Criteria For Functional Gastrointestinal Disorders Research Articles

The impact of psychiatric and extraintestinal comorbidity on quality of life and bowel symptom burden in functional GI disorders.

Functional gastrointestinal disorders (FGID) patients report poor health-related quality of life (HRQOL) and experience high rates of psychiatric and extraintestinal functional disorder (EIFD) comorbidity. The independent influence of these comorbidities on HRQOL and symptom burden remains unknown. We sought to determine whether FGID with mood or EIFD comorbidity have poorer HRQOL and greater GI symptom burdens; to determine the influence of comorbidities on HRQOL in FGID independent of bowel symptoms. Subjects reported on comorbidities (anxiety, depression, somatization, EIFD), FGID criteria (irritable bowel syndrome, IBS; functional dyspepsia, FD) using ROME III Research questionnaire, GI symptom burden, and HRQOL. Differences in measures were assessed between subjects with and without ROME III criteria. Multiple regression determined the relative contribution of comorbidities to HRQOL, and mediation analysis explored whether comorbidity influences HRQOL. In a cohort of 912 GI outpatients (47.2 ± 1.5 years, 75.8% female), 606 (66.4%) met Rome III IBS and/or FD criteria. Comorbidities were common in FGID (≥1 in 77.4%), leading to lower HRQOL and greater GI symptom burden (each p < 0.05). Poorer HRQOL was predicted by both psychiatric and EIFD comorbidity (each p < 0.05) independent of GI symptoms (p < 0.001). Comorbidities together exerted a greater effect on predicted variation in HRQOL (70.9%) relative to GI symptoms (26.5%). Psychiatric and EIFD comorbidities are common in FGID, decrease HRQOL and are associated with greater GI symptom burdens; these factors were stronger predictors of HRQOL than GI symptoms in FGID patients.

Predicting Persistence of Functional Abdominal Pain From Childhood Into Young Adulthood

Pediatric functional abdominal pain has been linked to functional gastrointestinal disorders (FGIDs) in adulthood, but little is known about patient characteristics in childhood that increase the risk for FGID in young adulthood. We investigated the contribution of gastrointestinal symptoms, extraintestinal somatic symptoms, and depressive symptoms in pediatric patients with functional abdominal pain and whether these predicted FGIDs later in life. In a longitudinal study, consecutive new pediatric patients, diagnosed with functional abdominal pain in a subspecialty clinic, completed a comprehensive baseline evaluation of the severity of their physical and emotional symptoms. They were contacted 5 to 15 years later and evaluated, based on Rome III symptom criteria, for abdominal pain-related FGIDs, including irritable bowel syndrome, functional dyspepsia, functional abdominal pain syndrome, and abdominal migraine. Controlling for age, sex, baseline severity of abdominal pain, and time to follow-up evaluation, multivariable logistic regression was used to evaluate the association of baseline gastrointestinal, extraintestinal somatic, and depressive symptoms in childhood with FGID in adolescence and young adulthood. Of 392 patients interviewed an average of 9.2 years after their initial evaluation, 41% (n = 162) met symptom criteria for FGID; most met the criteria for irritable bowel syndrome. Extraintestinal somatic and depressive symptoms at the initial pediatric evaluation were significant predictors of FGID later in life, after controlling for initial levels of GI symptoms. Age, sex, and abdominal pain severity at initial presentation were not significant predictors of FGID later in life. In pediatric patients with functional abdominal pain, assessment of extraintestinal and depressive symptoms may be useful in identifying those at risk for FGID in adolescence and young adulthood.

Irritable bowel syndrome in children: pathogenesis, diagnosis and evidence-based treatment.

Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies.

Predictive Factors of Impaired Quality of Life in Korean Patients With Inactive Inflammatory Bowel Disease

Inflammatory bowel disease is a chronic and relapsing inflammatory disorder of the intestine and has a great effect on patients' health-related quality of life (HRQOL). Some patients in remission are known to show functional gastrointestinal disorders (FGIDs) and mood disorders (MDs), which may also negatively impact HRQOL. The aim of this study was to evaluate predictors of impaired HRQOL in inactive inflammatory bowel disease (IBD) patients. Patients presenting a long-standing remission during the previous year completed questionnaires of EuroQol, Rome III criteria for FGID, and Hospital Anxiety and Depression Survey. Demographic data including age, sex, employment status, education, smoking, and location of residence were also collected. Among the 513 patients with IBD, 226 (Crohn's disease 107 and ulcerative colitis 119, age 39.01±15.63, male 141) defined in remission were enrolled. Overall, 147 (65.0%) had at least 1 FGID with irritable bowel syndrome being the most common disorder (36.3%). Anxiety and depression were identified in 27.4% and 33.6%, respectively. Participants with FGID or MD had a significantly lower HRQOL status than those without disorders (P<0.01). Among various demographic and clinical variables, aged 40 or older [odds ratio (OR), 2.342; 95% confidence interval (CI), 1.195-4.590; P=0.01], irritable bowel syndrome (OR, 3.932; 95% CI, 1.937-7.982; P<0.01), and anxiety (OR, 2.423; 95% CI, 1.067-5.502; P=0.03) were significant independent predictors of impaired HRQOL in inactive IBD patients. FGID and MD are common in Korean quiescent IBD patients. Appropriate management should be administered according to age of patients and presence of concomitant FGID and MD to improve patients' HRQOL.

Functional gastrointestinal disorders in adolescents and quality of school life

The prevalence of functional gastrointestinal disorders (FGID) in adolescents and their relationship to quality of school life (QOSL) are not fully understood. This study investigated the relationship between FGID and QOSL. Adolescents (10-17 years) were recruited from 40 schools. FGID diagnoses were based on the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version (QPGS-RIII). QOSL was evaluated by a questionnaire and calculated as the QOSL score. Five hundred and fifty-two of the 3976 students (13.9%) met the FGID criteria for one or more diagnoses according to the QPGS-RIII: 12.3% met the criteria for one, 1.5% for two or more. Irritable bowel syndrome (IBS) was the most common diagnosis (5.9%) followed by functional abdominal pain (3.1%). The prevalence of FGID was significantly higher in the female students in comparison to male students (P < 0.01). The prevalence of FGID was 9.5% in elementary school, 15.4% in junior high school, 26.0% in high school students, respectively. The prevalence of FGID was significantly increased with age (P < 0.01). The QOSL score of the patients with FGID was 10.9 ± 4.5 and that without FGID was 8.2 ± 2.8, respectively. The QOSL score of the patients with FGID was significantly worse than those without FGID (P < 0.01). The QOSL scores with IBS, aerophagia, and cyclic vomiting syndrome were significantly worse among the FGID (P < 0.01). The prevalence of FGID in adolescents was relatively high. The presences of FGID worsen the QOSL score. Medical intervention and/or counseling are needed for such students to improve the QOSL.

The impact of DSM-5 and guidelines for assessment and treatment of elimination disorders

Elimination disorders are very common in children: 10 % of 7-year-olds wet at night (nocturnal enuresis), 2-3 % during daytime (diurnal urinary incontinence) and 1-3 % soil (faecal incontinence). In the past decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies, comorbid disorders and specific treatment options. The aim of the paper is to present a short overview of the proposed DSM-5, the ICCS and the Rome-III classification systems, of assessment and of treatment. The DSM-5 criteria no longer reflect current research data and a revision is needed. Classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. Assessment of most elimination disorders can be performed in paediatric and child psychiatric primary care settings. The standard assessment consists of a thorough history, frequency/volume charts, specific questionnaires, a full physical examination, sonography and urinalysis. If possible, a child psychiatric assessment is performed. In all other settings, screening with a validated behavioural questionnaire and referral if indicated is recommended. All other investigations are indicated only in complicated cases and if an organic cause is to be ruled out. Treatment is symptom oriented and based on the exact diagnosis of the type of elimination disorder. Counselling is recommended in every case. Most elimination disorders can be treated by specific treatment programmes integrating cognitive-behavioural elements. Nocturnal enuresis is best treated with alarms. Medication can be indicated in nocturnal enuresis (desmopressin), urge incontinence (anticholinergics such as oxybutynin, propiverine, etc.) and faecal incontinence with constipation (polyethylene glycol). Comorbid behavioural and emotional disorders require additional treatment.

Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria.

Functional gastrointestinal disorders (FGID) are a group of disorders of the digestive system in which the chronic or recurrent symptoms cannot be explained by the presence of structural or tissue abnormality. This survey used a modified Rome III questionnaire on the health and nutrition status of a general population in Taiwan during 2005-2008. A total of 4,275 responders completed the questionnaire. The sample was evenly distributed for men (n=2,137) and women (n=2,138). The prevalence of FGID was 26.2%. Unspecified functional bowel disorder was the most prevalent (8.9%). The second was functional dyspepsia (5.3%), and the third were irritable bowel syndrome (4.4%) and functional constipation (4.4%). Women had a greater prevalence than males (33.2% compared to 22.4%, p<0.05) with regards to total FGID. Most categories of FGID were significantly prominent in women, except functional diarrhea. The FGID groups took fewer servings of vegetables and fruits than the non-FGID group each day (vegetables 2.51 vs 2.70, p<0.001; fruits 0.82 vs 0.91, p<0.001). Smoking, alcohol consumption, and betel nut chewing had no significant impaction on prevalence of FGID. The mean BSRS (brief-symptom rating scale) for screening depression and suicide ideation was higher in the FGID group (2.86 vs 1.63, p<0.001). In conclusion, FGID diagnosed with Rome III criteria are not uncommon in Taiwan's general population. Subjects who met the Rome III criteria for FGID in Taiwan were younger, had less vegetables and fruits intake, higher BSRS scores and were of greater female predominance.

Parental Report of Abdominal Pain and Abdominal Pain–related Functional Gastrointestinal Disorders From a Community Survey

Functional gastrointestinal disorders (FGIDs) are common in children. Abdominal pain (AP) is the most common gastrointestinal (GI) symptom in children. The severity of AP drives medical consultations and quality of life in adult patients with irritable bowel syndrome (IBS). Thirty-eight percent of 8- to 15-year-old schoolchildren report AP weekly with 24% of those children reporting persistence of AP >8 weeks. Despite the high prevalence of AP, only 2% of school children seek medical attention for AP. Lack of parental knowledge on their child's symptoms may constitute one of the factors affecting the low ratio of consultation in children reporting AP. The aim was to assess parental reports of AP symptoms in a population of healthy community children. Data of 5 studies with identical methodology to assess GI symptoms in children with celiac disease (CD), cow's milk allergy (CMA), pyloric stenosis (PS), Henoch-Schönlein purpura (HSP), and stem cell transplant (SC) and their healthy siblings were reviewed: a phone questionnaire on GI symptoms and Pediatric Gastrointestinal Symptoms Rome III version questionnaire (QPGS-RIII). Inclusion criteria were healthy children 4 to 18 years of age with a sibling previously diagnosed with CD, CMA, PS, HSP, or SC. Data on 246 healthy children, mean age (9.8 years, range 3-24, 112 girls) were obtained. Parents reported presence of AP in the last 8 weeks before the telephone contact in 20 (8.1%) children (age range 4-18 years, 11 girls). There was no significant difference in AP prevalence between boys and girls (P = 0.64). Six children (2.4%) met QPGS-RIII diagnostic criteria for FGIDs: 3 functional abdominal pain (FAP) and 3 IBS. AP was common in community children. FAP was the most common FGID among healthy community children. The prevalence of AP by parental report is lower than the previously published prevalence of AP reported by children. Lack of awareness of children's symptoms may play a role in the low ratio of consultation for AP in symptomatic children. Future prospective studies should confirm our findings and investigate the factors influencing the medical consultation decision including parental awareness of children's symptoms.

Evaluation of Constipation

The evaluation of the chronically constipated patient is multifaceted and challenging. Many clinicians define constipation according to the latest Rome III diagnostic criteria for functional gastrointestinal disorders. Female sex, older age, low fiber diet, a sedentary life style, malnutrition, polypharmacy, and a lower socioeconomic status have all been identified as risk factors for functional constipation. In elderly patients, it is important to rule out a colonic malignancy as the cause of constipation. The initial evaluation of the constipated patient includes a detailed history to elicit symptoms distinguishing slow transit constipation from obstructive defecation. Slow transit and obstructive defecation are the two major subtypes of functional constipation. In addition, the clinician should identify any secondary causes of constipation. The office examination of the constipated patient includes an abdominal, perineal, and a rectal exam. Many patients improve with lifestyle modification. When dietary interventions and lifestyle modifications fail, many diagnostic studies are available to further evaluate the constipated patient. Sitzmark transit study, nuclear scintigraphic defecography, electromyography, anorectal manometry, balloon expulsion test, paradoxical puborectalis contraction, cinedefecography, and dynamic magnetic resonance imaging defecography have all been used to diagnose the underlying causes of functional constipation.

The association of coeliac disease in childhood with functional gastrointestinal disorders: a prospective study in patients fulfilling Rome III criteria

An association between coeliac disease (CD) and functional gastrointestinal disorders (FGIDs) has at present only been demonstrated in adults. To assess the prevalence of FGIDs at 1 year and the role of psychological aspects on the development of FGIDs in CD children. One-hundred consecutive CD children (36M and 64F) were followed up for 1 year. Fifty-six children (25M and 31F) represented the control group. All children and/or their parents completed validated questionnaires for GI symptoms, depression, and anxiety. GI symptoms at diagnosis and after 1 year of gluten-free diet (GFD) were compared. Twenty-three/82 (28%) CD patients followed up prospectively, on GFD from at least 1 year, fulfilled the Rome III criteria for FGIDs compared with 5/56 (8.9%) controls (P = 0.008; χ² = 6.8; OR: 3.97; 95% CI: 1.40-11.21). Children complaining with GI symptoms alone [21/52 (40.3%)] more likely fulfilled Rome III criteria for FGIDs after 1 year of GFD than children with extra-intestinal symptoms (P = 0.045). CD children with FGDIs presented significantly higher anxiety and depression compared to CD children without FGIDs and controls (P = 0.02). This study demonstrates that children with CD on a GFD for a year have a much higher prevalence of functional GI symptoms than do controls. Whether the risk is due to the residua of a chronic inflammatory process, and/or due to psychological factors remains to be further tested.

ROME III Consensus Guidelines Compares Imperfectly With a Naturalistic Classification of Individuals Attending Gastroenterology Outpatient Clinics

Background: The Rome consensus guidelines are formed by an expert panel that carefully considers the available evidence. Such criteria are however necessarily based on disparate pieces of research and designed to apply to the majority of patients. The extent to which the criteria represent groupings of symptoms as they occur within individuals has not been well described. Aims: To determine whether the Rome III expert consensus guidelines compare closely to groupings of individuals that would be obtained through a natural classification system Method: Outpatients attending gastroenterology outpatient clinics (n= 1,015) completed validated symptom questionnaires that allowed assessment of Rome III criteria for functional gastrointestinal disorders (FGIDs). Latent symptom dimensions were identified using non-orthogonal factor analysis. Clusters of individuals were formed using non-hierarchical cluster analysis. Results: Cluster analysis yielded six distinct clusters of individuals. The distinguishing symptoms of each cluster and their representation of Rome III criteria were: cluster 1: fewer and harder stools when pain begins and 72% IBS including 32% IBS-C and only 2% IBS-D, cluster 2 : early satiety, postprandial fullness and loss of appetite with 73% functional dyspepsia and 49% GERD compared with overall rates of 40% and 26% respectively, cluster 3 : frequent stool, loose/watery stool, accidental leakage along with frequent and severe pain and 34% IBS-D compared with 14% overall and 26% diarrhea compared with 12% overall, cluster 4: no unusually high symptom features and lower than average on pain features and lower than average on all Rome III criteria considered, including 0% IBS. The 5th and 6th clusters did not have symptom profiles that matched the pattern of Rome III prevalence observed. Conclusions: The Rome III criteria and symptom patterns occurring naturally in groups of patients show some overlap in four clusters of individuals that represent approximately 65% of individuals. In three of these clusters there was a meaningful coincidence of IBS-C and constipation, IBS-D and diarrhea, functional dyspepsia and PDS. The fourth cluster was represented by GERD and constipation. Whether the remaining 35% of patients represent a discordance between Rome III criteria and natural symptom patterns requires further investigation.

ROME III Criteria for Functional Gastrointestinal Disorders: Too Much Overlap to Be Useful?

Introduction Functional gastrointestinal (GI) symptoms are common. The Rome III classification of these symptoms into mutually exclusive disorders attempts to improve the homogeneity of patients recruited into clinical trials from secondary and tertiary care. Previous investigators have reported significant degrees of overlap between some of these conditions, but no study has examined this issue in its entirety. Methods This was a cross-sectional survey of consecutive new patients consulting a Gastroenterologist at two tertiary care centres. All individuals were provided with the self-administered, validated, Rome III diagnostic questionnaire for the adult functional GI disorders. We scored completed questionnaires according to the algorithm devised by the authors, but suspended the mutual exclusivity between various syndromes, such as dyspepsia, irritable bowel syndrome and functional constipation, required by the questionnaire in order to examine the degree of overlap between them. Results A total of 1822 patients completed the questionnaire. There were 1253 (68.8%) who met criteria for at least one of the functional GI disorders and 880 (70.2%) of these patients met criteria for more than one disorder when the mutual exclusivity was suspended. The degree of overlap between the various disorders varied between 3% and 86% and was greatest for functional vomiting and chronic idiopathic nausea (table 1). Conclusion The degree of overlap between the various Rome III diagnostic was variable but large in some cases. The magnitude of this overlap was of remarkably similar magnitude in some instances. These data suggest that some of these disorders have similar aetiologies or pathogenetic mechanisms and that attempts to classify them separately may be both artificial and futile.

Functional gastrointestinal disorders and overlap syndrome in Korea

Functional gastrointestinal disorders (FGIDs) are common in clinical practice and in communities around the world, including Korea. In a recent point prevalence study on functional dyspepsia (FD) in Korea using the Rome III criteria, 13.4% of community respondents reported dyspepsia. Forty-seven percent of these FD cases were classified as postprandial distress syndrome, 26% as epigastric pain syndrome, and 27% as overlap syndrome. Upper and lower GI symptoms commonly overlap and FGIDs are related to psychological disorders. In our recent study of subjects recruited from a health-screening program, the point prevalence of FD, irritable bowel syndrome (IBS), and reflux esophagitis (RE) was 13.2%, 3.9%, and 8.2%, respectively. The odds ratio of having FD and IBS together was estimated to be 4.4 (95% CI: 1.21-15.71). We found a positive relationship between FD and IBS. Recently, several genetic studies have suggested that serotonin transporter (SERT) gene polymorphisms and the G-protein β3 (GNβ3) C825T gene polymorphism are associated with FD and IBS. However, we did not find an association between SERT and GNβ3 C825T genetic polymorphisms and overlap syndrome, including FD and IBS, in our previous study in a Korean population. We therefore undertook a validation study of the Rome III criteria for FGIDs by factor analysis of symptoms. The sensitivity and specificity of Rome III criteria in discriminating FGIDs from organic diseases of the upper GI tract was 60% and 53%, respectively, while the sensitivity and specificity of these criteria for the lower GI tract was 80% and 50%, respectively, partially supporting the use of the Rome III criteria in Korea.

Attitude of Swiss physicians towards opioid-induced constipation: A national survey

Background Opioid-induced constipation is a severe complication affecting up to 90% of chronic pain patients treated with opioids, causing considerable suffering and non-adherence to treatment. Objective To examine the attitude of Swiss practising physicians towards opioid-induced constipation awareness and management. Methods A total of 961 Swiss practising physicians were surveyed by questionnaire concerning their experience of and perspective on the prevalence and symptoms of opioid-induced constipation, time of development, treatment, impact on quality of life (QoL) and adherence to opioid treatment. Chronic constipation was defined following the Rome III diagnostic criteria for functional gastrointestinal disorders. Results Physicians stated that in their experience 62.4% (range 4–100%) of patients treated with opioids developed opioid-induced constipation and 82.4% of physicians observed it within the first week of opioid administration. Dry and/or hard stools were reported by 78.5% of physicians as the most prevalent observed symptom of opioid-induced constipation, 71.2% of physicians experienced a negative impact of opioid-induced constipation on the QoL of patients and 70.7% believed that opioid-induced constipation negatively affected patients’ treatment adherence. Perceived efficacy was judged by 91.4% of physicians to be a highly relevant aspect of opioid therapy, whereas only 22.1% rated therapy costs as highly relevant. Conclusion Swiss physicians consider opioid-induced constipation to be a major and early developing adverse effect of opioid therapy that negatively affects QoL and treatment adherence. To avoid opioid-induced constipation, administration of laxatives or a combination of opioids with receptor antagonists must be considered as preventive measures.

Rome III criteria for functional gastrointestinal disorders: too much overlap to be useful?

<h3>Introduction</h3> Functional gastrointestinal (GI) symptoms are common. The Rome III classification of these symptoms into mutually exclusive disorders attempts to improve the homogeneity of patients recruited into clinical trials from secondary and tertiary care. Previous investigators have reported significant degrees of overlap between some of these conditions, but no study has examined this issue in its entirety. <h3>Methods</h3> This was a cross-sectional survey of consecutive new patients consulting a Gastroenterologist at two tertiary care centres. All individuals were provided with the self-administered, validated, Rome III diagnostic questionnaire for the adult functional GI disorders. We scored completed questionnaires according to the algorithm devised by the authors, but suspended the mutual exclusivity between various syndromes, such as dyspepsia, irritable bowel syndrome and functional constipation, required by the questionnaire in order to examine the degree of overlap between them. <h3>Results</h3> A total of 1822 patients completed the questionnaire. There were 1253 (68.8%) who met criteria for at least one of the functional GI disorders and 880 (70.2%) of these patients met criteria for more than one disorder when the mutual exclusivity was suspended. The degree of overlap between the various disorders varied between 3% and 86% and was greatest for functional vomiting and chronic idiopathic nausea (table 1). <h3>Conclusion</h3> The degree of overlap between the various Rome III diagnostic was variable but large in some cases. The magnitude of this overlap was of remarkably similar magnitude in some instances. These data suggest that some of these disorders have similar aetiologies or pathogenetic mechanisms and that attempts to classify them separately may be both artificial and futile.

Somatic Complaints in Childhood Functional Abdominal Pain Are Associated With Functional Gastrointestinal Disorders in Adolescence and Adulthood

Nongastrointestinal (non-GI) somatic complaints are common in children and adults with functional gastrointestinal disorders (FGIDs). The aim of the present study was to determine whether non-GI somatic complaints in children with functional abdominal pain (FAP) were associated with FGIDs in adolescence and young adulthood. In a prospective clinic-based study, children and adolescents (ages 8-16 years) with FAP (n = 188) and well controls (n = 61) completed a validated measure of somatic symptoms. Participants were assessed 4 to 15 years later (as older adolescents and young adults) for presence of current FGIDs as defined by the Rome III criteria. Of the 188 youths with pediatric FAP, 35.6% met criteria for FGIDs at follow-up. Initial levels of non-GI somatic symptoms were significantly higher in pediatric FAP participants who subsequently met criteria for FGIDs at follow-up compared with controls and pediatric FAP participants who did not meet criteria for FGIDs at follow-up. The association of non-GI somatic symptoms with FAP in children may identify a group that is at risk for FGIDs later in life.

Elimination disorders: a critical comment on DSM-5 proposals

Elimination disorders are common in childhood and adolescence. Enuresis is defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards--after excluding organic causes. In the past few decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies and specific treatment options. The DSM-IV criteria no longer reflect this wealth of research data and a revision is needed. Classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. These are presented and discussed. Integration of these into DSM-5 is highly recommended.

Clinical Approach to Functional Gastrointestinal Disorders in Children: Revolve Around on Cyclic Vomiting Syndrome and Aerophagia

Functional gastrointestinal disorders (FGIDs) are defined as a chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. The Rome II pediatric criteria for FGIDs were announced in 1999. The Rome III criteria, update and revise the pediatric criteria, included FGIDs criteria of infant and toddler to child and adolescent (aged 4 to 18 years). The aerophagia was classified into abdominal pain-related FGIDs in the ROME II criteria. However, cyclic vomiting syndrome and aerophagia, both were classified into vomiting and aerophagia part in the ROME III criteria. We describe the clinical features, diagnostic criteria, and treatments of cyclic vomiting syndrome and aerophaiga among pediatric FGIDs. (Korean J Pediatr Gastroenterol Nutr 2011; 14(Suppl 1): S9∼S18)

Impact of the Rome II paediatric criteria on the appropriateness of the upper and lower gastrointestinal endoscopy in children

The demand for paediatric gastrointestinal (GI) endoscopy has increased, resulting in a significant rise of overall costs. To assess the clinical impact of the Rome II criteria for functional gastrointestinal disorders when selecting paediatric patients who underwent GI endoscopy. The indications and findings of GI endoscopic procedures performed before and after the publication of the Rome II criteria were evaluated retrospectively. Upper GI endoscopy was performed in 1124 children, whereas colonoscopy was performed in 500 subjects. A total of 607 (54%) oesophago-gastro-duodenoscopies (OGDs) were positive and 517 (46%) were negative, whereas 306 (61.1%) colonoscopies were positive and 194 (38.9%) were negative. Of the 1624 procedures, 26% were considered inappropriate according to the Rome II criteria. Inappropriate procedures decreased significantly after publication of the Rome II criteria (OR, 3.7; 95% CI, 1.8-7.5). Of 1202 appropriate GI endoscopies, 502 OGD (62.7%) were significantly contributive, compared with only 105 (32.5%) of the 323 inappropriate procedures (OR, 3.5; 95% CI, 2.6-4.6), whereas 265 (65.8%) colonoscopies were significantly contributive, compared with only 41 (42.3%) of the 97 inappropriate procedures (OR, 2.6; 95% CI, 1.6-4.1). The use of the criteria for functional gastrointestinal disorders makes a significant positive impact, they should reduce unnecessary paediatric GI endoscopy.

Conceptualization and Treatment of Chronic Abdominal Pain in Pediatric Gastroenterology Practice

The aim of this study was to examine how children with abdominal pain presently are viewed, assessed, and treated by pediatric gastroenterologists across North America, as well as how perspectives have changed since initial release of the Rome criteria for functional gastrointestinal disorders approximately 15 years ago. One hundred seventy-four full members of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition completed a pediatric gastroenterology practice survey designed by the authors in 2006. The responses were examined for practice patterns and specific knowledge/use of the Rome criteria. The responses were also compared with historical data from 151 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition members who completed a similar survey in 1992. There were few changes in the evaluation, treatment, or outcomes for children with abdominal pain for the past 15 years. Knowledge of the Rome criteria was common, but use in practice was not; several specific problems with the criteria were identified. A mismatch also appeared between belief in the importance of psychological factors in the creation/maintenance of pediatric abdominal pain and integration of these factors as part of standard evaluation and treatment. Finally, controversy emerged regarding both the term "functional" and the importance of histologic inflammation in the pathophysiology of pediatric abdominal pain. The evolution and dissemination of the Rome criteria for the past 15 years have not substantially changed evaluation or treatment practices for children with abdominal pain. Many areas of inconsistency and controversy remain. More focused research is needed to better understand this common pain condition and to establish an effective treatment program that can be disseminated across practitioners.