Biopsychosocial issues in functional abdominal pain

Effect of a Symbiotic Mixture on Fecal Microbiota in Pediatric Patients Suffering of Functional Abdominal Pain Disorders

(1) Background: Functional abdominal pain disorders (FAPDs) represent one of the main etiologies of chronic abdominal pain in the pediatric population. A wide spectrum of probiotic or prebiotic mixtures has been evaluated in trials regarding benefits in patients with FAPDs, mainly in the adult population. (2) Methods: This study was interested in evaluating the effect of oral supplementation with a symbiotic mixture on intestinal microbiota in children with functional dyspepsia (FD), irritable bowel syndrome with diarrhea (IBS-D), and irritable bowel syndrome with constipation (IBS-C). A combination of six bacterial strains (Lactobacillus rhamnosus R0011, Lactibacillus casei R0215, Bifidobacterium lactis BI-04, Lactobacillus acidophilus La-14, Bifidobacterium longum BB536, Lactobacillus plantarum R1012) and 210 mg of fructo-oligosaccharides-inulin were administered orally, daily, for 12 weeks and patients were scored for severity of symptoms and fecal microbiota before and after the treatment. (3) Results: The proportion of patients with adequate symptom relief was higher in the IBS-D than in the IBS-C group; however, the difference was not statistically significant (74.4% vs. 61.9%, p = 0.230). There was an increasing proportion of bacterial genera associated with health benefits, for both IBS-C and IBS-D (IBS-C: 31.1 ± 16.7% vs. 47.7 ± 13.5%, p = 0.01; IBS-D: 35.8 ± 16.2% vs. 44.1 ± 15.1%, p = 0.01). (4) Conclusions: Administration of a symbiotic preparation resulted in significant changes to the microbiota and gastrointestinal symptoms in patients with FAPDs.

Effect of a low-FODMAP diet for the management of functional abdominal pain disorders in children: a study protocol for a randomized controlled trial

Background

Evidence from studies in adults documents that fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may be triggers of symptoms in individuals with functional abdominal pain disorders (FAPDs). However, in children, the evidence is very limited. We aim to assess the effects of a low-FODMAP diet compared with a regular diet for the management of children with FAPDs.

Methods

We will perform a randomized, quadruple-blinded, controlled trial. Seventy-four children aged 8 to 18 years with a FAPD (Irritable Bowel Syndrome or Functional Abdominal Pain-Not Otherwise Specified), diagnosed according to the Rome IV criteria, will be randomly allocated to receive either a low-FODMAP diet or a regular diet for 4 weeks. The primary outcome will be the percentage of the responders, defined as the participants who have at least 30% improvement in abdominal pain intensity on a Visual Analogue Scale (VAS) during the last week of the trial compared with baseline, that is at least equal to the Reliable Change Index (≥ 25 mm change on VAS). Other outcomes will include changes in stool consistency, abdominal pain frequency, total scores on the Gastrointestinal Symptom Rating Scale, KIDSCREEN-10 Index and World Health Organization Five Well-Being Index, child’s school attendance and parents’ work absenteeism, and BMI-for-age z-score. Compliance, tolerability of the low-FODMAP diet, and adverse events also will be evaluated. Each FAPD subtype will be assessed separately.

Discussion

There is a need for high-quality evidence regarding the dietary management of children with FAPDs. This randomized controlled trial (RCT) of rigorous methodological design will help to establish the effectiveness, if any, of a low-FODMAP diet for the management of FAPDs in the pediatric population. The findings of this RCT will assist with the development of guidelines and influence the direction of further research.

Trial registration

NCT04528914

Data and protocol version identifier: 24/08/2020

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-020-00656-3.

The Impact of Perceived Etiology, Treatment Type, and Wording of Treatment Information on the Assessment of Gastritis Treatments

How patients assess the suitability of a certain therapy for treating a disease depends on a variety of influencing factors. Three key factors are people's subjective perceptions of a disease, the type of treatment, and the kind of communication used to convey information. The study presented here was a randomized controlled experiment in which we examined these three factors. We used a mixed design where we manipulated perceived etiology of gastritis (biopsychosocial vs. biomedical) as a between-group factor, and treatment type (behavioral vs. pharmacological) and wording of treatment information (holistic vs. scientific) as within-group factors. We found that gastritis treatments that matched the perceived etiology of the illness were assessed to be more effective. Moreover, treatments that matched the perceived etiology enhanced participants' intention to undergo the treatment themselves and their willingness to recommend it to a person close to them. Finally, participants' intention to undergo the treatment was also enhanced when the wording of the treatment information matched the perceived etiology. We discuss the implications of our findings in terms of health communication and patient education.

Abdominal pain is a common and recurring problem in paediatric emergency departments

AIM

Abdominal pain is a frequent reason for paediatric emergency department visits, but specific research is lacking. Our aim was to obtain information on the diagnosis of abdominal pain and what healthcare services children with this condition need.

METHODS

This retrospective study focused on patients visiting the emergency department of the Children's Hospital Iceland in 2010 with abdominal pain and any subsequent visits up to 1 January 2015.

RESULTS

There were 11 340 visits to the emergency department in 2010 and 1118 children made 1414 (12%) visits due to abdominal pain. The majority (58%) with abdominal pain were girls (p < 0.001) and they were older than the boys, with an average age of 12 versus 10 years (p < 0.001). The most common diagnoses were non-specific abdominal pain (40%), constipation (22%) and viral infections (13%). During the follow-up period, 423/1118 children (38%) visited the emergency department 883 times, 58% were girls and the most common diagnosis was non-specific abdominal pain (37%). Of the 436 children initially diagnosed with non-specific abdominal pain, 154 (35%) revisited the emergency department during the follow-up period.

CONCLUSION

Abdominal pain was a common reason for visits to the paediatric emergency room and a third paid more than one visit.

Recurrent abdominal pain: what determines medical consulting behavior?

Recurrent abdominal pain (RAP) is associated with increased health care visits and school absences. In adults suffering from functional pain, psychosocial factors determine illness behavior and we aimed to investigate its role among children. A community sample of 40 RAP consulters, 41 RAP nonconsulters, and 36 pain-free controls and their mothers completed questionnaires on GI and non-GI symptoms, school absences, psychological symptoms, coping, self-esteem, and behavioral and cognitive responses to RAP. T-tests showed significant differences between RAP and controls in (1) GI and non-GI symptoms and school absences, (2) child distress and passive coping, and (3) mother's IBS severity, somatization, and fears about RAP. RAP consulters reported the same levels of GI symptoms and psychological distress as nonconsulters but missed significantly more school and their mothers reported more fears about RAP. Severity of symptoms and psychological distress did not predict consulting behavior. Only maternal fears about abdominal symptoms differentiated consulters from nonconsulters.

Childhood gastrointestinal complaints in women with bulimia nervosa

OBJECTIVE

The current study describes childhood gastrointestinal (GI) complaints in adult women presenting for a treatment trial for bulimia nervosa (BN) and examines the correlates of BN symptomatology.

METHOD

The sample comprised 135 women with BN who underwent an assessment including questions regarding childhood GI complaints. Individuals were grouped into one of three categories: no GI complaints, GI complaints with/without constipation (GI complaints), and constipation only. Eating disorder psychopathology was compared across these groups.

RESULTS

One third of participants reported GI complaints or constipation only in childhood. Women with GI complaints were younger, and had an earlier onset of BN and self-induced vomiting compared with women with no GI complaints. Trends existed for a younger age of first binge, and a higher frequency of binge eating in this group.

DISCUSSION

These findings suggest that individuals with childhood GI complaints and other risk factors for BN may be at greater risk of developing a more severe eating disorder at an earlier age.

Psychosocial risk factors for the onset of abdominal pain. Results from a large prospective population-based study

OBJECTIVE

To determine the psychosocial risk factors for the development of abdominal pain and to determine whether, in those people who consulted, symptoms had been attributed to an organic cause.

DESIGN

Prospective population-based postal survey with follow-up survey at 12 months.

SETTING

A mixed sociodemographic suburban area of Manchester, UK.

PARTICIPANTS

Subjects aged 18-65 years were randomly selected from a population-based primary care register who had responded to a detailed pain questionnaire, which included a pain manikin drawing. They also completed the following psychosocial instruments: General Health Questionnaire, Somatic Symptom Checklist, Fatigue Questionnaire and the Illness Attitude Scales (including the 'health anxiety' and 'illness behaviour' sub-scales).

MAIN OUTCOME MEASURES

The onset of new abdominal pain.

RESULTS

Of the 1953 participants at baseline, 1763 were free of abdominal pain: 1551 were followed up at 12 months (adjusted follow-up rate of 92%) of which 69 subjects reported new abdominal pain (new onset rate 4.6%). New abdominal pain was similar in females (4.9%) and males (4.2%), and did not vary by age group. Baseline factors which predicted onset were high levels of fatigue (odds ratio [OR] = 3.3, 95% CI: 1.9-5.8), psychological distress (OR = 3.4, 95% CI: 1.9-6.0), high scores on the illness behaviour scale (OR = 3.3, 95% CI: 1.7-6.7) and high levels of health anxiety (OR = 2.1, 95% CI: 1.1-3.9). Reporting low back pain at baseline was also associated with an increased risk of reporting abdominal pain (OR = 2.0, 95% CI: 1.2-3.3). On multivariate analysis, high levels of psychological distress and aspects of prior illness behaviour were the major independent predictors of outcome. Of those who sought health care, only one consultation led to a definite diagnosis.

CONCLUSION

In subjects free of abdominal pain, psychological distress, fatigue, health anxiety and illness behaviour are predictors of future onset rather than merely a consequence of symptoms. These results suggest that abdominal pain shares some common features of onset with pain at other sites thought not to be primarily organic in origin.