mast cell densities as compared those without nausea. Nausea was also associated with a wide variety of individual gastrointestinal symptoms, as well as headaches, fatigue, and dizziness. Lastly, nausea was associated with elevated self-report scores for anxiety (55.2 vs. 50.0), depression (50.2 vs. 46.1), and somatization (70.3 vs. 61.8). Conclusions Nausea is common in children and adolescents with pain-associated FGIDs as defined by Rome IV and is not unique to either FD or IBS. Nausea is associated with increased mucosal mast cell density, non-gastrointestinal somatic symptoms, and psychologic dysfunction.
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Affiliation(s)
- Craig Friesen
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Meenal Singh
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Vivekanand Singh
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, Missouri, 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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