Functional abdominal pain disorders and patient- and parent-reported outcomes in children with inflammatory bowel disease in remission

Léa Chantal Tran,Nicolas Caron,Emmanuel Mas,Ahlem Bouazza,Emilie Chaillou-Legault,Valérie Bertrand,Georges Dimitrov,Vanessa Degas,Laure Bridoux-Henno,Camille Grandjean,Bénédicte Pigneur,Raphaël Enaud,Édouard Lacotte,Claire Dupont-Lucas,Stéphanie Coopman,Swellen Gastineau,Jérôme Viala,Christine Martinez-Vinson,Alexis Mosca,A Vanrenterghem ,J Languepin ,Jean‐Pierre Hugot ,T Lamireau ,C Spyckerelle ,Nicolas Thomassin ,A Dabadie ,S Willot ,E Carré ,Frank M Ruemmele ,H Clouzeau ,D Djeddi ,A Breton

doi:10.1016/j.dld.2021.05.034

Abstract

BackgroundChronic abdominal pain occurs frequently in pediatric patients with inflammatory bowel disease (IBD) in remission. AimsTo assess the prevalence and factors associated with Functional Abdominal Pain Disorders among IBD children in remission (IBD-FAPD). MethodsPatients with IBD for > 1 year, in clinical remission for ≥ 3 months were recruited from a National IBD network. IBD-FAPDs were assessed using the Rome III questionnaire criteria. Patient- or parent- reported outcomes were assessed. ResultsAmong 102 included patients, 57 (56%) were boys, mean age (DS) was 15.0 (± 2.0) years and 75 (74%) had Crohn's disease. Twenty-two patients (22%) had at least one Functional Gastrointestinal Disorder among which 17 had at least one IBD-FAPD. Past severity of disease or treatments received and level of remission were not significantly associated with IBD-FAPD. Patients with IBD-FAPD reported more fatigue (peds-FACIT-F: 35.9 ± 9.8 vs. 43.0 ± 6.9, p = 0.01) and a lower HR-QoL (IMPACT III: 76.5 ± 9.6 vs. 81.6 ± 9.2, p = 0.04) than patients without FAPD, and their parents had higher levels of State and Trait anxiety than the other parents. ConclusionsPrevalence of IBD-FAPD was 17%. IBD-FAPD was not associated with past severity of disease, but with fatigue and lower HR-QoL.

Highlights

The paradigms of pediatric inflammatory bowel disease (IBD) care have evolved over the last thirty years
The first objective of our study was to test for an association between Functional Abdominal Pain Disorder in remission of IBD (IBD-Functional Abdominal Pain Disorders (FAPD)) and past characteristics of IBD
Patient characteristics and disease phenotype Data collected from the chart were: disease characteristics at diagnosis of IBD (Paris classification), treatments received since diagnosis, history of steroid dependency [13] or steroid-refractory disease [14], comorbidities, most recent imaging, endoscopy, laboratory results from the last 3 months including fecal calprotectin (FC) and clinical activity indices (PCDAI, PUCAI)

Summary

Introduction

The paradigms of pediatric inflammatory bowel disease (IBD) care have evolved over the last thirty years. We have moved from treating inflammation with step-up immunomodulators and biologics, to trying to reverse the natural history of disease, in the aim of preventing intestinal damage. Pediatric IBD patients suffer from increased anxiety, depression, and lower quality-of-life (QoL) than healthy controls [4,5]. These symptoms are increased in the setting of active disease [6,7]. Chronic abdominal pain occurs frequently in pediatric patients with inflammatory bowel disease (IBD) in remission. Aims: To assess the prevalence and factors associated with Functional Abdominal Pain Disorders among IBD children in remission (IBD-FAPD)

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Conclusion