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Initial Diagnosis of Functional Gastrointestinal Disorders in Children Increases a Chance for Resolution of Symptoms

  • Trivic, Ivana (Referral Centre for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb) ;
  • Hojsak, Iva (Referral Centre for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb)
  • Received : 2018.02.21
  • Accepted : 2018.04.20
  • Published : 2018.10.15

Abstract

Purpose: The aim of this study was to describe functional gastrointestinal disorders (FGID) presented in a tertiary medical center, characteristics of patients and results of the diagnostic work-up together with an outcome during the follow up. Methods: This was a retrospective, single center, observational study including all patients who were diagnosed with FGID based on Rome III criteria from January to December 2015 in tertiary medical center. Results: Overall 294 children were included (mean age, 8.9 years [range, 1-18 years]; 165 females). Majority had functional constipation (35.4%), followed by functional abdominal pain (30.6%), irritable bowel syndrome (17.0%), functional dyspepsia (12.6%), functional nausea (3.4%) and abdominal migraine (1.0%). Regression model found that only significant factor associated with improvement of symptoms is the establishment of the functional diagnosis at the first visit (hazard ratio, 2.163; 95% confidence inverval, 1.029-4.544). There was no association between improvement of symptoms and presence of alarm signs/symptoms (weight loss, nocturnal symptoms and severe vomiting) at diagnosis. Furthermore, in pain symptoms (functional abdominal pain, irritable bowel syndrome, dyspepsia) no treatment positively correlated with pain improvement. Conclusion: Regardless of the initial diagnosis of FGID, positive diagnosis at the first visit increases a chance for resolution of symptoms.

Keywords

References

  1. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology 2016:150;1262-1279.e2. https://doi.org/10.1053/j.gastro.2016.02.032
  2. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional disorders: children and adolescents. Gastroenterology 2016;150:1456-68.e2. https://doi.org/10.1053/j.gastro.2016.02.015
  3. Scarpato E, Kolacek S, Jojkic-Pavkov D, Konjik V, Zivkovic N, Roman E, et al. Prevalence of functional gastrointestinal disorders in children and adolescents in the Mediterranean region of Europe. Clin Gastroenterol Hepatol 2018;16:870-6. https://doi.org/10.1016/j.cgh.2017.11.005
  4. Di Lorenzo C, Colletti RB, Lehmann HP, Boyle JT, Gerson WT, Hyams JS, et al. Chronic abdominal pain in children: a technical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005;40:249-61. https://doi.org/10.1097/01.MPG.0000154661.39488.AC
  5. Dhroove G, Chogle A, Saps M. A million-dollar work-up for abdominal pain: is it worth it? J Pediatr Gastroenterol Nutr 2010;51:579-83. https://doi.org/10.1097/MPG.0b013e3181de0639
  6. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2006;130:1527-37. https://doi.org/10.1053/j.gastro.2005.08.063
  7. Schmulson MJ, Ortiz-Garrido OM, Hinojosa C, Arcila D. A single session of reassurance can acutely improve the self-perception of impairment in patients with IBS. J Psychosom Res 2006;61:461-7. https://doi.org/10.1016/j.jpsychores.2006.02.011
  8. Assa A, Ish-Tov A, Rinawi F, Shamir R. School attendance in children with functional abdominal pain and inflammatory bowel diseases. J Pediatr Gastroenterol Nutr 2015;61:553-7. https://doi.org/10.1097/MPG.0000000000000850
  9. 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 2014;39:45-54.
  10. Spee LA, Lisman-Van Leeuwen Y, Benninga MA, Bierma-Zeinstra SM, Berger MY. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice. Scand J Prim Health Care 2013;31:197-202. https://doi.org/10.3109/02813432.2013.844405
  11. Helgeland H, Flagstad G, Grotta J, Vandvik PO, Kristensen H, Markestad T. Diagnosing pediatric functional abdominal pain in children (4-15 years old) according to the Rome III criteria: results from a Norwegian prospective study. J Pediatr Gastroenterol Nutr 2009;49:309-15. https://doi.org/10.1097/MPG.0b013e31818de3ab
  12. Saps M, Nichols-Vinueza DX, Rosen JM, Velasco-Benitez CA. Prevalence of functional gastrointestinal disorders in Colombian school children. J Pediatr 2014;164:542-5.e1. https://doi.org/10.1016/j.jpeds.2013.10.088
  13. Miele E, Simeone D, Marino A, Greco L, Auricchio R, Novek SJ, et al. Functional gastrointestinal disorders in children: an Italian prospective survey. Pediatrics 2004;114:73-8. https://doi.org/10.1542/peds.114.1.73
  14. Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PLoS One 2015;10: e0126982. https://doi.org/10.1371/journal.pone.0126982
  15. Gijsbers CF, Benninga MA, Schweizer JJ, Kneepkens CM, Vergouwe Y, Büller HA. Validation of the Rome III criteria and alarm symptoms for recurrent abdominal pain in children. J Pediatr Gastroenterol Nutr 2014; 58:779-85.
  16. Lane MM, Weidler EM, Czyzewski DI, Shulman RJ. Pain symptoms and stooling patterns do not drive diagnostic costs for children with functional abdominal pain and irritable bowel syndrome in primary or tertiary care. Pediatrics 2009;123:758-64. https://doi.org/10.1542/peds.2008-0227
  17. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treat- ment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58:258-74.
  18. Korterink JJ, Rutten JM, Venmans L, Benninga MA, Tabbers MM. Pharmacologic treatment in pediatric functional abdominal pain disorders: a systematic review. J Pediatr 2015;166:424-31. https://doi.org/10.1016/j.jpeds.2014.09.067

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