Criteria For Functional Abdominal Pain Research Articles

Functional Abdominal Pain Disorders in Children

Diagnostic criteria for functional abdominal pain has developed in the last decade, from the Rome III criteria to the Rome IV criteria. The major change was in the phrase "abdominal pain related gastrointestinal disorders" to "functional abdominal pain disorders (FAPD)". According to Rome IV criteria, FAPD are divided into functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, and functional abdominal pain-not otherwise specified (FAP-NOS). In order to diagnose FAPD, it is important to pay attention to alarm signs that can indicate organic abnormalities. The pathophysiology of FAPD was a complex interaction between psychosocial, genetic, environmental and life experiences of children through the gut brain axis. The risk factors for functional abdominal pain in children include psychological factors including anxiety and depression, stress conditions, negative experiences, and socioeconomic status.

Does a Minority of Children With Functional Gastrointestinal Disorders Receive Formal Diet Advice?

Diet therapies may be recommended for pediatric functional gastrointestinal disorders (FGIDs). However, little is known about the frequency with which diet therapy is recommended in FGIDs. Our aims were to determine and contrast the frequency and types of diet recommendations provided to children with FGIDs by pediatric gastroenterologists (PGIs) versus primary care pediatricians (PCPs). A retrospective chart review was performed using data from a large, metropolitan children's academic healthcare system to identify subjects meeting Rome IV criteria for functional abdominal pain, functional dyspepsia, irritable-bowel syndrome (IBS), and/or abdominal migraine over a period of 23months. Of 1929 patient charts reviewed, 268 were included for further analyses. Of these, 186 patients (69%) were seen by a PGI and 82 (31%) by a PCP. The most common diagnosis was IBS (49% for PGIs and 71% for PCPs). Diet recommendations were provided to 115 (43%) patients (PGI group: 86 [75%] vs PCP group: 29 [25%]; P < .1). The most frequent recommendations were high fiber (PGI: 15%; PCP: 14%) and low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet (PGI: 12%; PCP: 4%). Of those provided with diet recommendations, only 20% (n = 23) received an educational consult by a dietitian. Provision of diet recommendations was not affected by years in practice. Despite increasing awareness of the role of diet in the treatment of childhood FGIDs, a minority of patients receive diet recommendations in tertiary care or primary care settings. When diet recommendations were given, there was great variability in the guidance provided.

Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

Objective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting with abdominal pain, and (iv) evaluate whether children with GPFAP fulfill diagnostic criteria for functional abdominal pain (FAP) as described in current literature: chronic abdominal pain (CAP) and the Rome III criteria (PRC-III) for abdominal pain-related functional gastrointestinal disorders (FGID). Design. Cross-sectional study. Setting. General practices in the Netherlands. Subjects. 305 children aged 4–17 years consulting for abdominal pain. Main outcome measures. GPFAP, CAP, FGIDs. Results. 89.2% of children were diagnosed with GPFAP. Headaches and bloating were positively associated with GPFAP whereas fever and > 3 red flag symptoms were inversely associated. Additional diagnostic tests were performed in 26.8% of children. Less than 50% of all children with GPFAP fulfilled criteria for CAP and FGIDs; in 47.9% of patients the duration of symptoms at presentation was less than three months. Conclusions. In almost 90% of children included in this study the GP suspected no organic cause for the abdominal pain. GPs diagnose FAP in children without alarm symptoms and order diagnostic testing in one out of four children presenting with abdominal pain. No difference was found in GPs’ management between children with a diagnosis of GPFAP and other diagnoses. Only about half of the children with a GP diagnosis of FAP fulfilled time-criteria of FAP as defined in the literature.

Delayed gastric emptying rates and impaired antral motility in children fulfilling Rome III criteria for functional abdominal pain

Gastric sensorymotor dysfunctions have been implicated in the pathophysiology of some functional gastrointestinal disorders, such as functional dyspepsia and irritable bowel syndrome. Therefore, we hypothesized that abnormal gastric emptying and impaired antral motility are possible underlying mechanisms of symptoms in children with functional abdominal pain (FAP). Hundred and two children [37 (36.3%) males, 4-14 years, mean 7.8 years, SD 2.7 years] fulfilling Rome III criteria for FAP were recruited for this study. An age and sex compatible group of healthy children (n = 20) were selected as controls [8 (40%) males, 4-14 years, mean 8.4 years, SD 3.0 years]. Liquid gastric emptying rate (GER) and antral motility parameters (amplitude of antral contractions, frequency of antral contractions and antral motility index) were assessed using a previously reported ultrasound method. Average GER (42.1% vs 66.2% in controls), amplitude of antral contractions (56.5% vs 89%), frequency of contractions per 3 min (8.5 vs 9.3), and antral motility index (4.9 vs 8.3) were significantly lower in patients with FAP compared with controls (P < 0.01). Fasting antral area was higher in patients (1.4 vs 0.6, P < 0.0001). GER negatively correlated with the scores obtained for severity of abdominal pain (r = -0.29, P = 0.004). Gastric emptying rate and antral motility parameters were significantly impaired in patients with FAP and GER negatively correlated with symptom severity. These findings highlight the possible role of gastrointestinal motility abnormalities in the pathophysiology of childhood FAP.

Recurrent abdominal pain in childhood.

Chronic, recurrent abdominal pain is common among children and adolescents. It interferes with everyday life, causes absence from school, and leads to frequent medical consultations, often involving burdensome diagnostic testing and protracted attempts at treatment. Selective review of the literature. Organic causes should be ruled out with a thorough medical history and physical examination and a small number of laboratory tests. The pediatric Rome III criteria include valid diagnostic criteria for functional abdominal pain in childhood. The available data imply that this condition is best treated with cognitive behavioral therapy, rather than with medications or dietary measures. A systematic approach to chronic recurrent abdominal pain in children and adolescents is key to ruling out organic diseases while avoiding unnecessary tests and treatments.

Psychosocial Factors Influence Child's Self-Report and Parent Report of Child's Pain in Functional Abdominal Pain (FAP) or Irritable Bowel Syndrome (IBS)

Background: Psychosocial variables (e.g., marital status, parent's educational level) have been found to be associated with pediatric chronic pain syndromes (i.e., headaches, back pain). Whether these factors are related to pain symptoms in children with FAP/IBS remains unclear. The aims of our study were to assess how psychosocial variables are related to child self-report and parent report of child's pain intensity, frequency, and pain related interference with activities in children with FAP/IBS. Methods: Participants included 94 children 7-10 years of age with FAP or IBS meeting Pediatric Rome II criteria were studied. Parents completed a demographic questionnaire and rated their child's pain intensity (0-10 scale), pain frequency (episodes/month), and whether or not pain interfered with activities (yes/ no). Children completed a 2-wk daily pain diary (pain intensity, frequency, pain interference with activities). Results: Girls (n=57) self reported higher mean (P=0.002) and maximum pain ratings (P=0.005) but parent report of child's pain did not differ between genders. African-American children (n=13) reported more pain episodes interfering with activities (P=0.05) compared with other racial/ethnic groups. However, parent report yielded no difference with regard to race/ethnicity. The child's pain self-report (intensity, frequency, interference with activities) did not differ based on the number of parents in the household. In contrast, parent rating of child mean pain intensity was higher for single parents (n= 16) (P=0.03). Furthermore, parents from 2-parent households reported greater child pain frequency (P =0.003) and more pain episodes interfering with activities (P=0.01). The child's self-report of pain did not differ based on the number of siblings. Parents reported more pain episodes interfering with activities in subjects with one sibling as compared to those with no or two or more siblings (P =0.05). Child self-report and parent report of child's pain did not differ based on the parent's educational level or the family's socioeconomic status. Child self-report did not differ depending on where the child lived within the city. In contrast, according to parent report, children living in suburban areas had higher mean pain (P =0.04) and more pain episodes per month than those in urban areas (P =0.03). Whether the child met criteria for FAP (n=39) or IBS (n=55) did not affect either the child or parent report results. Conclusions: 1) Pain intensity, frequency, and pain interference with activity may be influenced by psychosocial factors; 2) Child self-report and parent report of child's pain often differ; 3) Even in young children, child pain self-reports differ based on gender and race/ethnicity. Family living environment should be taken into account in assessing child and parent reports of child abdominal pain in FAP/IBS.

M1209 Has the ROME Criteria for Functional Abdominal Pain in Children Impacted Physician Practice?

M1209 Has the ROME Criteria for Functional Abdominal Pain in Children Impacted Physician Practice?

Childhood Functional Gastrointestinal Disorders: Child/Adolescent

The Rome II pediatric criteria for functional gastrointestinal disorders (FGIDs) were defined in 1999 to be used as diagnostic tools and to advance empirical research. In this document, the Rome III Committee aimed to update and revise the pediatric criteria. The decision-making process to define Rome III criteria for children aged 4-18 years consisted of arriving at a consensus based on clinical experience and review of the literature. Whenever possible, changes in the criteria were evidence based. Otherwise, clinical experience was used when deemed necessary. Few publications addressing Rome II criteria were available to guide the committee. The clinical entities addressed include (1) cyclic vomiting syndrome, rumination, and aerophagia; 2) abdominal pain-related FGIDs including functional dyspepsia, irritable bowel syndrome, abdominal migraine, and functional abdominal pain; and (3) functional constipation and non-retentive fecal incontinence. Adolescent rumination and functional constipation are newly defined for this age group, and the previously designated functional fecal retention is now included in functional constipation. Other notable changes from Rome II to Rome III criteria include the decrease from 3 to 2 months in required symptom duration for noncyclic disorders and the modification of the criteria for functional abdominal pain. The Rome III child and adolescent criteria represent an evolution from Rome II and should prove useful for both clinicians and researchers dealing with childhood FGIDs. The future availability of additional evidence-based data will likely continue to modify pediatric criteria for FGIDs.

The Leech method for diagnosing constipation: intra- and interobserver variability and accuracy

The data concerning the value of a plain abdominal radiograph in childhood constipation are inconsistent. Recently, positive results have been reported of a new radiographic scoring system, "the Leech method", for assessing faecal loading. To assess intra- and interobserver variability and determine diagnostic accuracy of the Leech method in identifying children with functional constipation (FC). A total of 89 children (median age 9.8 years) with functional gastrointestinal disorders were included in the study. Based on clinical parameters, 52 fulfilled the criteria for FC, six fulfilled the criteria for functional abdominal pain (FAP), and 31 for functional non-retentive faecal incontinence (FNRFI); the latter two groups provided the controls. To assess intra- and interobserver variability of the Leech method three scorers scored the same abdominal radiograph twice. A Leech score of 9 or more was considered as suggestive of constipation. ROC analysis was used to determine the diagnostic accuracy of the Leech method in separating patients with FC from control patients. Significant intraobserver variability was found between two scorers (P=0.005 and P<0.0001), whereas there was no systematic difference between the two scores of the other scorer (P=0.89). The scores between scorers differed systematically and displayed large variability. The area under the ROC curve was 0.68 (95% CI 0.58-0.80), indicating poor diagnostic accuracy. The Leech scoring method for assessing faecal loading on a plain abdominal radiograph is of limited value in the diagnosis of FC in children.