Functional Gastrointestinal Disorders In Children Research Articles

Rome IV—Functional GI Disorders: Disorders of Gut-Brain Interaction

Rome IV—Functional GI Disorders: Disorders of Gut-Brain Interaction

The prevalence of functional gastrointestinal disorders in children in Panama: a school-based study.

Functional gastrointestinal disorders (FGIDs) are common in children, but the epidemiology of FGIDs is incompletely understood. Our aim was to perform a population-based study using Rome III criteria to describe the prevalence of FGIDs in children in Panama. We performed a cross-sectional study of children attending three schools in Panama City, Panama. Children with organic medical diseases were excluded. Subjects provided demographic information and completed the Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III Spanish version. A total of 321 subjects (61.1% female, median age 10 years, range 8-14 years) completed our study. A total of 92 subjects (28.7%) met criteria for an FGID. Gender, age and school type did not differ significantly between subjects with and without FGIDs. The most common FGIDs included functional constipation (15.9%), irritable bowel syndrome (5.6%), and functional abdominal pain or functional abdominal pain syndrome (4.0%). Abdominal pain-related FGIDs were present in 12.1%. FGIDs are common in school-aged children in Panama. The prevalence of abdominal pain-related FGIDs in children in Panama is similar to that described in other parts of the world. Further population-based studies utilising Rome III criteria to measure FGID prevalence in children are needed to advance our understanding of the pathogenesis of FGIDs.

Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents

Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents

Outcome of a public consultation on the draft guidance of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on the scientific requirements for health claims related to the immune system, the gastrointestinal tract and defence against pathogenic microorganisms

Outcome of a public consultation on the draft guidance of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on the scientific requirements for health claims related to the immune system, the gastrointestinal tract and defence against pathogenic microorganisms

PP‐7 CHILDHOOD RECURRENT ABDOMINAL PAIN IS ASSOCIATED WITH DUODENAL EOSINOPHILIA REGARDLESS OF H. PYLORI INFECTION

Objectives:This study aimed to investigate histologic features of children with RAP undergoing upper gastrointestinal endoscopy, after exclusion of common organic disease.Methods:Children referred for endoscopy were prospectively enrolled at a single tertiary center between 2008 and 2010, after obtaining informed consent. Cases were defined as children with clinical diagnosis of RAP, as opposed to controls with suspicion of organic disease. Gastric and duodenal biopsies were analysed by pathologists blinded to indication. Demographic and clinical variables, H. pylori infection, biochemical, endoscopic and pathologic results were compared between cases and controls.Results:A total of 101 children were included after exclusion of villous enteropathy (n = 6) and parasitic, rotaviral or salmonella enteritis (n = 14), resulting in 72 cases and 29 controls. There were no significant differences in demographics, clinical symptoms, H. pylori infection and endoscopic findings between cases and controls. Duodenal eosinophil counts per 5 HPF were significantly increased in cases vs. controls (median (IQR) 86 (62–114) vs. 49 (31–88); p < 0.001) and did not differ regarding age, gender and H. pylori. Intraepithelial lymphocytes per 100 enterocytes were similar in cases vs. controls (19 (15–25) vs. 18 (14–23); p = 0.89) with ≥ 25 in 25% of cases. Duodenal eosinophilia was equally observed in H. pylori negative cases (n = 50) vs. controls (n = 19) (87 (61–119) vs. 53 (36–95); p = 0.01), as well as positive cases (n = 21) vs. controls (n = 10) (85 (55–105) vs. 42 (18–65); p = 0.03). Logistic regression yielded an adjusted odds ratio of 1.23 (95% CI 1.08–1.40) for duodenal eosinophilia in RAP.Conclusions:Children with a clinical diagnosis of RAP have marked duodenal eosinophilia, independent of H. pylori infection, suggesting the role of unknown infectious or allergic triggers in the pathogenesis of functional gastrointestinal disorders in childhood. Further research is needed on the diagnostic and therapeutic benefits of targeting duodenal eosinophilia.

Fast foods--are they a risk factor for functional gastrointestinal disorders?

Fast-food consumption has greatly increased in Taiwan. Frequent fast food intake is associated with both allergy and obesity. The aim of this study was to describe fast food habit changes, and to assess the relationship between fast food intake and the risk of functional gastrointestinal disorders (FGIDs) among Taiwanese adolescents. This analysis used data from the Nutrition and Health Survey in Taiwan (NAHSIT) of high school students conducted in 2011. A total of 2,042 adolescents (12-19 years) completed the questionnaire. The survey included the Rome III criteria for FGIDs, translated into Chinese for adolescents. Respondents with previously diagnosed chronic organic gastrointestinal diseases were excluded from the study. In total, 2,034 children were enrolled. 545 subjects (26.8%) had history of at least one FGID. 88.1% of the subjects reported fast foods consumption. A significantly higher prevalence of FGIDs was noted in adolescents with a history of fast foods consumption, compared with those reported not to have ingested fast foods in the past 30 days (27.6% vs 20.6%, p=0.024). An increased risk of FGIDs in children and adolescents was associated with fast food intake (OR 1.8, 95% CI: 1.78-1.83). FGIDs were common among Taiwanese adolescents. Fast-food consumption may contribute to a positive association with the development of functional gastrointestinal disorders. Lower fiber intake and more frozen desserts in the diet may be complicit in FGIDs. The findings have public health relevance in regard to the global increase in fast food consumption.

Water Load Test in Childhood Functional Abdominal Pain

This cross-sectional study evaluates the relations between the water load test in childhood functional gastrointestinal disorders with food intake and nutritional status. Patients with functional dyspepsia required a lower maximum water intake to produce fullness (n = 11, median = 380 mL) than patients with irritable bowel syndrome (n = 10, median = 695 mL) or functional abdominal pain (n = 10, median = 670 mL) (P < 0.05). Among patients who ingested ≤560 mL (n = 17) or >560 mL (n = 14) in the water load test, there was no relation between the maximum drinking capacity and food intake, body mass index, or height.

Education and Hypnosis for Treatment of Functional Gastrointestinal Disorders (FGIDs) in Pediatrics

FGIDs in children and adolescents (ROME III classification) have a significant impact on the daily functioning and quality of life. Often it is the pain that is one of the main contributors to the burden of functional dyspepsia, functional abdominal pain (syndrome), and irritable bowel syndrome. Current knowledge confirms that a number of integrated networks at cortical and subcortical sites are responsible for the experience of pain. From the work of Mayer and Tillisch (2011), mainly based on structural and functional magnetic resonance imaging and positron emission tomography, it has become clear that abdominal pain syndromes are disorders of the bi-directional mind–brain–gut interactions. In this multi-factorial bio-psycho-social model we recognize the importance of neurobiological processes in the mind–brain–gut interactions, leading to alterations in motility, sensation, and immune functions. Medical treatment often offers little or no relief. Until now pharmaceutical research has not succeeded in developing safe new drugs with an effect on the brain–gut axis. More recent published research shows the rationale for the use of medical hypnosis in FGID. In this article the author will illustrate her specific approach in a pediatric gastroenterology clinic with children and adolescents with FGIDs. Being a pediatric gastroenterologist, the author emphasizes the importance of a clear diagnosis, explains the rationale for educating the patient and his or her parents on the multi-factorial bio-psycho-social model and the concepts of chronic pain, discusses the specific settings and pitfalls for hypnosis treatment in children, and last but not least, provides some examples of hypnotic sessions used with FGIDs.

소아의 기능성 위장관 질환과 기질 및 성격과의 관계

Abstract The Relationship Between Children's Temperament and Character to Functional Gastrointestinal Disorders Lee Eun Ju ․ Kim Hyung Joong ․ Lee Sun Haeng ․ Chang Gyu Tae Department of Pediatrics of Korean Medicine, Kyung Hee University Hospital at Gang-dong Pediatrics of Clinical Korean Medicine, College of Korean Medicine, Kyung Hee University Objectives The purpose of this study is to establish relationship between functional gastrointestinal disorders in children and Temperament and Character using objective criteria and questionnaires. Methods This study surveyed 3-6 years old 130 children who were attending the kindergarten or daycare center in the vicinity of Gangdong from May 15th, 2014 to November 30th, 2014. The Korean-translated Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-Rome III) and The Junior Temperament and Character Inventory 3-6 (JTCI 3-6) questionnaires were used. Results 1. Between the groups, functional gastrointestinal disorder group scored significantly higher on NS, NS1, NS4, HA4, ST and ST1.2. As the number of functional gastrointestinal disorders increase, the group scored higher on NS, NS1, NS4, HA4, ST and ST1.

Infantile colic, regurgitation, and constipation: an early traumatic insult in the development of functional gastrointestinal disorders in children?

Functional gastrointestinal disorders (FGIDs) are defined as a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. Infantile colic, gastroesophageal reflux, and constipation are the most common FGIDs that lead to referral to a pediatrician during the first 6 months of life and are often responsible for hospitalization, feeding changes, use of drugs, parental anxiety, and loss of parental working days with relevant social consequences. We performed a retrospective study on patients referred for recurrent abdominal pain from January 2002 trough December 2009 to our Pediatric Gastroenterology Outpatient Unit. The population studied was matched with healthy control without history of recurrent abdominal pain, enrolled among pediatricians practicing primary health care. History of infantile colic, regurgitation, and functional constipation was detected respectively in 26.41, 25.31, and 30.16% of children diagnosed with FGIDs compared to 11.34, 12.85, and 11.76% of healthy children. According to our data, children with a history of gastrointestinal infantile distress have a higher prevalence of FGIDs years later.

Mebeverine for Pediatric Functional Abdominal Pain: A Randomized, Placebo-Controlled Trial

Introduction: Few studies are conducted on the efficacy of antispasmodics in the treatment of functional gastrointestinal disorders in children. We evaluated the effectiveness of a smooth-muscle relaxant (mebeverine) in the treatment of childhood functional abdominal pain (FAP). Materials and Methods: Children (n=115, aged 6-18 years) with FAP were randomized to receive mebeverine 135 mg twice daily or placebo for 4 weeks. Response was defined as ≥ 2 point reduction in the 6-point pain rating scale or “no pain”. Secondary outcome measures were physician-assessed global severity and improvement. Patients were followed for 8 weeks after medication period. Results: Eighty seven patients completed the trial (44 in the mebeverine group). Response rate in the mebeverine and the placebo group was 54.5% and 39.5% at week 4 (P=0.117) and 72.7% and 53.4% at week 12 (P=0.050), respectively. No significant difference was observed between the two groups in change of the global severity or improvement at week 4 (P=0.723 and 0.057) or at week 12 (P=0.870 and 0.183), respectively. In regression analysis, male gender (Beta=3.470, P=0.025) and baseline pain score (Beta=3.665, P<0.001) were associated with response at week 4, but the association of mebeverine was not significant (Beta=2.585, P=0.078). At week 12, mebeverine was non-significantly associated with response (Beta=2.616, P=0.0503). Conclusions: Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo due to high placebo response and limited sample of the study. Further trials are recommended in this regard (ACTRN12613000158763).

Role of Probiotics and Prebiotics in Functional Gastrointestinal Disorders in Children

Introduction: Functional gastrointestinal disorders (FGID) are non-fatal, unknown etiology disorders with absence of a structural or biochemical explanation and accounting for up to 50% of gastroenterology referrals. Infant regurgitation, rumination and cyclic vomiting constitute the vomiting disorders. Abdominal pain disorders are classified as: functional dyspepsia, irritable bowel syndrome (IBS), functional abdominal pain, abdominal migraine and aerophagia. Disorders of defecation include: infant dyschezia, functional constipation, functional fecal retention and functional non-retentive fecal soiling. Current researches suggest a role of gut microbiota in pathogenesis of FGID and qualitative and quantitative alterations in the normal gut flora in some functional disorder such as IBS, chronic constipation and formula-fed infants which suffering colic or regurgitation have been described. Probiotics are nonpathogenic microorganisms, when they are ingested, have positive effects on the host’s health. They influence intestinal physiology by different ways. Prebiotics are non-digestible carbohydrates which promote the growth and/or activity of probiotic bacteria. Evidences for the therapeutic or preventive effect of particular probiotic strains with or without prebiotics in FGID are available in many of articles. Results are encouraging in symptomatic alleviation and improvement in quality of life in IBS, functional constipation, functional abdominal pain, infantile colic, aerophagia and infantile regurgitation. Conclusion: Different probiotic strains have different effects, so selection of strains with specific health benefits is important. In general according to review of articles, although some of specific probiotic strains can provide a health benefit in these disorders, it seems, more high-quality and long-duration placebo-con-trolled trials are required. Keywords: Functional gastrointestinal disorders, Probiotic.

Treatment of Functional Gastrointestinal Disorders in Children and Future Challenges

Functional gastrointestinal disorders (FGIDs) are a common problem in children. These disorders in children are classified into the following categories according to the ROME III classification: Functional Dyspepsia, Irritable bowel syndrome (IBS), Abdominal Migraines, Childhood Functional abdominal pain (FAP), Childhood functional abdominal pain syndrome and functional constipation. FGIDs are diagnosed based on history and normal physical examination provided that there is no evidence of underlying disease such as anatomical abnormalities, infectious, inflammatory and malignancies. This group of poorly defined diseases represent a huge treatment challenge to the specialist, because, until now there is no therapy that has been effective in improving the symptoms. FGIDs also cause deep family problems as the disease interrupts their routine and positive response to treatment is rarely seen. On the other hand there is no objective document of the disease neither endoscopic, radiologic nor pathologic. Therapeutic strategies of FGIDs are: education and parent's assurance, detection and modifying physical and psychological stress, dietary intervention, pharmacological treatment, psychotherapy and other complementary medical treatments. Some foods may trigger the illness such as coffee, fatty foods and spicy foods, therefore they should be avoided. Lactose-free diet cannot improve symptoms of FGIDs, except in children with lactose intolerance. The beneficial effect of fiber supplement in children with FGIDs remains unknown but it has been useful in adults with IBS. Probiotics have potential efficacy in treating IBS but the efficacy in children with FGIDs remains uncertain and needs to be further studied. In patients with severe symptoms, pharmacological agents can be effective. These drugs include Antacids, Prokinetics, Anticholinergic, Tricyclic antidepressants (TCAS) and Serotonergic agents (Agonists and anti agonists). Psychotherapy in FAP and IBS is preferred rather than standard drug treatments. Cognitive Behavioral treatment is useful in children with RAP and hypnotherapy in adults with IBS. Complementary and alternative therapies include massage therapy, acupuncture and traditional medicine such as Peppermint oil, Fumitory, Ginger and Zingier could have a role in treatment of FGIDs. Keywords: Functional Gastrointestinal Disorders (FGIDs), Irritable Bowel Syndrome (IBS), ROME III, Functional Abdominal Pain (FAP), Psychotherapy.

The Efficacy of Citalopram in the Treatment of Functional Abdominal Pain in Children: A Randomized, Double-Blind, Placebo-Controlled Study

Introduction: Limited data are available on the effectiveness of antidepressants in the treatment of functional gastrointestinal disorders in children. We evaluated the effectiveness of citalopram in the treatment of childhood functional abdominal pain (FAP). Material and Methods: Children with FAP (n=115, aged 6-18 years) received either citalopram 20 mg/day or placebo for 4 weeks. Treatment response was defined as ≥ 2 point reduction in the 6-point pain rating scale or “no pain”. Depression, anxiety, somatization, and physician-assessed global severity and improvement were also evaluated. Patients were followed for 8 weeks after medication period. Results: Eighty six patients completed the trial (43 in each group). Treatment response rate in the citalopram and the placebo group was 55.8% and 39.5% at week 4 (P=0.097) and 72.0% and 53.4% at week 12 (P=0.059), respectively. Controlling for baseline characteristics, more reduction was observed in pain (z=-2.67, P=0.008) and global severity scores (z=-3.08, P=0.002) in the citalopram group compared with the placebo group. Changes in depression, anxiety, and somatization scores were comparable between the two groups. Receiving citalopram (OR=7.718, P=0.006), father education level (OR=3.179, P=0.040), baseline pain score (OR=5.621, P<0.001), baseline somatization score (OR=0.863, P=0.017), and change in somatization severity (OR=1.168, P=0.039) were predictors of treatment response at week 4. The association of receiving citalopram and treatment response at week 12 was not statistically significant (OR=2.944, P=0.096). Conclusion: Four-week treatment with citalopram is effective in reducing pain in children with FAP, independent from patients’ baseline psychological status or psychotropic effects of the drug. Keywords: Abdominal Pain, Antidepressive Agents, Child, Serotonin Reuptake Inhibitors, Randomized Controlled Trial.

소아·청소년의 알레르기 질환 (천식, 알레르기비염, 아토피피부염)과 기능성 위장관 질환과의 관계 (단면 조사 연구)

Abstract The Relationship between Allergic Diseases and Functional Gastrointestinal Disordersin Children and Adolescents Kim Min Joo ․ Kim Deog Gon ․ Lee Jin Yong Pediatrics of Clinical Korean Medicine, College of Korean Medicine, Kyung Hee University Objectives The purpose of this study is to establish relationship between allergic diseases and functional gastrointestinal disorders in children and adolescents using objective criteria and questionnaires. Methods This study surveyed 237 children and adolescents who visited the department of Pediatrics of ○○ Korean Medicine Hospital from September 23rd, 2013 to December 26th, 2013. The Korean version of International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and the Korean-translated Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-Rome III) were used. We analyzed the data by using PASW Statistics 18.0 with Chi-square test, Fisher’s exact test and Linear by linear association. Results There was no significant difference between prevalence of allergic diseases and functional gastrointestinal disorders. Also, there was no strong relationship between the number of allergic diseases and the functional gastrointestinal disorders. However, some parts showed significant relationships – such as asthma symptoms ever and belch; asthma symptoms last 12 months and belch; allergic rhinitis diagnosis ever and belly aches and abdominal pain around and below the belly button; allergic rhinitis treatment last 12 months and belly aches and abdominal pain around and below the belly button; and atopic dermatitis diagnosis ever and irritable bowel syndrome (respectively;

Probiotics for childhood functional gastrointestinal disorders: a systematic review and meta‐analysis

A systematic review and meta-analysis were performed to investigate the quantity and quality of the current evidence regarding the effect of different probiotic strains in the treatment of functional gastrointestinal disorders (FGID) in children and adolescents. Probiotics are more effective than placebo in the treatment of patients with abdominal pain-related FGID, especially with respect to patients with irritable bowel syndrome. To date, however, probiotics have not proved effective for children with functional constipation.

Infant Distress and Development of Functional Gastrointestinal Disorders in Childhood

Infant Distress and Development of Functional Gastrointestinal Disorders in Childhood

High Prevalence of Nausea in Children With Pain‐Associated Functional Gastrointestinal Disorders

The aim of the study was to determine the prevalence of nausea in pediatric patients with pain-associated functional gastrointestinal disorders (FGIDs), examine the effect on social and school functioning, and examine the applicability of pediatric Rome III criteria. A total of 221 pediatric patients (6-18 years of age) with chronic abdominal pain prospectively completed a demographic, history, and gastrointestinal symptom questionnaire adapted from the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS). The 6-item, revised Pediatric Migraine Disability Assessment Score tool was used to assess the effect of symptoms on school, home, and social disability. Rome III criteria were applied to all subjects. A total of 183 patients with pain and nausea for a minimum of 2 months were identified. Ninety-six patients were studied after excluding those with vomiting and/or organic disease. Among these, 53% had nausea at least 2 times per week and 28% experienced daily nausea. Frequency of nausea was significantly correlated with poor school and social functioning, and uniquely predicted social disability beyond pain. Although 87% met adult Rome criteria for functional dyspepsia, only 29% met corresponding pediatric Rome criteria. Additionally, 22% met the criteria for irritable bowel syndrome (IBS)-diarrhea, 13% for IBS-constipation, 13% for abdominal migraine, and 31% were classified as having functional abdominal pain. Pediatric IBS-diarrhea and IBS-constipation overlapped in 5% of patients. Nausea is a prevalent symptom in patients with pain-associated FGIDs and correlates with poor school and social functioning. There is substantial overlap among FGIDs in children with nausea.

Umbilical Hernia Repair Increases the Rate of Functional Gastrointestinal Disorders in Children

To hypothesize that hernia repair would not change the incidence of functional gastrointestinal disorders (FGIDs) due to the benign and limited nature of the procedure. This cohort study assessed a randomized selection of children aged 4-18 years who underwent hernia repair more than 4 years prior at Ann and Robert H. Lurie Children's Hospital of Chicago. Controls were siblings who had not undergone surgery previously. Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version by telephone for subjects and controls. The primary outcome was the presence of FGIDs. Fifty children with hernia repair and 43 sibling controls were identified. At the time of survey, subjects with hernia repair were average age 12.9 years (range 5-18 years, 60% male) and controls were average age 12.2 years (range 4-18 years, 49% male). Average age at surgical repair was 5.2 years (median 5.2 years, range 0.2-10.4 years) and average time since surgical repair was 7.8 years (range 4.8-13.7 years). FGIDs were diagnosed in 10/50 (20%) cases of hernia repair and 2/43 (5%) controls (P = .033, Fisher 2-tailed test). Umbilical hernia repair increases the likelihood of FGIDs in childhood. Additional studies are needed to identify aspects of surgery that may be associated with development of FGIDs.

Mo1213 Hernia Repair Increases the Rate of Functional Gastrointestinal Disorders in Children

Mo1213 Hernia Repair Increases the Rate of Functional Gastrointestinal Disorders in Children