Functional Gastrointestinal Disorders In Infants Research Articles

Research status and prospects of probiotics in functional gastrointestinal disorders in infants and toddlers

Functional gastrointestinal disorders (FGIDs) are common digestive system diseases in children, which can severely affect the growth and development of infants and toddlers. Probiotics therapy, as a relatively safe treatment method, have attracted the attention of researchers. However, their effectiveness in treating FGIDs in infants and toddlers is still unclear. This article reviews the mechanisms of probiotics in treating FGIDs in infants and toddlers, explores the reasons for the inconsistency in various research results, and aims to provide assistance for the clinical treatment of FGIDs in infants and toddlers and future research.

Пребиотик лактулоза в питании детей первого года жизни

Aim. To evaluate the effect of the lactulose prebiotic on the functional state of the gastrointestinal tract and the state of the intestinal microbiome of infants with constipation based on data from Russian and foreign publications. Key points. The multiple positive effects of breastfeeding on the health of mother and child are unique. However, more than 50% of children in the Russian Federation are artificially fed, and the choice of formula for artificial feeding is fundamental and determines the further state of the baby's health. The review describes on the role of the development of the intestinal microbiota in the child's health, examines the origin and functioning of the “brain — intestine — microbiota” axis, its role in the genesis of functional gastrointestinal disorders (FGID) in children — the most common FGID in infants — functional constipation. The article discusses the use of lactulose in the dietary nutrition of infants, primarily with functional constipation. Conclusion. The multilevel action of prebiotic lactulose allows it use it for a significant number of therapeutic indications. Lactulose-enriched formulas for the nutrition of children of the first year of life is justified. The article The article contains the Russian and foreign experience of using lactulose-enriched formulas in the nutrition of children of the first year of life. Кeywords: children, lactulose, formulas, functional constipation.

Prevalence and Risk Factors of Functional Gastrointestinal Disorders in Infants in Indonesia

Information regarding functional gastrointestinal disorders (FGIDs) in infants is currently lacking in Indonesia. This study aimed to describe the prevalence and risk factors of FGIDs in infants aged 6 weeks to 4 months in Indonesia. This cross-sectional study of 433 infants was conducted between September 2018 and February 2020. Information on FGIDs was collected using the Infant Gastrointestinal Symptom Questionnaire and the Feeding Practice and Gut Comfort Questionnaire. Adapted Rome IV criteria were used to define the FGIDs. The prevalence of regurgitation was 26.3%; 16.8% of the infants presented crying-related symptoms and 5.5% exhibited constipation. The statistical analyses revealed that constipation was associated with sex (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.07-7.71; p=0.043), employment of the father (OR, 0.3; 95% CI, 0.12-0.77; p=0.01), and education of the mother (OR, 1.92; 95% CI, 1.07-3.51; p=0.031). Length at birth (OR, 0.74; 95% CI, 0.55-0.99; p=0.042) was associated with constipation. Length at visit (OR, 0.83; 95% CI, 0.76-0.91; p<0.001) was associated with regurgitation, and the weight at visit (OR, 0.58; 95% CI, 0.35-0.96; p=0.038) was associated with crying and/or colic. A history of parental FGIDs was associated with crying-related symptoms (OR, 2.12; 95% CI, 1.23-3.68; p=0.007). Regurgitation, crying, and constipation are common FGIDs in infants. Some parental and infant characteristics may be predictors for FGIDs. Further investigations are needed to evaluate the clinical relevance of our findings. Understanding the determinants of FGIDs will benefit healthcare professionals and parents to improve infant's quality of life and better manage these condition.

Alleviating Gasto-Intestinal Discomfort in Infants: Quest for Effective Interventions

Functional gastrointestinal disorders (FGIDs) are common among infants, yet precise diagnosis and optimal management strategies remain a challenge. Understanding the prevalence and impact of these conditions is essential for improving infant health. We present a comprehensive review of the evolution of treatment strategies for FGIDs tracing the identification of the first case to the recent advancements in disease management. The article explores the journey of the Rome criteria, which is the most widely used diagnostic parameter for FGIDs, as it transformed from consensus-based recommendations culminating in the present-day evidence-based guidelines, setting the stage for the upcoming Rome V criteria. FGIDs were initially hypothesized solely as a GI entity; however, thorough etio-pathologic research has elucidated the complex bio-psychosocial basis of FGIDs. In infants, these conditions can be particularly challenging to identify and manage due to their limited ability to communicate discomfort and distress. The article briefly refers to pathophysiology and diagnostic challenges as an exploratory background for effective management. An overview of existing research can shed light on the various treatment approaches for FGIDs in infants. We examined pharmacotherapy in FGID management in terms of its indications and limitations, which would allow its judicious use in clinical practice. The article underscores the efficacy and safety of a dietary approach in FGID management in infants, especially in the absence of red flags. We highlight key research details that led to newer advancements in nutritional interventions such as probiotics. L reuteri DSM 17938 is the most extensively studied probiotic with proven benefits and manifold indications. We highly recommend large prospective studies to identify the ideal therapeutic agent that can provide a potential opportunity to prevent FGIDs.

Prevalence and Risk Factors of Functional Gastrointestinal Disorders: A Cross-Sectional Study in Italian Infants and Young Children.

Reports of prevalence of functional gastrointestinal disorders (FGIDs) in infants/toddlers are widely variable. Reasons for this variability are not yet fully understood. The objective of this study is to estimate the prevalence of FGIDs according to Rome IV criteria and to evaluate associated factors, in Italian infants and toddlers. Subjects aged 0-48 months were enrolled by general pediatricians from 3 Italian regions. Parents or legal guardians were administered questionnaires including information about the child, the family, and GI symptoms according to Rome IV criteria. Five hundred eight infants aged 0-12 months [mean age 4.4 ± 3.4 months; females (F) 40.9%], and 268 children aged 13-48 months (mean age 30.8 ± 10.7 months; F 44.4%) were included. In infants, prevalence of FGIDs was 21.1%, and the most prevalent FGID was infant colic (9.3%). In toddlers, prevalence of FGIDs was 19.6%, with functional constipation being the most frequent disorder (16.1%). In infants, multivariable analysis found that being older, being the only child, and living in a rural environment were associated with a lower rate of FGIDs. Prevalence was, in contrast, higher in infants fed with formula. One out of 5 Italian infants and young children is affected by at least 1 FGID. The most frequent FGID in infants is infant colic, while in toddlers this is functional constipation. In infants, prevalence of FGIDs is lower if the subject has no siblings, and in children living in a rural environment, while formula feeding represents a risk factor for FGIDs occurrence.

A population-based study on prevalence and predisposing risk factors of infant functional gastrointestinal disorders in a single center in Southern Fujian.

Background and aimThe prevalence of infant functional gastrointestinal disorders (FGIDs) varies across different areas but is largely unknown in southern Fujian. The aim of this study is to evaluate the prevalence of infant FGIDs in southern Fujian according to Rome IV diagnostic criteria.MethodsA cross-sectional prospective questionnaire-based survey was conducted among healthy infants between 0 and 3 months of age in southern Fujian. A total of 1,006 infants who received a physical examination from October 2017 to October 2018 were recruited in this study. Parents or caregivers provided demographic information and completed the questionnaire on gastrointestinal symptoms for infants. Infants with FGIDs were diagnosed using the Rome IV criteria.ResultsBased on the Rome IV criteria, the prevalence of having a FGID in infants is 58.3% (586/1,006). The most common FGIDs in infants were regurgitation (45.7%, 460/1,006), followed by difficult defecation (3.6%, 36/1,006), functional constipation (3.2%, 32/1,006), and colic (2.4%, 24/1,006). No infants fulfilled diagnostic criteria for rumination syndrome and cyclic vomiting syndrome. Among the infants with FGIDs, 457 cases (78.0%, 457/586) were found with single FGID. Combined FGIDs were diagnosed in 129 (22.0%, 129/586) infants; of whom, 21.2% (124/586) had double disorders and 0.9% (5/586) had triple disorders. The most common combined FGIDs were regurgitation and difficult defecation (12.8%), followed by regurgitation and colic (2.4%). Risk factor analysis revealed that younger paternal age (B = 0.424, P = 0.004), paternal history of FGIDs (B = 0.821, P = 0.000), maternal history of FGIDs (B = 0.427, P = 0.012), and probiotics received in infant (B = 0.324, P = 0.032) were associated with an increased risk of infant FGIDs, whereas vitamin D supplementation after birth (B = −0.690, P = 0.000) can reduce the risk of developing FGIDs.ConclusionFGIDs are common in infants living in southern Fujian according to Rome IV diagnostic criteria. The most common FGIDs in infants were regurgitation, difficult defecation, and functional constipation. Factors including younger paternal age, parental history of FGIDs, and the probiotic supplementation in infant showed a significant association with infant FGIDs. Whereas, vitamin D supplementation in infant was found to be a protective factor against FGIDs.

Dynamics of the mother-child relationship in the presence of functional gastrointestinal disorders in infants

Motherhood is still insufficiently explored regarding its psychological aspects. Maternity brings an innovative perspective in the diagnosis and treatment of various disorders of mother and child in the first year of life. Functional gastrointestinal disorders are the most common diagnosis in Pediatric Gastroenterology, being recognized as a group of diseases difficult to diagnose and manage. Among diagnosed and treated infants, some display a long-lasting suffering, which shows that a number of clinical aspects may be insufficiently explored. One such dimension is the one described under the term "birth-related illnesses", i.e. psychosomatic symptoms that occur in the infant as a result of a deficient or non-existent emotional relationship with the mother. This paper aims to illustrate how the mother-infant emotional relationship influences the functional digestive manifestations of the infant, their relational dynamics, and the development of symptoms, with and without specific maternal therapeutic intervention. The results represent an argument for the use of the mother-child dyadic therapy for improving the infant's digestive function.

Лечение функциональных гастроинтестинальных расстройств у детей раннего возраста

В статье изложены современные сведения об основных патогенетических механизмах развития и клинических проявлениях функциональных гастроинтестинальных расстройств у детей раннего возраста в соответствии с Римскими критериями ІV. Представлены требования к пробиотическим препаратам, которые применяются в современной медицине. Акцентировано внимание на основных характеристиках наиболее изученного пробиотического штамма Lactobacillus rhamnosus (LGG). Проведен анализ результатов клинических исследований с применением LGG с целью лечения и профилактики функциональных и органических заболеваний у детей. Представлены основные фармакологические свойства и характеристика продукта Актив Флора беби, который недавно появился на фармацевтическом рынке Украины, обоснованы и представлены основные показания к назначению продукта.

Функциональные гастроинтестинальные расстройства у детей раннего возраста: лечить, наблюдать или корректировать?

В статье рассмотрены функциональные нарушения желудочно-кишечного тракта у детей раннего возраста. Частота функциональных гастроинтестинальных расстройств является чрезвычайно высокой во всех возрастных группах, но у детей раннего возраста функциональные заболевания фактически являются вариантом нормы — наиболее часто практическому врачу приходится сталкиваться с функциональными нарушениями пищеварения именно у детей раннего возраста, что обусловливает повышенный интерес педиатров к их этиологии, патогенезу и терапии. Наиболее распространенными гастроинтестинальными нарушениями являются младенческие колики, срыгивания и запор: они составляют большую часть жалоб, с которыми родители детей первого года жизни обращаются к педиатру. Несмотря на то, что эти расстройства не представляют большой опасности для жизни и, как правило, не оказывают существенного влияния на здоровье детей в будущем, они в значительной степени влияют на качество жизни, приводят к большому количеству неоправданных госпитализаций, применению избыточной фармакотерапии, нарушают психологический климат в семье. Поэтому коррекцию функциональных гастроинтестинальных расстройств целесо­образно проводить не при помощи медикаментов, а путем назначения продуктов функционального питания, в частности заменителей грудного молока, которые получают дети, находящиеся на искусственном вскармливании. Вопросы, связанные с применением смесей, являющихся заменителями грудного молока, особенно способных корректировать малые пищеварительные дисфункции, являются актуальной темой для обсуждения клиницистов и врачей педиатрического профиля.

Functional gastrointestinal disorders and the health visitor role

Bethany Boddy explores the guidance and evidence into functional gastrointestinal disorders in infants and how to support parents to support their infants

The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals.

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs.

Prevalence of functional gastrointestinal disorders in infants and young children in China

BackgroundThe prevalence of functional gastrointestinal disorders (FGIDs) in children, particularly from Asia, is largely unknown. There are not many studies done in Asia especially using the Rome IV criteria. The aim of this study is to assess the prevalence of FGIDs in infants and young children in a representative sample in China.MethodsA prospective, cross-sectional, community-based survey was conducted among healthy infants and young children between the ages of 0–4 years in Jinhua and Shanghai, China. A total of 2604 subjects (1300 subjects from Jinhua and 1304 subjects from Shanghai) completed a validated questionnaire on pediatric gastrointestinal symptoms. FGIDs in infants and young children were diagnosed using the Rome IV criteria.ResultsAccording to the Rome IV criteria, the prevalence of having a FGID in Chinese infants and young children is 27.3%. Infant regurgitation (33.9%) was the most common FGID among the 0–6 months old while functional constipation (7.0%) was the most common among the 1–4 years old. Risk factor analysis revealed that prevalence of infantile colic was higher with better maternal education and low birth weight. Prevalence of infantile regurgitation was significantly greater in males, living in a rural area, being exclusively breast fed at least up to 4 months and starting formula feeds within the first month. The risk of functional constipation was lower for infants who were delivered vaginally.ConclusionsInfantile regurgitation was the most common FGID in Chinese infants while functional constipation was most prevalent among young Chinese children.Trial registrationNetherlands Trial Registry Identifier: NL6973/NTR7161.

МИКРОБЫ ВНУТРИ НАС: СЛУЧАЙНЫЕ ПОПУТЧИКИ ИЛИ УСЛОВИЕ НАШЕГО ВЫЖИВАНИЯ? ИЛИ ЗАЧЕМ НУЖНЫ ПРОБИОТИКИ В ДЕТСКИХ МОЛОЧНЫХ СМЕСЯХ

This literature review describes evolutionary aspects of the formation of relationships between microorganisms and the human body. The formation of symbiotic relationships, which resulted in the formation of a holobiont, is discussed. Separate chapter of the article is dedicated to describing positive effects of Lactobacillus reuteri DSM 17938 strain for human health, including effective prevention and treatment of functional gastrointestinal disorders in infants.

A cross sectional survey in paediatricians pertaining to management of functional gastrointestinal disorders in infants: Indian perspectives

Background: Functional gastrointestinal disorders (FGIDs) in infants and toddlers possess extensive burden to the parents and healthcare professionals. Guidelines addressing the practices in diagnosis and management of FGIDs in infants in Indian subcontinent is unavailable. Hence this study assessed current knowledge, attitude and practice of pediatricians in diagnosis and treatment of FGIDs.Methods: A cross-sectional survey based on a structured questionnaire assessed pediatrician’s knowledge about prevalence and profile of most common GI disorders in pediatric age groups (birth to 12 months), association of FGIDs with different feeding practices, impact of FGID on quality of life, various management options and physician preferred method of treatment.Results: Colic was rated as the most common GI disorder, followed by gassiness/fussiness, regurgitation and constipation. About 59% pediatricians come across FGIDs more in formula-fed infants compared to breastfed infants (4.2%) and 93.9% pediatricians affirm that FGIDs affect quality of life. Approximately 91% pediatricians believed reassurance and education was the best management option, which was also reported as the preferred mode of management by about 89% pediatricians, whereas pharmacological therapies were the least preferred (1.6%). For breastfed infants suffering with regurgitation, colic or constipation, majority pediatricians opted for switching to 100% whey partially hydrolysed protein formula; sequentially followed by use of pre/probiotics and switch to extensively hydrolyzed protein formula.Conclusions: Parental education and reassurance offer an ideal mode of management of FGIDs. Partially hydrolysed protein formula may be considered one of the best management options irrespective of the FGID condition in infants who are breastfeed.

Functional Gastrointestinal Disorders in Outpatients Aged up to 12 Months: A French Non-Interventional Study.

Background: The aim of this study was to estimate the frequency of functional gastrointestinal disorders (FGIDs) in infants aged up to 12 months according to the new ROME IV criteria defining these disorders, and to describe the management of FGIDs in France. Methods: This French non-interventional, cross-sectional, and multicenter study was conducted among private-outpatient physicians who each included four consecutive patients aged up to 12 months. The frequency of FGIDs was described using the ROME IV criteria versus clinicians’ diagnosis. The characteristics of infants with and without FGID were compared, and the management of the FGIDs was described. Results: In the 1722 infants analyzed, the following frequencies were observed according to the ROME IV criteria versus the physicians’ diagnosis: regurgitation 41% versus 45%; colic 18% versus 30%; constipation 9% versus 19%; diarrhea 3% versus 8%. Of note, FGID infants were less frequently exclusively breastfeeding at the maternity hospital (p < 0.001), were introduced to cow’s milk earlier after leaving the maternity hospital (p < 0.001), and more frequently had symptoms suggestive of cow’s milk protein allergy (p < 0.001). Physicians frequently recommended an adapted infant formula (in 77% to 82% of cases depending on the FGID diagnosed) and prescribed a specific treatment in 51% to 66% of infants (probiotics: 35% to 64%). Conclusions: This real-world study confirms the high frequency of FGIDs in infants in France, and provides new information regarding the characteristics of FGID infants.

Функциональные нарушения пищеварения у детей раннего возраста. Результаты онлайн-анкетирования

Aim: to study the possibilities of online surveys for mothers using a questionnaire on the basis of the Rome IV criteria (2016) as a screening for functional gastrointestinal disorders (FGID) in infants and toddlers. Patients and Methods: an anonymous online survey of 477 mothers was conducted regarding the health condition of their children under the age of 4 years. The survey consisted of 2 question pools. The first pool included general questions regarding the age of the mother at the time of delivery, obstetric and gynecological history, feeding of an infant/toddler at the time of the survey. The second pool included questions regarding FGID in infants and toddlers on three separate topics: functional disorders of the first year of life; diagnosis of cyclic vomiting syndrome; bowel movement disorder. Results: among 130 infants, regurgitation was in 50% of cases (at the age of 6 months — in 75%, at the age of 6 to 12 months — in 35%), baby colic — in 49%. The incidence of functional constipation in children under 6 months was 5.8%, from 6 to 12 months — 7.6%, gradually increasing by 3–4 years to 21.5%. Toilet skills were taught to 15 (12%) children aged 1 year — 1 year 11 months, 58 (59%) — at the age of 2 years — 2 years 11 months, and 119 (98%) — at the age of 3 years — 3 years 11 months. Mothers who were unaware of their child’s physical development and/or defecation problems accounted for 20.1% of those who took part in the survey. Conclusion: online survey results of mothers coincide with modern statistical data on FGID disorder. The survey results generally reflect the anatomical and physiological patterns of the child’s GI development. Online survey on the detection of FGID in infants/toddlers allows to make a preliminary diagnosis, identify existing problems and determine further patient management tactics. KEYWORDS: functional gastrointestinal disorders, infant, toddler, Rome IV criteria, questionnaire for parents, functional constipation, online survey, baby colic, regurgitation, toilet skills. FOR CITATION: Dubrovskaya M.I., Gryaznova E.I. Functional gastrointestinal disorders in infants and toddlers. Online survey results. Russian Medical Inquiry. 2020;4(5):274–281. DOI: 10.32364/2587-6821-2020-4-5-274-281.

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.

Functional gastrointestinal disorders in infants: Practice, knowledge and needs of Australian pharmacists

To determine the nature and extent of interactions between retail pharmacists and families of infants concerned about functional gastrointestinal disorders. A 15-question online survey was developed that could be completed by retail pharmacists in approximately 5 min. This survey aimed to obtain information relating to the frequency of interactions with parents of infants seeking advice and/or information about colic, gastro-oesophageal reflux (GOR) or constipation in pharmacies; what recommendations and/or advice was given by the pharmacists; from where the pharmacists obtained their information and what guidelines/recommendations they would value; and demographic information. A total of 362 pharmacists from every state and territory within Australia completed the survey. Conversations with parents/carers about constipation at least once a week were reported by 85% of pharmacists, with the equivalent percentages for GOR and colic both being 76%. In the case of constipation, medication was recommended in 70% of cases, and a nutritional approach was recommended in 67% of cases. Medication was recommended in 81% of cases of suspected colic, significantly greater than nutritional advice at 50%. For possible GOR, recommendations were similar, with medication being suggested in 66% and nutritional advice in 68%. GOR guidelines were the most sought after, with 42% of pharmacists placing such guidelines as their number one need. This survey indicates the need for greater emphasis to be given to reassurance by health-care professionals involved in the management of functional gastrointestinal disorders in infancy, as well as consideration of the construction of easily accessible, evidence-based national guidelines.

Cow's Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children?

The role and prevalence of cow’s milk protein allergy (CMA) in functional gastrointestinal disorders remains unclear. The aim of this review is to update knowledge on the relationship between CMA and functional abdominal pain disorders (FAPDs) in children. Cochrane Database and Pubmed were searched from inception using general and specific terms for CMA and functional gastrointestinal disorders. CMA is reported as a predisposing or coexisting factor in a wide range of functional gastrointestinal disorders in infants and children. Pathogenesis of both conditions is complex and multiple mechanisms including dysmotility and hypersensitivity might contribute to the clinical manifestations. Data supporting the possible role of food allergies in the pathogenesis of FAPDs are limited. CMA may predispose to early life inflammation and visceral hypersensitivity, which in turn might manifest as FAPDs. The diagnosis of either CMA or FAPDs and distinction between them is challenging because of nonspecific and overlapping symptoms. Lack of accurate allergy tests in non-IgE (immunoglobulin E) mediated cases is also problematic. Oral food challenge, following an elimination diet, should be performed to diagnose a suspected non-IgE CMA allergy in children with FAPDs. In the management of FAPDs, an elimination diet should be considered for a limited period to verify if the symptoms improve or resolve.