Inflammation and the Biopsychosocial Model in Pediatric Dyspepsia

Abstract

In the late 1980s, a group of experts met in Rome to establish symptom-based diagnostic criteria for functional gastrointestinal disorders (FGIDs). This first set of “Rome criteria,” published in 1989, focused exclusively on adults [1]. In 1999, when these criteria were revised, a pediatric committee established a parallel set of diagnostic criteria for FGIDs in children and adolescents [2]. The Rome II pediatric subcommittee defined four pediatric disorders related to abdominal pain: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, and functional abdominal pain. With Rome II, FD was defined as persistent or recurrent pain or discomfort centered in the upper abdomen (above the umbilicus) that was unrelated to a change in stool frequency or form and not exclusively relieved by defecation. Further, there had to be no evidence of an inflammatory, anatomic, metabolic, or neoplastic process to explain the patient’s symptoms. Importantly, the committee determined that mild, chronic inflamma‐ tory changes on mucosal biopsies should not preclude the diagnosis of FD. Similar to the adult criteria on which they were based, the Rome II pediatric criteria for FD included 3 subtypes: 1) ulcer-like, in which pain was the predominant symptom; 2) dysmotility-like, in which discomfort (e.g., bloating, early satiety, postprandial fullness) was the predominant symptom; and, 3) unspecified.