Development Of Functional Gastrointestinal Disorders Research Articles

Screening for functional gastrointestinal disorders in preterm infants up to 12 months of corrected age: a prospective cohort study

Functional gastrointestinal disorders (FGIDs) are characterized by a variety of symptoms that are frequently age-dependent, chronic, or recurrent and are not explained by structural or biochemical abnormalities. There are studies in the literature reporting different results regarding the relationship between prematurity and FGIDs. The main objective of this study was to compare the frequency of FGIDs between preterm and term infants. The secondary objective was to evaluate whether there was any association between neonatal characteristics and development of FGIDs. A multicenter prospective cohort study that included preterm infants born before 37 weeks of gestation and healthy term infants was carried out. At 1, 2, 4, 6, 9, and 12 months of age, infants were assessed for the presence of FGIDs using the Rome IV criteria. In preterm infants, an additional follow-up visit was made at 12 months corrected age. 134 preterm and 104 term infants were enrolled in the study. Infantile colic, rumination syndrome, functional constipation, and infant dyschezia were more common in preterm infants. Incidence of other FGIDs (infant regurgitation, functional diarrhea and cyclic vomiting syndrome) were similar among preterm and term infants. Preterm infants who are exclusively breastfeed in the first 6 months of life have a lower incidence of infantile colic (18.8% vs 52.1%, p = 0.025). In terms of chronological age, FGIDs symptoms started later in preterm infants; this difference was statistically significant for infantile colic and regurgitation (median age 2 months vs 1 month, p < 0.001). Conclusions: Preterm infants have a higher prevalence of FGIDs compared with term controls. Therefore, especially if they have gastrointestinal complaints, they should be screened for FGIDs. Possibly due to maturational differences, the time of occurrence of FGIDs may differ in preterm infants. Infantile colic incidence decreases with exclusive breastfeeding.What is Known:• The functional gastrointestinal disorders are a very common in infancy.• Data on preterm infants with FGIDs are currently very limited.What is New:• Preterm infants have a higher incidence of infantile colic, rumination syndrome, functional constipation and infant dyschezia when compared to term infants.• Preterm infants who are exclusively breastfed during the first 6 months of life experience a lower incidence of infantile colic.

Evaluation of the physical activity in children with functional gastrointestinal disorders

Abstract. Functional gastrointestinal disorders have been known for centuries. However, this concept appeared quite recently, and is currently a common pediatric problem. Interest in functional pathology is fully justified and understandable: despite the fact that functional diseases of the gastrointestinal tract do not pose a direct threat to the patient’s life, they significantly reduce the quality of his life. The problem of functional disorders is also complicated by the fact that they affect all strata of society, regardless of age, socio-economic status, gender or race. The active process of studying the clinical and anamnestic features of various nosological forms, predictors of functional disorders, combined functional disorders and prevention approaches is also due to significant economic damage due to direct and indirect costs of their treatment. The prevalence of functional gastrointestinal disorders in the world reaches 40.3 %, and among children's gastro pathology they occupy one of the leading places. More than half of children of various age groups have at least one of the symptoms, which is a cause of concern for both the child and the parents, as well as entails a violation of the microclimate in the family. The peak prevalence of various symptoms of disorders of the gastrointestinal tract occurs at school age and adolescents, who almost fill the appointment of a pediatrician and a pediatric gastroenterologist. If we trace the evolution of ideas about functional disorders of the digestive organs, it can be noted that it changed many times and influenced the understanding of the pathogenesis and, especially, the etiology of this nasology. According to the Rome Consensus IV (2016), functional gastrointestinal disorders are defined as disorders of the interaction of the «gut-brain» axis, taking into account this concept, a lot of time has been devoted to studying the role of various factors: genetic predisposition, infection theory, nature of feeding at an early age, hormonal imbalance, psychological state, food preferences, lifestyle and physical activity. An important aspect of studying predictors of functional bowel disorders is the level of physical activity of children and adolescents. In the process of studying literary data, it was noted that the role of insufficient physical activity in the development of functional gastrointestinal disorders remains not fully determined. Most of the materials are related to the adult population and critically few among children. That complicates the study of forecasting and prevention of a more severe course of functional dyspepsia and irritable bowel syndrome, and, as a consequence, to optimize therapy. The aim of the study was to assess the level of physical activity in children with FGID. Materials and methods. 72 children aged 8–14 with FGIR were observed. I group of study included 26 patients with combined functional dyspepsia (FD) and irritable bowel syndrome (IBS), the II group – 46 patients with FD. The control group included 22 healthy children. The diagnosis of FD and IBS were established based on the analysis of clinical symptoms according to the Rome IV criteria (2016). The PAQ-C questionnaire, developed by K. Kowalski, P. Kroker, and R. Donen, was used to assess PA in children. Research results. The total PA index in children with combined FD and SPC was 1,87 ± 0,07 and was lower compared to the group of children with FD (2,21 ± 0,05; p &lt; 0,05) and the control group (2,75 ± 0,05; p &lt; 0,01). The total PA index in children with FD is lower than in the control group (p &lt; 0,01). Conclusion. Insufficient physical activity can be considered a risk factor for the development of functional gastrointestinal disorders in children.

Features of drug therapy for functional gastrointestinal disorders in children of preschool and primary school age

The article explores modern concepts about functional gastrointestinal disorders in children, considers features of the classification according to the Rome criteria and Russian clinical guidelines, and presents the evolution of views in the context of understanding the general pathophysiological mechanism as impaired “gut-brain” interactions, which leads to dysmotility in different parts of the gastrointestinal tract, visceral hypersensitivity, changes in the local immune system functions, dysbiosis of the gut microbiota and a failure of the central nervous system to process signals. Dysregulation of the central nervous system and the enteric nervous system causes functional gastrointestinal disorders with pain syndrome: irritable bowel syndrome, functional dyspepsia and centrally mediated abdominal pain syndrome. In addition, the article discusses the Russian version of the guidelines due to differences in the diagnostic instrumental and laboratory facilities, as well as national peculiarities of marketing authorization, indications and contraindications for drug use in children. Subject to understanding of the mechanisms of functional gastrointestinal disorders in children, the authors presented information on the role of trimebutine, a universal motility regulator of different parts of the gastrointestinal tract, in the development of functional gastrointestinal disorders, as well as modern approaches to their prevention and correction using a drug of proven efficacy. Numerous national and foreign studies proved the efficacy of trimebutine in hyperkinetic and hypokinetic movement disorders, decreased gastric evacuation function, and impaired gallbladder contractile function in patients with both hypomotor and hypermotor types of functional disorders. The accumulated experience determines the prospects for its use in pediatric practice.

Effect of the nutrition violation on the of development of functional gastrointestinal disorders in school-age children

Nutrition is one of the important risk factors for the occurrence of functional gastrointestinal disorders in children (FGID).&#x0D; Objective — to study the nutrition violations in children with FGID.&#x0D; Materials and methods. Observation involved 110 children with FGID aged 6 to 18 years. The patients were divided into two groups: I study group included 44 children with an overlap of functions dyspepsia (FD) and irritable bowel syndrome (IBS). The II study group consisted of 66 pediatric patients with FD. The control group consisted of 30 healthy children. The diagnosis of functional dyspepsia and IBS was established based on the clinical symptoms according to the Rome IV criteria (2016). To detect violations in the nutritional regimen and food preferences of schoolchildren, a questionnaire survey was performed with the use of the Youth Adolescent Food Frequency Questionnaire, adapted to the model of children’s nutrition in Ukraine.&#x0D; Results. The frequency of violations in the nutritional regimen, such as refusal of breakfast or a full lunch at school, reducing the daily frequency of meals, was higher in children with FGID than in healthy children. The violations of nutrition in children with overlapping FD and IBS was observed more often than in children with FD. The frequency of consumption of vegetables, cereals and grains was lower in children with FGID, and the consumption of meat, sausages and confectionery, fast food, chips, nuts and seeds, energetics and sweet carbonated beverages was higher than in healthy children. In children with overlapping FD and IBS, the frequency of consumption of vegetables, cereals and grains is lower, and the consumption of confectionery, fast food, energetics, and sweet carbonated drinks was higher than in children with FD.&#x0D; Conclusions. Violations of the regimen and quality of nutrition is a risk factor for the formation of FGIR in children and should be considered in the treatment.&#x0D;

Emotional-Single Prolonged Stress: A promising model to illustrate the gut-brain interaction

Excessive stress can precipitate depression and anxiety diseases, and damage gastrointestinal functionality and microbiota changes, favoring the development of functional gastrointestinal disorders (FGIDs) – defined by dysregulation in the brain-gut interaction. Therefore, the present study investigated if Emotional-Single Prolonged Stress (E-SPS) induces depressive/anxiety-like phenotype and gut dysfunction in adult Swiss male mice. For this, mice of the E-SPS group were subjected to three stressors sequential exposure: immobilization, swimming, and odor of the predator for 7 days (incubation period). Next, animals performed behavior tests and 24 h later, samples of feces, blood, and colon tissue were collected. E-SPS increased the plasma corticosterone levels, immobility time in the tail suspension and forced swim test, decreased the grooming time in the splash test, OAT%, and OAE% in the elevated plus-maze test, as well as increased anxiety index. Mice of E-SPS had increased % of intestinal transit rate, % of fecal moisture content, and fecal pellets number, and decreased Claudin1 content in the colon. E-SPS decreased the relative abundance of Bacteroidetes phylum, Bacteroidia class, Bacteroidales order, Muribaculaceae and Porphyromonadaceae family, Muribaculum, and Duncaniella genus. However, E-SPS increased Firmicutes and Actinobacteria phylum, Coriobacteriales order, and the ratio of Firmicutes/Bacteroidetes, and demonstrated Mucispirillum genus presence. The present study showed that E-SPS induced depressive/anxiety-like phenotype, predominant diarrhea gut dysfunction, and modulated the gut bacterial microbiota profile in male adult Swiss mice. E-SPS might be a promising model for future studies on the brain-gut interaction and the development of FGIDs with psychological comorbidities.

Prematurity and functional gastrointestinal disorders in infancy: a cross-sectional study.

ABSTRACTBACKGROUND: Functional gastrointestinal disorders (FGIDs) are defined as a variable combination of chronic or recurrent gastrointestinal symptoms that are not explained by structural or biochemical abnormalities. Their relationship with prematurity has been increasingly studied.OBJECTIVE: To compare the frequency of FGIDs in preterm and term infants and to evaluate whether invasive procedures during the neonatal period in preterm infants are associated with greater likelihood of FGIDs in the first two years of life.DESIGN AND SETTING: Controlled nested cross-sectional study conducted in a Brazilian university hospital.METHODS: This was a controlled nested cross-sectional study on a retrospective cohort of infants born preterm who were compared with infants born at term regarding the presence of FGIDs. Medical consultations were conducted by a single pediatric gastroenterologist to obtain information on the gestational and neonatal periods and on clinical manifestations of the digestive tract. The Rome IV criteria for the diagnosis of FGIDs were used.RESULTS: A total of 197 infants (< 24 months), including 99 preterm and 98 term infants, were studied. Infant regurgitation was more prevalent in term infants (35.1% and 15.6%; P < 0.001). The frequencies of other FGIDs (infant colic, functional constipation, functional diarrhea and infant dyschezia) in preterm infants did not differ from those of term infants (P > 0.05). No relationship was found between invasive procedures during the neonatal period and development of FGIDs in preterm infants.CONCLUSION: Infants born preterm did not have higher frequency of FGIDs in the first two years of life.

Goat Milk Formula. To whom, why, how

From an evolutionary standpoint, breast milk is the optimal food for nutrition of infants, which contains, in addition to macro- and micronutrients, functional components required for the morphofunctional maturation and development of regulatory interactions between organs and systems mostly of the digestive system. The choice of formula for artificial feeding of infants is determined, first of all, on the basis of its functionality. Interest in goat milk as a source of nutrition has been known for a long time, and recommendations highlighting its dietary and healing properties are found in both ancient treatises and modern guidelines. In this regard, goat milk formulas deserve special attention. Based on the results of the research, were identified the features of goat milk composition, which determine the unique metabolic and physiological properties for young children. The article presents comparative data on the features of the chemical composition of goat, cow and breast milk, as well as the functional characteristics of the adapted goat milk based formula. The advantages of goat’s milk allow us to consider goat milk based formula as physiological (providing normal physical development and metabolic processes), as functional (due to growth, regulatory and protective factors) and prophylactic — to prevent the occurrence of functional disorders (regurgitation, constipation) due to compliance with the functional capabilities of the gastrointestinal tract of the child. Such formulas are indicated for healthy infants and can be used in infants with risk factors for the development of functional gastrointestinal disorders. Such risk factors include caesarean-section delivery, exposure to antibiotics in the first days of life, perinatal pathology of the central nervous system.

Neonatal Antibiotics and Food Allergy Are Associated With FGIDs at 4-6 Years of Age.

Antibiotics may contribute to the development of functional gastrointestinal disorders (FGIDs). This study aimed to determine whether antibiotics during the first week of life, infantile colic in the first year of life, gut-associated immune markers at 1 year of age, and allergies at 4-6 years of age in term-born children were associated with a higher prevalence of FGIDs at 4-6 years of age. A prospective observational cohort of 436 term-born infants was followed up at the age of 4-6 years; 151 received broad-spectrum antibiotics (AB+), and 285 healthy controls (AB-). Validated Questionnaire On Pediatric Gastrointestinal Symptoms-Rome III and International Study of Asthma and Allergy in Childhood questionnaires were sent to parents of 418 available children. The independent t-test, chi-squared test or non-parametric test and logistic multivariate regression analyses were used. In total, 340 of 418 (81%) questionnaires were completed. Only the presence of functional abdominal pain was significantly higher in AB+ than AB- (4% vs 0.4%, respectively, P = 0.045). Children with food allergy fulfilled significantly more often the criteria for irritable bowel syndrome (IBS) and abdominal migraine (26% vs 9%, P = 0.002 and 7% vs 1%, P = 0.043, respectively) compared to non-allergic children. No differences in FGIDs existed at the age of 4-6 years between children with and without a history of infantile colic. There were significant differences in gut-associated immune markers between children with and without FGIDs. Antibiotics during the first week of life resulted in a higher risk for functional abdominal pain at 4-6 years. Furthermore, food allergy was associated with IBS and abdominal migraine at 4-6years.

Is there an association between necrotizing enterocolitis in premature neonates and functional gastrointestinal disorders later in childhood?

Stressful events during infancy may predispose to the development of functional gastrointestinal disorders (FGIDs) in childhood. To evaluate the association of necrotizing enterocolitis (NEC) with childhood FGIDs. We conducted a study, comparing 29 children of eight to ten years with a history of NEC with 58 children with no history of NEC. Subjects were assessed for FGIDs, based on Rome-III criteria. Among 29subjects with NEC, 17had surgical and 12 conservative NEC. Subjects with surgically, or conservatively managed NEC developed FGIDs at a significantly higher proportion, as compared to children with no history of NEC, later in childhood (41%, 33%, and 13% respectively, p=0.033). Functional constipation was the most frequently identified disorder (35%, 33%, and 7% respectively). A significant association was detected between FGIDs and the history of perinatal stress (p=0.049), NEC (p=0.011), and the surgical management of NEC (p=0.015). Our study suggests that there is a potential association between NEC and FGIDs later in childhood with functional constipation being the most frequently identified disorder.

Sexual dimorphism in maternally separated rats: effects of repeated homotypic stress on gastrointestinal motor functions.

Experiencing stressful events during early life has been considered as a risk factor for development of functional gastrointestinal disorders in adulthood. This study aimed to investigate the sex-related differences in stress-induced gastrointestinal (GI) dysmotility in rats exposed to neonatal maternal separation (MS). Newborn pups were removed from mothers for 180min from postnatal day-1 to day-14. Experiments were performed in male and female offsprings at adulthood. Elevated plus maze (EPM) test was used to assess MS-induced anxiety-like behaviors. Ninety minute of restraint stress was applied for once or 5 consecutive days for acute stress (AS) or repeated homotypic stress (RHS), respectively. Measurement of fecal output (FO) and gastric emptying (GE), and hypothalamic microdialysis were performed. Both in males and females, MS produced anxiety-like behaviors. AS delayed GE and increased FO in all groups. In RHS-loaded MS females, AS-induced alterations in GE and FO were restored, however, no adaptation was observed in male counterparts. Regardless of sex and neonatal stress experience, AS significantly increased corticotropin-releasing factor (CRF) release from paraventricular nucleus of hypothalamus, whereas females were found more susceptible than males. Following RHS, AS-induced elevations in CRF release were attenuated only in MS females, but not in males. Both females and males seem to be prone to AS-induced alterations in hypothalamic CRF system and in GI motor functions. Neonatal MS disturbs chronic stress coping mechanisms in males. Conversely, females are likely to circumvent the deleterious effects of neonatal MS on GI functions through developing a habituation to prolonged stressed conditions.

Features of the Composition of the Colon Microbiota in Children of the First Year of Life with Functional Gastrointestinal Disorders

Background. The development of functional gastrointestinal disorders (FGID) in children, especially in the first year of life, is a key factor in the formation of an altered colon microbiota and its formation in older age. The article presents both clinical-detailed anamnesis, symptoms of FGID, and bacteriological characteristics – qualitative and quantitative composition of the colon microbiota in children of the first year of life. Aim: to determine the features of the colon microbiota in children of the first year of life with FGID. Materials and methods. The objects of the study were children of the first year of life (n = 28) with a diagnosis of FGID established by a gastroenterologist. The material was divided into two comparison groups, depending on the age of the subjects: the first group included stool sample cultures of children aged from birth to 6 months (n = 17), the second – from 6 to 12 months (n = 11). The bacteriological study of the quantitative and qualitative composition of the contents of the colon was performed using standard methods. Results . According to the anamnesis, colic and flatulence were the key symptoms of FGID (p &lt; 0.05). The results show that the formation of FGID in children from birth to 6 months and from 6 to 12 months may be associated with altered colon microbiota. There was a decrease in the quantitative indicators of the indigenous microbiota: bifidobacteria, E. coli with normal sensitivity and Enterococcus spp., and an increase in the degree of contamination of Klebsiella spp., S. aureus, Clostridium spp. Conclusion . It is shown that the determining factor in reducing the risk of developing FGID in children of the first year of life is a high concentration and diversity of indigenous microbiota.

Are functional gastrointestinal disorders a clinically significant comorbid factor for acute respiratory infection in children?

Rationale: Functional gastrointestinal disorders (FGID) are highly prevalent in children worldwide. Current concept of FGID pathophysiology implies contributions from various mechanisms. Information in the role of acute respiratory infections in the development of FGID in children is lacking.Aim: To determine the prevalence of FGID in children hospitalized to the department of infectious diseases with acute respiratory tract infections (ARTI) and their association with demographic, medical biological factors and clinical manifestations.Materials and methods: We performed observational and cross-sectional study with continuous patient sampling. The study included 180 ARTI patients, whose mothers agreed to fill in the proposed questionnaire of 41 items. The diagnosis of FGID during in-hospital stay was made based on clinical data in accordance with the Rome criteria IV (2016) and by standard collection of the information from the parents. The stool characteristics were assessed with the Bristol scale. The rate of recurrent ARTI was assessed by the resistance index of above 0.5. We considered clinical symptoms of ARTI at the admittance, the rates of bacterial complications and the need in antibacterial treatment.Results: The prevalence of FGID in hospitalized children with ARTI below 4 years of age (n = 134) was 35.1% (95% confidence interval [CI]) 27.0– 43.9); they had higher rates of functional diarrhea (14.9%, 95% CI 9.4–22.1) and constipation (14.2%, 95% CI 8.8–21.3). Among those above 4 years of age (n = 46), FGID were diagnosed in 50% (95% CI 34.9–65.1) of the cases; with most frequent symptoms being abdominal pain (39.1%, 95% CI 25.1–54.6) and irritable bowel syndrome (10.8%). Irrespective of their age, the children with FGID had higher rates of ARTI recurrence (by 34.0%, 95% CI 20.0–48.1; relative risk 1.98, 95% CI 1.47–2.69; odds ratio 4.13, 95% CI 2.18–7.85) and intestinal infections in their past history, compared to those without any gastrointestinal symptoms during the index hospitalization. In children with FGID, ARTI were more frequently complicated by otitis and they had higher requirement in antibiotics. The mothers of the infants and toddlers with FGID had lower educational level (smaller proportion of those with high school education) and were less satisfied with their home and living conditions, whereas their fathers were older and more frequently employed in vehicle operations and less frequently were occupied in communication-related professions.Conclusion: Acute respiratory infections, especially recurring, may plaу a significant role in the development and maintenance of FGID in children. Further studies are necessary, which may result in useful information for the development of tailored strategies to treatment and prevention.

Birth Weight and the Development of Functional Gastrointestinal Disorders in Infants.

PurposeTo assess the association between birth weight and the development of functional gastrointestinal disorders (FGIDs) in the first year of life.MethodsThis is a secondary analysis of a prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up for one year. At birth all infants were classified by birth weight as extremely low (ELBW), very low, or low when <1,000, <1,500, and <2,500 g, respectively, and by birth weight for gestational age as appropriate (AGA, weight in the 10–90th percentile), small (SGA, weight <10th percentile), and large (LGA, weight >90th percentile) for gestational age. FGIDs were classified according to the Rome III criteria and assessed at 1, 3, 6, and 12 months of life.ResultsAmong 1,152 newborns enrolled, 934 (81.1%) completed the study: 302 (32.3%) were preterm, 35 (3.7%) were ELBW, 104 (11.1%) were SGA, 782 (83.7%) were AGA, and 48 (5.1%) were LGA infants. Overall, throughout the first year of life, 718 (76.9%) reported at least one FGID. The proportion of infants presenting with at least one FGID was significantly higher in ELBW (97%) compared to LBW (74%) (p=0.01) and in LGA (85.4%) and SGA (85.6%) compared to AGA (75.2%) (p=0.0001). On multivariate analysis, SGA was significantly associated with infantile colic.ConclusionWe observed an increased risk of FGIDs in ELBW, SGA, and LGA neonates. Our results suggest that prenatal factors determining birth weight may influence the development of FGIDs in infants. Understanding the role of all potential risk factors may provide new insights and targeted approaches for FGIDs.

Neonatal Antibiotics and Prematurity Are Associated with an Increased Risk of Functional Gastrointestinal Disorders in the First Year of Life

To assess the prevalence of functional gastrointestinal disorders (FGIDs) in the first year of life and the influence of different neonatal factors on development of FGIDs. A prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up until 1year. Gestational age, neonatal antibiotic administration, duration of hospitalization, mode of delivery, birth weight, and feeding pattern were recorded. FGIDs were classified according to Rome III criteria and assessed at 1, 3, 6, and 12months of life. Among 1152 newborns enrolled, 934 (81.1%) completed the study, 302 (32%) were newborns born preterm, 320 (34%) had neonatal antibiotics, and 718 (76.9%) had at least 1 FGID according to Rome III criteria (443 [47.4%] infantile colic, 374 [40.0%] regurgitation, 297 [31.8%] infant dyschezia, 248 [26.6%] functional constipation, and 34 [3.6%] functional diarrhea) throughout the first year of life. The proportion of infants born preterm presenting with FGIDs (86%) was significantly greater compared with infants born full term (72.5%) (χ2=21.3, P=.0001). On multivariate analysis, prematurity and neonatal use of antibiotics was significantly associated with at least 1 FGID. We found a high rate FGIDs in infants, likely related to the population recruited, the long observation period, the diagnosis based on Rome III criteria, and parental reports. Preterm delivery and neonatal use of antibiotics in the first months of life are associated with an increased incidence of FGIDs, particularly infantile colic and regurgitation. In our population, cesarean delivery and feeding pattern at 1month of life emerged as additional risk factors for infant dyschezia and functional diarrhea. Other neonatal factors associated with FGIDs need to be further explored.

Allergic Proctocolitis Is a Risk Factor for Functional Gastrointestinal Disorders in Children

To prospectively evaluate the long-term effect of allergic proctocolitis on the development of functional gastrointestinal disorders (FGIDs), defined as gastrointestinal symptoms that cannot be attributed to another medical condition.The study included 80 Italian children consecutively diagnosed with allergic proctocolitis, in addition to 80 matched controls.Patients presenting to the Pediatric Gastroenterology Unit of Sapienza, University of Rome, with newly diagnosed allergic proctocolitis were recruited for participation in the study. Each subject underwent an anal inspection, stool culture, fecal calprotectin, and rectosigmoidoscopy with mucosal biopsies obtained from the left colon and rectum. Serum-specific immunoglobulin E and skin-prick testing (cow’s milk, soy, rice, wheat, and egg) were also performed. Subjects were managed with a stepwise protocol progressing from cow’s milk protein maternal avoidance, then extensively hydrolyzed formula, and then amino acid–based formula. For the control group, each subject was matched with either a sibling <6 years of age without a history of cow’s milk allergy or with another child of similar age and sex who presented to the hospital emergency department for mild trauma in the absence of previous chronic gastrointestinal symptoms. Subjects had monthly clinic follow-up until remission of symptoms, followed by telephone interview every 12 months until the age of 4 years. After subjects turned 4 years old, parents were mailed the parental Questionnaire on Pediatric Gastrointestinal Symptoms, Rome III version, a validated questionnaire for the diagnosis of FGIDs.There were 80 subjects in each of the allergic proctocolitis and control groups, with no significant differences in demographics of the 2 groups. Throughout the course of the study, none of the allergic proctocolitis patients had a change in their diagnosis, and none in the control group developed an organic disorder. In the allergic proctocolitis group, 12 subjects (15%) met FGID criteria compared with 4 subjects in the control group (5%) (P = .035). For the allergic proctocolitis group, adjusting for age and sex, the odds for developing an FGID was odds ratio 4.39 (95% confidence interval, 1.03–18.68). There was no correlation between FGIDs and family history of atopy, positive allergy testing results, fecal calprotectin, endoscopic score, histologic score, or eosinophil score. In the allergic proctocolitis group, the only variable that was statistically significant for development of an FGID was duration of hematochezia (odds ratio 3.14; 95% confidence interval, 1.72–5.74)Allergic proctocolitis is a risk factor for the development of FGID in children, further supporting that both transient infectious and noninfectious inflammatory triggers can contribute to the development of FGIDs.The authors of this study prospectively identify allergic proctocolitis as a risk factor for the development of FGIDs, describing long-term morbidity with what is considered a self-limiting, relatively mild disease. This supports the idea that prolonged inflammation, in the absence of infection, can lead to the development of FGIDs. Interestingly, the duration of hematochezia was associated with an increasing rate of developing FGIDs, which suggests that prompt treatment could have an impact on this associated morbidity.

Anxiety, depression, and anger in functional gastrointestinal disorders: A Cross-sectional observational study

Previous studies have identified a link between anger and somatization. However, little is known about the associations between anger and the development and progression of Functional Gastrointestinal Disorders (FGID). The study aim was to determine the associations between FGID and anger, anxiety, and depression. Participants in this cross-sectional observational study were 109 consecutive patients aged 18–64 years with FGID at Gastroenterology Clinic of Başkent University Hospital. A control group comprised of 96 individuals with no chronic gastrointestinal disorders recruited via snowball sampling. Sociodemographic and clinical information were obtained and participants completed the Hospital Anxiety and Depression Scale and the State-Trait Anger Expression Inventory-2. FGID participants scored higher than controls on depression, anxiety, state anger, and anger expression-in. When the FGID group was divided into upper and lower gastrointestinal symptom groups, the lower symptom group showed higher anger expression-out scores than the upper symptom group. Anger may contribute to the etiology and development of FGID. This is the first study to demonstrate a significant psychological difference between individuals with lower and upper FGID. Interdisciplinary collaboration with gastroenterologists and psychiatrists could strengthen FGID evaluation and may improve treatment compliance.

Allergic Proctocolitis Is a Risk Factor for Functional Gastrointestinal Disorders in Children

To test the hypothesis that allergic proctocolitis, a cause of self-limiting rectal bleeding in infants, can predispose to the development of functional gastrointestinal disorders (FGIDs) later in childhood. We studied a cohort of 80 consecutive patients diagnosed with allergic proctocolitis. Their sibling or matched children presenting to the same hospital for minor trauma served as controls. Parents of the patients with allergic proctocolitis and controls participated in a telephone interview every 12 months until the child was at least 4 years old. At that time, they were asked to complete the parental Questionnaire on Pediatric Gastrointestinal Symptoms, Rome III version. Sixteen of the 160 subjects (10.0%) included in the study met the Rome III criteria for FGIDs. Among the 80 patients with allergic proctocolitis, 12 (15.0%) reported FGIDs, compared with 4 of 80 (5.0%) controls (P = .035). After adjustment for age and sex, the OR for FGIDs in allergic proctocolitis group was 4.39 (95% CI, 1.03-18.68). FGIDs were significantly associated with iron deficiency anemia, duration of hematochezia, and younger age at presentation. In a multivariate analysis, only the duration of hematochezia was significantly associated with the development of FGIDs (OR, 3.14; 95% CI,1.72-5.74). We have identified allergic proctocolitis as a new risk factor for the development of FGIDs in children. Our data suggest that not only infection, but also a transient early-life allergic inflammatory trigger may induce persistent digestive symptoms, supporting the existence of "postinflammatory" FGIDs.

Mood and Anxiety Disorders Precede Development of Functional Gastrointestinal Disorders in Patients but Not in the Population.

Understanding the interactions between brain and gastrointestinal disorders requires analysis of the order of disease onset. We analyzed data from 2 independent studies to determine the proportion of individuals with diagnoses of functional gastrointestinal disorders (FGIDs) before diagnoses of mood or anxiety disorders (gut to brain), and vice versa (brain to gut). We collected data from a retrospective study of 4966 patients diagnosed with a FGID (irritable bowel syndrome, dyspepsia, or constipation) and mood or anxiety disorder at general practices in the United Kingdom (health care seekers) over an average period of 13.1 years; we recorded which diagnosis appeared first and compared these with patients' sex and socioeconomic factors. We also collected data from a population study of 1002 randomly selected individuals in Australia (non-heath care seekers) followed from 1997 through 2009; we determined whether subjects were free of either FGID or an anxiety or mood disorder at baseline but developed either one after a 12-year follow-up period. Among the 4966 health care seekers, 3279 patients were diagnosed with a mood or anxiety disorder before an FGID (ratio of 2:1). This ratio increased with socioeconomic disadvantage. The time period between diagnosis of mood or anxiety disorder and FGID was longer (median, 3.5 years) than time period between diagnosis of an FGID and a mood or anxiety disorder (median, 1.8 years). Among non-heath care seekers (population study), equal proportions were diagnosed with a mood or anxiety disorder before versus after an FGID. In an analysis of data from a study of patients and a population-based study of individuals with these diagnoses, we found 2-fold more patients to receive a diagnosis of a mood or anxiety disorder before an FGID, but equal proportions of individuals in the population to be diagnosed with the mood or anxiety disorder before versus after an FGID. Among patients, the mood or anxiety disorder was on average diagnosed more than 3 years before the FGID, offering opportunity for prevention. Our findings support a role for adverse socioeconomic factors in development of FGIDs in patients with psychological disorders.

Functional Gastrointestinal Disorders in Infants: Long-Tern Consequences and Modern Approaches for Prevention and Treatment

The article discusses modern ideas about the genesis of the most common variants of functional gastrointestinal disorders (FGID) in infants, and their ability to lead to long-term negative consequences for the health of the child. The article provides data on role of intestinal microbiota in development of FGID in infants and current approaches to prevention and correction using probiotics with proven effectiveness.

Stress and sleep quality in doctors working on-call shifts are associated with functional gastrointestinal disorders.

AIMTo investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders (FGIDs) in doctors that work 24 hour-on-call shifts.METHODSIn this cross-sectional observation study, using the Rome III Questionnaire and Pittsburgh Sleep Quality Index (PSQI), we analyzed 170 doctors with 24 hour-on-call shifts.RESULTSAmong the participants that had experienced a 24 hour-on-call shift within the last 6 mo, 48 (28.2%) had FGIDs. Overall prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) were 16.5% and 17.1%, respectively, with 5.3% exhibiting both. Sleep scores (PSQI) (8.79 ± 2.71 vs 7.30 ± 3.43, P = 0.008), the presence of serious psychosocial alarm (83.3% vs 56.6%, P = 0.004), and the proportion of doctors who experienced over two months of recent on-call work (81.2% vs 68.9%, P = 0.044) were significantly different between individuals with or without FGIDs. Multivariate analysis revealed that presenting serious psychosocial alarm was an independent risk factor for prevalence of FD (OR = 5.47, 95%CI: 1.06-28.15, P = 0.042) and poor sleep quality (PSQI ≥ 6) was a predictor of IBS (OR = 4.17, 95%CI: 1.92-19.02, P = 0.016).CONCLUSIONPhysicians should recognize the role of sleep impairment and psychological stress in the development of FGIDs and a comprehensive approach should be considered to manage patients with FGIDs.