Functional Nausea Research Articles

A prevalence study of functional gastrointestinal disorders among the school-going adolescent population in an urban city in northern India

BackgroundFunctional Gastrointestinal disorders (FGIDs) are highly prevalent in the adolescent population leading to morbidity. However, their exact prevalence is not clearly known. The present study attempts to assess their prevalence in adolescent children. Material & methodsA total of 757 school/college-going adolescents aged 10–19 years attending four different schools covered in a field study were assessed for the prevalence of FGIDs using a questionnaire based on ROME-IV criteria. Socio-demographic data of the participants were also noted. Prevalence and type of FGIDs were determined. The chi-square test and Independent samples ‘t’-test were used to compare the data. ResultsThe prevalence of FGIDs was 15.85 % (n = 120) in the adolescent population in our study. Functional abdominal pain disorders (n = 65; 54.2 %) were the most common type followed by functional defecation disorders (n = 49; 40.8 %) and functional nausea and vomiting disorders (n = 6; 5 %) respectively. Adolescents with FGIDs had significantly lower mean age (12.98 ± 2.30 years) and mean BMI (16.9 ± 3.2 kg/m2) as compared to those without FGIDs (p < 0.001). However, no significant association of sex was seen with FGID prevalence (p = 0.755). ConclusionsFGIDs were found to be prevalent in school/college-going adolescents in our setting with functional abdominal pain disorders contributing to the majority of FGIDs. The Rome-IV criteria-based questionnaire is a useful tool in diagnosing FGIDs among adolescents.

Enhanced recovery after caesarean section: Implementation of an ERAC protocol in a tertiary obstetric hospital.

Assess safety and efficacy of an Enhanced Recovery After Caesarean protocol. Caesarean sections are among the most commonly performed surgeries worldwide, but have been associated with postoperative chronic pain and opioid abuse. ASA 2 females, over 18 years, non-primiparous, repeat elective LSCS. Primary outcomes were length of stay and opioid consumption. Secondary outcomes were pain scores, functional assessment scores, pruritus, nausea and vomiting. A total of 579 women divided into standard care (389 patients) and enhanced recovery after caesarean groups (190 patients). Enhanced recovery after caesarean associated with reduced length of stay, 50.8 hours (interquartile range 48.6, 53.6) versus 72.2 hours (interquartile range 53.2, 75.7) in standard care. Enhanced recovery after caesarean associated with reduced opioid consumption, median 10 (interquartile range 0, 27.5mg) versus 120mg (interquartile range 90, 145mg) in standard care at 24 hours and 30 (interquartile range 7.7, 67.5mg) versus 177.5mg (interquartile range 132.5, 222.5 mg) at 48 hours. Pain scores reduced from moderate to mild in the enhanced recovery after caesarean. functional assessment scores trend towards improved function in the enhanced recovery after caesarean group (Functional assessment scores B 8.9% in enhanced recovery after caesarean versus 147% in standard care). Increased pruritus in the enhanced recovery after caesarean with 41.6% compared with 9.3% in standard care. Nausea and vomiting increased in enhanced recovery after caesarean group 48.9% versus 11.6% in standard care. Enhanced recovery after caesarean associated with a reduction in length of stay, opioid consumption and improved pain scores with an increase in side effects.

Risk of malnutrition and predisposing factors among Mexican patients with advanced cancer.

12033 Background: Malnutrition is a predictor of cancer survival independent of cancer site. However, routine screening for malnutrition is underutilized. Advanced cancer accounts for 60% of cancer cases in developing countries of which approximately 52 % have malnutrition. This study aimed to describe factors associated with risk of malnutrition among patients with advanced cancer. Methods: We conducted a cross-sectional analysis of baseline data from patients with recently diagnosed advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompañamos). At the time of enrollment in the program, patients completed a series of questionnaires including assessments of quality of life (FACT-G), various symptoms and the validated malnutrition screening tool (MST). Clinic and demographic characteristics were obtained from the patient chart. Descriptive statistics were used for analysis and factors associated with risk of malnutrition were analyzed by bivariate testing. Results: Between August 2017 and December 2022, a total of 601 patients were included. Mean age was 62 years (range 18-94), 57.2% were women, 56% had gastrointestinal and 28% gynecological malignancies. 72 % screened positive for malnutrition on the MST and 49 % reported nausea on FACT-G. Patients with an ECOG performance status ≥3 were more likely to screen positive for malnutrition (OR 5.9 95%CI 2.5- 13) as well as those with baseline nausea (OR 2.99; 95%CI 1.9-4.7). On the other hand, patients with active chemotherapy (OR 1.4 95%CI, 1.016-1.95) and those receiving antiemetic treatment with a single medication (OR 1.63 95%CI, 1.1-2.4) were more likely to have nausea. No other clinical or demographic characteristics were significantly associated with screening positive for malnutrition or reporting nausea, including gender, age, history of smoking or alcohol abuse, type of neoplasia, or oncologic treatment. Conclusions: Our results show that a high proportion of patients with advanced cancer are at increased risk for malnutrition and report nausea. Poor functional status and nausea were strongly associated with a higher risk of malnutrition, while receiving insufficient antiemetic medication was associated with increased odds of nausea. This suggests that appropriate treatment of nausea and nutritional interventions should be prioritized early in the management of patients with advanced cancer regardless of the type of cancer treatment in order to avoid malnutrition and improve patient well-being.

Children with functional gastrointestinal disorders with and without co-existing nausea: A comparison of clinical and psychological characteristics.

Nausea co-existing with functional gastrointestinal disorders (FGIDs) has been suggested to negatively impact physical and psychological factors in children. This study aims to compare clinical and psychological characteristics of a large cohort of pediatric patients with an FGID with and without nausea. Patients of two previous randomized controlled trials were included, the first assessing the effect of hypnotherapy (HT) in 260 children fulfilling Rome criteria of irritable bowel syndrome (IBS) or functional abdominal pain (FAP), the second examining the effect of HT in 100 children with nausea in children with either functional nausea (FN) or functional dyspepsia (FD). At inclusion, demographics, clinical features, including the presence of nausea, depression and anxiety, somatization, and health-related quality of life (QoL) were assessed in patients. In total, 355 patients with IBS (n = 131), FAP (n = 127), FN (n = 62), and FD (n = 35) were included, of which 255 (72%) patients experienced nausea versus 100 (28%) without nausea. Age at onset of symptoms was higher in children experiencing nausea (12.0y vs. 9.0y, p = 0.000). Significantly higher somatization, anxiety and depression scores, and lower health-related QoL were reported for children with nausea. There were no significant differences between children with only nausea and children with nausea and abdominal pain. Children with nausea, either with or without abdominal pain, report higher somatization scores, increased anxiety and depression, and lower overall QoL, compared to children with pain-related FGIDs without accompanying nausea. Addressing the presence of nausea in children with FGIDs seems essential to customize their treatment and improve overall quality of life.

Multichannel magnetogastrogram: a clinical marker for pediatric chronic nausea.

Chronic nausea is a widespread functional disease in children with numerous comorbidities. High-resolution electrogastrogram (HR-EGG) has shown sufficient sensitivity as a noninvasive clinical marker to objectively detect distinct gastric slow wave properties in children with functional nausea. We hypothesized that the increased precision of magnetogastrogram (MGG) slow wave recordings could provide supplementary information not evident on HR-EGG. We evaluated simultaneous pre- and postprandial MGG and HR-EGG recordings in pediatric patients with chronic nausea and healthy asymptomatic subjects, while also measuring nausea intensity and nausea severity. We found significant reductions in postprandial dominant frequency and normogastric power, and higher levels of postprandial bradygastric power in patients with nausea in both MGG and HR-EGG. MGG also detected significantly lower preprandial normogastric power in patients. A significant difference in the mean preprandial gastric slow wave propagation direction was observed in patients as compared with controls in both MGG (control: 180 ± 61°, patient: 34 ±72°; P < 0.05) and HR-EGG (control: 240 ± 39°, patient: 180 ± 46°; P < 0.05). Patients also showed a significant change in the mean slow wave direction between pre- and postprandial periods in MGG (P < 0.05). No statistical differences were observed in propagation speed between healthy subjects and patients in either MGG or HR-EGG pre/postprandial periods. The use of MGG and/or HR-EGG represents an opportunity to assess noninvasively the effects of chronic nausea on gastric slow wave activity. MGG data may offer the opportunity for further refinement of the more portable and economical HR-EGG in future machine-learning approaches for functional nausea.NEW & NOTEWORTHY Pediatric chronic nausea is a difficult-to-measure subjective complaint that requires objective diagnosis, clinical assessment, and individualized treatment plans. Our study demonstrates that multichannel MGG used in conjunction with custom HR-EGG detects key pathological signatures of functional nausea in children. This quantifiable measure may allow more personalized diagnosis and treatment in addition to minimizing the cost and potential radiation associated with current diagnostic approaches.

S3556 Unique Approach to Refractory Nausea With Ketamine Infusion

Introduction: Functional refractory nausea is defined as nausea that persists for more than 4 weeks. Nausea can result from complex interactions between afferent and efferent pathways of the central nervous system and gastrointestinal tract. Management of refractory nausea, especially if it is associated with migraines, can be difficult to treat as conventional therapies such antiemetic and prokinetics are ineffective. We present a case of functional refractory nausea that was incidentally treated successfully with ketamine infusion. Case Description/Methods: A 37-year-old male with a history of pancreatic insufficiency, migraines, and chronic refractory nausea since 2016 with recurrent ED visits presented this time with headache and nausea for 7 days. He had tried multiple prophylactic medications at home including triptans and muscle relaxers without relief. For his nausea he tried ondansetron but it only provided temporary relief for 15-20 minutes. In the ED, the patient received prochlorperazine, diphenhydramine, and ketorolac for his headache and nausea. He continued to complain of his symptoms and was subsequentially given 20.4 milligram of ketamine infusion over 1 hour with resolution of his headache as expected. Surprisingly, the patient’s nausea concomitantly resolved with the ketamine infusion. After discharge, he was followed in GI clinic after one week and 3 months where he stated he was completely free of nausea without the use of his prophylactic medications. Discussion: Functional refractory nausea has been associated with decreased quality of life for patients. This presents as an economic burden in terms of health care costs and resources with recurrent admissions and ED visits. Conventional treatments for nausea include the use of antiemetics and prokinetics to name a few. The use of ketamine infusion has only been reported in one other case study for abortive and prophylactic therapy for nausea. Ketamine is a noncompetitive antagonist to N-methyl-d-aspartate receptor. The mechanism by which it helps with refractory nausea is still unclear but it is believed to be related to reduction of neural transmissions by ketamine. Ketamine is a generic medication that is cost effective. Side effects of ketamine are dose dependent and include cystitis and liver toxicity, which is unlikely with the doses given for nausea treatment. This case represents incidental resolution of nausea with ketamine administration and more studies are required for its role in abortive and prophylactic therapy.

Automated Machine Learning Pipeline Framework for Classification of Pediatric Functional Nausea Using High-Resolution Electrogastrogram.

Pediatric functional nausea is challenging for patients to manage and for clinicians to treat since it lacks objective diagnosis and assessment. A data-driven non-invasive diagnostic screening tool that distinguishes the electro-pathophysiology of pediatric functional nausea from healthy controls would be an invaluable aid to support clinical decision-making in diagnosis and management of patient treatment methodology. The purpose of this paper is to present an innovative approach for objectively classifying pediatric functional nausea using cutaneous high-resolution electrogastrogram data. We present an Automated Electrogastrogram Data Analytics Pipeline framework and demonstrate its use in a 3x8 factorial design to identify an optimal classification model according to a defined objective function. Low-fidelity synthetic high-resolution electrogastrogram data were generated to validate outputs and determine SOBI-ICA noise reduction effectiveness. A 10 parameter support vector machine binary classifier with a radial basis function kernel was selected as the overall top-performing model from a pool of over 1000 alternatives via maximization of an objective function. This resulted in a 91.6% test ROC AUC score. Using an automated machine learning pipeline approach to process high-resolution electrogastrogram data allows for clinically significant objective classification of pediatric functional nausea. To our knowledge, this is the first study to demonstrate clinically significant performance in the objective classification of pediatric nausea patients from healthy control subjects using experimental high-resolution electrogastrogram data. These results indicate a promising potential for high-resolution electrogastrography to serve as a data-driven screening tool for the objective diagnosis of pediatric functional nausea.

Use of Cluster Analysis to Identify Subtypes of Pediatric Functional Nausea.

The aim of the study was to evaluate whether there are clinical subtypes in children with functional nausea based on comorbidities and responses to the Nausea Profile questionnaire. Patients from the Neurointestinal and Motility Program clinical registry at Lurie Children's Hospital were included if they met Rome IV criteria for functional nausea. Patients completed the Nausea Profile, a multidimensional measure of nausea with gastrointestinal, emotional, and somatic subscales. Comorbidities were assessed by chart review and self-report measures. Latent class analysis was used to identify patient groups based on comorbidities. To assess if model-identified groups were predictive of differences in nausea quality, Nausea Profile subscale means were compared between groups and used to predict group membership. Conversely, k-means analysis was used to divide the sample into groups based upon Nausea Profile subscale scores, to determine if identified groups had different comorbidities. Seventy-two patients (n = 53 girls) with a mean age (±SD) 14.5 ± 2.9 were included. Two clinical subtypes were identified based on comorbidities, with responses on the emotional subscale of the Nausea Profile predicting group membership (P < 0.04). When patients were grouped by nausea quality, the resulting clusters differed on psychiatric comorbidities (P < 0.001). Our findings support the existence of nausea subtypes within the broad diagnosis of functional nausea. One such subtype is an emotional predominant nausea supporting the notion that anxiety and depression constitute a subset of patients with nausea. Thus, patients may benefit from a treatment approach that integrates both GI assessment and psychiatric support in their care.

Functional Nausea Is Real and Makes You Sick.

Functional nausea is a condition that severely impairs the quality of life of affected individuals. Only recently, it has been added to the pediatric list of disorders of gut-brain interaction. In most cases, only minimal testing is needed to diagnose functional nausea. Hypnotherapy has been shown to be a very effective treatment and there are several other medical and non-medical interventions which have the potential to benefit sub-groups of patients with chronic nausea.

Effect of Mirtazapine on Nausea in Children with Functional Nausea and Functional Dyspepsia Postprandial Distress Syndrome.

The objective of this study was to assess the clinical response and safety of mirtazapine in the pediatric population with a diagnosis of functional nausea and nausea associated with functional dyspepsia postprandial distress syndrome. This was a retrospective chart review to evaluate the safety and efficacy of mirtazapine for pediatric nausea and nausea associated with functional dyspepsia postprandial distress syndrome. Clinical response was classified as complete response, partial response, and no response. We also identified the prescribed doses, side effects, and weight changes during mirtazapine therapy. Among the 57 total patients, 67% were females and ages ranged from 7 to 19 years with a mean of 14±3 years. Clinical (complete and partial) response was reported in 82% of patients. Nausea resolved in 82% and insomnia in 77% of the patients. Eighty-four percent gained weight with a mean of 4±7kg. Sixty-five percent did not report adverse effects. The most common adverse effects were undesired weight gain (16%) and dysphoria (9%). Two patients discontinued the medicine after the first dose because of adverse effects. There was a significant correlation between the initial dose and weight (rs=0.478; p=0.0002). The median initial and final doses were 15mg, respectively. Mirtazapine is an option for treating children and adolescents with functional nausea and nausea associated with functional dyspepsia post-prandial distress syndrome, especially for a select group of patients with concurrent weight loss, anxiety, and insomnia.

Skills or Pills: Randomized Trial Comparing Hypnotherapy to Medical Treatment in Children With Functional Nausea

The potential effectiveness of gut-directed hypnotherapy (HT) is unknown for pediatric chronic nausea. This randomized controlled trial compared HT with standard medical treatment (SMT). One hundred children (ages, 8-18 y) with chronic nausea and fulfilling functional nausea (FN) or functional dyspepsia (FD) criteria were allocated randomly (1:1) to HT or SMT, with a 3-month intervention period. Outcomes were assessed at baseline, at the halfway point, after treatment, and at the 6- and 12-month follow-up evaluation. Children scored nausea symptoms in a 7-day diary. The primary outcome was treatment success, defined as a reduction in nausea of 50% or more, at the 12-month follow-up evaluation. Secondary outcomes included adequate relief of nausea. After treatment and at the 6-month follow-up evaluation, there was a trend toward higher treatment success in the HT group compared with the SMT group (45% vs 26%, P= .052; and 57% vs 40%, P= .099, respectively). At 12 months, treatment success was similar in both groups (60% in the HT group and 55% in the SMT group; P= .667). In the FN group, significantly higher success rates were found for HT, but no differences were found in patients with FD. Adequate relief was significantly higher in the HT group than in the SMT group at the 6-month follow-up evaluation (children: 81% vs 55%, P= .014; parents: 79% vs 53%; P= .016), but not at the 12-month follow-up evaluation. HT and SMT were effective in reducing nausea symptoms in children with FN and FD. In children with FN, HT was more effective than SMT during and after the first 6 months of treatment. Therefore, HT and SMT, applied separately or in combination, should be offered to children with FN as a treatment option (Clinical trials registration number: NTR5814).

Kynurenine Pathway of Tryptophan Metabolism in Migraine and Functional Gastrointestinal Disorders

Migraine, the leading cause of disability in the population aged below 50, is associated with functional gastrointestinal (GI) disorders (FGIDs) such as functional nausea, cyclic vomiting syndrome, and irritable bowel syndrome (IBS). Conversely, changes in intestinal GI transit may cause diarrhea or constipation and are a component of the autonomic symptoms associated with pre- and post-dorsal phases of migraine attack. These mutual relationships provoke a question on a common trigger in migraine and FGIDs. The kynurenine (l-kyn) pathway (KP) is the major route for l-tryptophan (l-Trp) metabolism and transforms l-Trp into several neuroactive compounds. Changes in KP were reported in both migraine and FGIDs. Migraine was largely untreatable, but several drugs approved lately by the FDA, including monoclonal antibodies for calcitonin gene-related peptide (CGRP) and its receptor, create a hope for a breakthrough in migraine treatment. Derivatives of l-kyn were efficient in pain relief with a mechanism including CGRP inhibition. KP products are important ligands to the aryl hydrocarbon receptor (AhR), whose activation is implicated in the pathogenesis of GI and migraine. Toll-like receptors (TLRs) may play a role in migraine and IBS pathogeneses, and KP metabolites detected downstream of TLR activation may be an IBS marker. The TLR4 signaling was observed in initiating and maintaining migraine-like behavior through myeloid differentiation primary response gene 88 (MyD88) in the mouse. The aim of this review is to justify the view that KP modulation may provide common triggers for migraine and FGIDs with the involvement of TLR, AhR, and MyD88 activation.

A Comparison of Generic and Condition-Specific Preference-Based Measures Using Data From Nivolumab Trials: EQ-5D-3L, Mapping to the EQ-5D-5L, and European Organisation for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions

ObjectivesThere is growing interest in condition-specific preference measures, including the European Organisation for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions (QLU-C10D). This research assessed the implications of using utility indices on the basis of the EQ-5D-3L, a mapping of EQ-5D-3L to the EQ-5D-5L, and the QLU-C10D, and compared their psychometric properties. MethodsData were taken from 8 phase 3 randomized controlled trials of nivolumab with or without ipilimumab for the treatment of solid tumors. Utilities for progression-related states were calculated using the UK and English value sets and incremental quality-adjusted life-years (QALYs) derived from established UK cost-effectiveness models. The psychometric properties of the utility indices were assessed using pooled trial data. ResultsCompared with the EQ-5D-3L index, the mapped EQ-5D-5L index yielded an average of 6% more and the QLU-C10D index an average of 2% fewer incremental QALYs for nivolumab versus comparators. All indices could differentiate between groups defined by performance status, cancer stage, or self-reported health status at baseline and detect meaningful changes in performance status, tumor response, health status, and quality of life over approximately 12 weeks of treatment. ConclusionsThe lower QALY yield of the QLU-C10D was balanced by evidence of greater validity and responsiveness. Benefits gained from using the QLU-C10D may be apparent when treatments affect targeted symptoms and functional aspects, including sleep, bowel function, appetite, nausea, and fatigue. The observed differences in QALYs may not be sufficiently large to affect health technology assessment decisions.

An elevated anxiety level among prepubertal autistic boys with non-treatment-seeking functional gastrointestinal disorders: A case-control study.

Children with autism commonly suffer from comorbid functional gastrointestinal disorders (FGID) and anxiety. The raised prevalence of both conditions in autism suggests complex reciprocal relationships, which are seldom explored in non-treatment-seeking FGID. The relationships between subtypes of FGID and anxiety are also unclear. This study recruited boys with autism and age-matched typically developing (TD) boys, aged 4-11 years, who were not actively seeking help for gastrointestinal problems. Their parents completed the Rome IV Diagnostic Questionnaires for Pediatric FGID. Four groups of children with and without autism/FGID were identified and compared on their anxiety level using the Spence children's anxiety scale. In 69 boys with autism and 69 age-matched TD boys, FGID were identified in 22 and 16 boys, respectively. ANCOVA demonstrated a significant interaction effect of autism and FGID on anxiety (F[1, 129]=5.43, p=0.021), while conditional logistic regression identified an interaction effect of autism and anxiety on the odds of FGID (OR 1.038, 95% CI 1.002-1.075, p=0.038). Explorative post hoc analysis showed higher anxiety in functional nausea and vomiting disorder (p=0.033) and functional abdominal pain disorder (p=0.029) among boys with autism than TD boys with the same respective subtypes of FGID. In summary, among prepubertal boys with autism, the presence of FGID that are non-treatment-seeking in nature, has a significantly stronger association with higher levels of anxiety than TD boys. The strength of association may be more prominent in subtypes of FGID. Possible pathomechanisms including the underlying microbiota spectra and inflammatory paths should be explored in future studies. LAY SUMMARY: Anxiety and gastrointestinal problems are common symptoms in autism. Given that gut health could be linked to emotions, their association in young boys with autism was studied. The presence of nausea vomiting, or abdominal pain were associated with raised anxiety among boys with autism, yet this was not observed in typically developing boys. This suggests that anxiety among autistic children could be partly explained by the presence of FGID.

Abnormalities on Electrogastrography in Nausea and Vomiting Syndromes: A Systematic Review, Meta-Analysis, and Comparison to Other Gastric Disorders.

Functional nausea and vomiting syndromes and gastroparesis, collectively grouped as nausea and vomiting syndromes (NVS), are overlapping conditions with incompletely understood pathophysiology. Gastric slow wave abnormalities are thought to contribute. This study aimed to systematically review and meta-analyze the prevalence of slow wave abnormalities measured by electrogastrography (EGG) in patients with NVS. MEDLINE, EMBASE, EMBASE classic, and CENTRAL databases were systematically searched for articles using EGG in adults (≥ 18years) with NVS. EGG metrics of interest were percentage time in bradygastria, normogastria, and tachygastria as well as dominant frequency and dominant power. Outcomes were also compared with functional dyspepsia (FD), gastroesophageal reflux disease (GORD), and control cohorts. Seven hundred and sixty NVS patients and 308 controls were included from 24 studies. Overall, 64% of patients had EGG abnormalities. Average percent time in normogastria was low during fasting (50%; 95% CI 40-63%) and fed (53%; 95% CI 41-68%) states in patients, with substantial periods in fasting bradygastria (34.1%; 95% CI 25-47%) and postprandial tachygastria (21%; 95% CI 17-26%). Across gastric disorders, pooling of 84 studies showed a comparably high prevalence of EGG abnormalities in NVS (24 studies; n = 760) and GORD (13 studies; n = 427), compared to FD (47 studies; n = 1751) and controls (45 studies; n = 1027). Frequency-based gastric slow wave abnormalities are prominent in NVS. The strength and consistency of these associations across many studies suggests that gastric dysrhythmia may be an important factor in NVS, motivating the development of more reliable methods for their clinical assessment.

Blood and faecal lead levels in children with various functional gastrointestinal disorders

IntroductionTo investigate the blood lead levels (BLLs) and faecal lead levels (FLLs) in children with various functional gastrointestinal disorders (FGIDs) and compare them with controls. Patients and methodsOne hundred and two children with FGIDs defined by the Rome IV criteria, aged 4–18 years, and one hundred and two sex matched healthy children were enrolled in the study. Children with FGIDs were divided into three subgroups as functional constipation (FC) (n = 36), functional abdominal pain (FAP) (n = 36) and functional nausea (FN) (n = 30). The lead levels were measured using atomic absorption spectrometer. ResultsThe median BLLs in the FGIDs group was significantly higher than in controls (5.12 and 1.77 µg/dL, respectively). The BLLs were above 5 µg/dL in 51,9% of children with FGIDs. There was statistically significant difference in BLLs between FC subgroup and the other subgroups (FAP and FN) (p = 0.003, p < 0.001 respectively). The FLLs in the FGIDs group was significantly higher than in controls (28.08 and 0.01 µg/g, respectively). There was no significant difference in FLLs between FC subgroup and the other subgroups (p = 0.992, p = 0.989 respectively). No significant relation found between BLLs and FLLs of the FGIDs group (p = 0.123). ConclusionThis study revealed that children with FGIDs had higher BLLs and FLLs than controls and also more than half of children with FGIDs had BLLs ≥5 µg/dL which is considered as toxic level. These results might revive the question of whether or not clinicians need to evaluate routine BLLs in children with FGIDs.

Functional digestive disorders in children. Guidelines of the Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists. Part 2

A group of experts, leading specialists in the field of pediatric gastroenterology have prepared clinical recommendations for the diagnosis and treatment of functional digestive disorders in children; they have summarized the international recommendations and domestic experience, suggesting the tactics of in everyday pediatrician’s practice. The second part of the guidelines discusses functional disorders with abdominal pain: functional nausea and vomiting, functional dyspepsia, irritable bowel syndrome, functional abdominal pain. The authors have clarified the definitions, classification and criteria for the diagnosis of functional dyspepsia and irritable bowel syndrome taking into account actual concepts. They also have defined current therapeutic principles. The diagnosis of functional nausea and vomiting, as well as functional abdominal pain, is rarely found in our pediatric practice, and therefore the detailed information provided on these diseases is of particular importance for a practitioner.

The effect of chronic nausea on gastric slow wave spatiotemporal dynamics in children

Chronic nausea in adolescents with functional gastrointestinal disorders is an increasingly reported but poorly understood symptom that negatively affects quality of life. Functional gastrointestinal disorders are known to correlate closely with slow wave rhythm disturbances. The ability to characterize gastric electrophysiologic perturbations in functional nausea patients could provide potential diagnostic and therapeutic tools for nausea patients. We used high-resolution electrogastrograms (HR-EGG) to measure gastric slow wave parameters in pediatric chronic nausea patients and healthy subjects both pre- and postprandial. We computed the dominant frequency, percentage power distribution, gastric slow wave propagation direction, and speed from HR-EGG. We observed significant differences in the dominant frequency and power distributed in normal and bradyarrhythmia frequency ranges when comparing patients and healthy subjects. Propagation patterns in healthy subjects were predominantly anterograde, while patients exhibited a variety of abnormalities including retrograde, anterograde, and disrupted patterns. There was a significant difference in the preprandial mean slow wave direction between healthy subjects (222°±22°) and patients (103°±66°; p˂0.01), although the postprandial mean direction between healthy subjects and patients was similar (p=0.73). No significant difference in slow wave propagation speed was found between patients and healthy subjects in either pre- (p=0.21) or postprandial periods (p=0.75). The spatiotemporal characterization of gastric slow wave activity using HR-EGG distinguishes symptomatic chronic nausea patients from healthy subjects. This characterization may in turn inform and direct clinical decision-making and lead to further insight into its pathophysiology.

S1349 Impact of Chronic Nausea and Vomiting Syndrome on Work Productivity and Quality of Life: A Prospective Case-Control Study

INTRODUCTION: Chronic nausea and vomiting syndrome (CNVS) is an uncommon functional nausea and vomiting disorder. It has been associated with several disorders of the brain-gut axis including irritable bowel syndrome and functional dyspepsia. The prevalence of functional nausea and vomiting disorders is 2.2% from which 50% are CNVS, affecting predominantly productive population. Mounting evidence has previously described a negative impact of CNVS on quality of life; however, the influence on work productivity it is reported in nausea and vomiting as isolated symptoms and not as part of CNVS. METHODS: A prospective case-control study was conducted to analyze socioeconomic and work productivity impact of CNVS on productive Mexican population. The research took place on Mexico during 2020. An internet survey was applied to 1000 active workers selected by random sampling. This study collected social, demographic and work related information; and analyzed psychological and digestive symptoms. Rome IV criteria for CNVS diagnosis, EQ-5D for evaluate quality of life (QOL) and Goldberg Scale for depression and anxiety. Comparisons with a logistic regression univariate and multivariate analysis with chi-squared test with 95% confidence intervals were calculated, as well as a comparative T-test. RESULTS: CNVS prevalence was 12.6%. Demographics were age of 30 ± 11 years with a predominance of female gender (66.3%). On CNVS, the mean age was (28 ± 9) with a predominance female gender (82.5%). Among employed with CNVS, 74% reported an impact on daily life versus 49% of those on the control group. Based on EQ-5D, pain-discomfort status was present on 48.4% and anxiety-depression status on 65%, 74.4% reported CNVS as a cause of presenteeism and 44.4% as a cause of annual absenteeism. Multiple logistic regression indicated that anxiety-depression overlap OR 2.104 (CI 95% 1.367-3.240, P = 0.001) and presenteeism OR 4.874 (CI 95% 2.784-8.536, P=< 0.001) were independently associated with CNVS, as well as male gender is a protective factor for developing CNVS OR 0.417 (CI 95% 0.248-0.699, P = 0.001). T-test indicated that CNVS patients have more per capital annual health spending and frequently sought medical attention (P=< 0.001). CONCLUSION: CNVS is more frequent on Hispanic population, affecting predominantly working age population. CNVS influences negatively in per capita annual health spending and work productivity being a common cause of absenteeism and presenteeism, as well as an independent factor for this last one.Table 1.: Multivariate analysis of associated factors to chronic nausea and vomiting syndromeTable 2.: T-Studen analysis of associated factors to chronic nausea and vomiting syndrome

Barriers to achieving same day discharge following unilateral unicompartmental knee arthroplasty

BackgroundEvidence suggests that only a minority of unselected patients are able to achieve same day (SD) discharge following unilateral unicompartmental knee arthroplasty (UKA). However, many hospitals continue to classify UKA as an outpatient procedure, creating financial pressure to limit prolonged hospitalizations. To understand and address challenges that decrease patients' likelihood of achieving SD discharge, this study aimed to identify barriers commonly contributing to SD discharge failures with following a rapid discharge protocol (RDP). MethodsRetrospectively collected data from 158 unselected patients having undergone unilateral UKA between 2018 and 2019 were reviewed. All patients were treated using an established RPD with intended SD discharge. ResultsSuccessful SD discharge was achieved by 84.2% of patient. Overall, those failing to achieve SD discharge were older (p < 0.001), more commonly female (p = 0.037), have multiple functional deficits (p < 0.05) and experience post-operative nausea (p < 0.001). Increased age, the use of an assisted device, and post-operative nausea accounted for 44.8% of the variability for patient not achieving SD discharge. The model was able to classify 95.7% of SD discharge and 38.1% of unsuccessful SD discharge patients, for an overall success rate of 85.1%. ConclusionsThe use of a well-developed, interdisciplinary RDP for unilateral UKA results in high SD discharge success in a community hospital setting. However, with 15.8% of patients still not able to achieve SD discharge, a more efficient RDP may include prioritizing patient scheduling, with lower priority given to older individuals requiring an assisted device, and changes to preventative and symptomatic treatment options for post-operative nausea.