Pediatric Gastroenterology Clinic Research Articles

Investigation of the frequency of application of physiotherapy in infants with gastroesophageal reflux

Introduction: Gastroesophageal reflux (GER) is defined as the reflux of gastric and/or intestinal contents into the esophagus. It is a common phenomenon, seen in 40-65% of infants and is due to transient relaxations of the lower esophageal sphincter.Many infants have daily episodes of GER, of short duration after meals, during sleepeven while awake. Its early diagnosis helps towards early intervention and successful treatment of complications. Furthermore, it contributes to improving the infant’s and the family’s quality of life. Physiotherapy as an adjunctive therapeutic intervention seems to be able to contribute significantly to the improvement of GER in infants. The goal is to improve movement, body posture, cardiorespiratory function and coordination in order to limit the phenomenon. Aim:The main purpose of this study was to investigate whether infants with GER, in addition to dietary and other instructions and any pharmaceutical intervention, also undergo physical therapy treatment to improve their symptoms. Additional objectives were to record the infant’s and the family’s quality of life, and to explore parents’ expectations of a physical therapy program. Patients and methods:Thirty infants with GER participated in the study. The research was conducted in Thessaloniki, Greece, in a regular pediatric gastroenterology clinic. The questionnaire was given to the parents and completed under the supervision of the researcher in case of need for clarification. Results:None of the 30 infants studied was following a physical therapy program. In addition, GER was found to have a great impact on parents’ quality of life, since 80% answered that they were significantly affected, not knowing how to manage the condition. Regarding the need for physical therapy intervention and informing parents, 70% answered that they would like to have information and help from a physical therapist. A percentage of 80% of parents were in favor of a physical therapy program that could contribute to the reductioneven the elimination of their children’s medication. Conclusions:Gastroesophageal reflux affects a large percentage of infants. In severe cases, if not treated in time, it can affect the health of young infants and the families’ quality of life. Most parents seem to trust a physical therapy program to improve their children’s health for the fastest recovery from GER. This research can be a pilot for further studies, in the context of a more holistic intervention by doctors and physical therapists in infants with GER symptoms.

Review of interruptions in a pediatric subspecialty outpatient clinic.

IntroductionThe objective of this study was to describe interruptions in the pediatric ambulatory setting and to assess their impact on perceived physician communication, patient satisfaction and recall of provided physician instructions.MethodsAn observational study was performed at the Children’s Hospital of Philadelphia, Pediatric Gastroenterology clinic. Participation consisted of video recording the clinic visit and the caregiver completed post-visit surveys on communication and satisfaction. Video recordings were coded for interruptions, which were divided into 3 main categories: Visit Associated, Pediatric Associated, and Unanticipated. An interruption rate was calculated and correlated with the following outcome variables to assess the impact of interruptions: caregiver satisfaction, caregiver perception on the quality of physician communication, and caregiver instruction recall.ResultsThere were 675 interruptions noted in the 81 clinic visits, with an average of 7.96 (σ = 7.68) interruptions per visit. Six visits had no interruptions. The Patient was the most frequent interrupter. Significantly higher interruption rates occurred in clinic visits with younger patients (<7 years old) with most of the interruptions being Pediatric Associated interruptions. There was minimal correlation between the clinic visit interruption rate and caregiver satisfaction with the communication, caregiver perception of quality of communication, or caregiver instruction recall rate.ConclusionThe effect of interruptions on the pediatric visit remains unclear. Interruptions may be part of the communication process to ensure alignment of the patient’s agenda. Additional studies are needed to help determine the impact of interruptions and guide medical education on patient communication.

Annelerin Çocuklarının Sağlıklı Beslenme Alışkanlıkları Edinmesi Konusundaki Farkındalıklarının Değerlendirilmesi

Objective: Nutrition is important not only in terms of ideal growth of the baby, but also in terms of being the determinant of the healthiness during infancy, childhood, and adulthood and adopting healthy eating habits that continue lifetime. The aim of this study is to evaluate the level of knowledge and misapplications of mothers about babies' feeding habits. &#x0D; Materials and Metods: This was planned as an analytical cross-sectional study and was applied to the mothers of the patients who admitted to Inonu University Faculty of Medicine Pediatric Gastroenterology, Hepatology and Nutrition outpatient clinic, between January-March 2020, for any reason. A value of p

Prevalence of Familial Mediterranean Fever in Children with Cryptogenic Cirrhosis.

Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by abdominal and chest pain and recurrent fever due to inflammation in the serosal membranes such as peritoneum, pleura and synovia. In FMF, recurrent inflammatory cytokine production may lead to cirrhosis. The aim of this study was to determine the prevalence of FMF in children with cryptogenic cirrhosis and it was found to be high, to add FMF among the etiological causes of cirrhosis. This prospective cohort study conducted at the Hospital of İnönü University, Malatya, Turkey. In this study, 44 patients diagnosed with cryptogenic cirrhosis by biopsy, in the Pediatric Gastroenterology, Hepatology and Nutrition Clinic, were included, after the other reasons that may cause chronic liver disease were excluded. MEVF gene analysis was performed for all patients with cryptogenic cirrhosis. FMF genetic mutation was detected in 9 (20%) of 44 patients. M694V mutation was detected in one patient (2.27%) and E148Q homozygous mutation was detected in one patient (2.27%). Various other heterozygous mutations were detected in seven other patients. Homozygous and heterozygous R202Q mutations were detected in one patient. We suggest that FMF plays a role in the etiologic differential diagnosis of cryptogenic cirrhosis.

Adherence to the Mediterranean diet and risk of functional constipation in children in Turkey: case–control study

Background: Functional constipation is often seen in children, affecting quality of life and imposing a considerable burden on health care services. The Mediterranean diet is associated with a lower risk of functional gastrointestinal disorders. Aims: This study aimed to evaluate the relationship between functional constipation and adherence to the Mediterranean diet in Turkish children aged 6–18 years. Methods: In this case–control study, 221 children with functional constipation (cases) were selected from a paediatric gastroenterology clinic between May 2018 and September 2019, and 230 children without constipation (controls) were randomly selected from those attending a well-child check-up. Cases and controls were matched on sex, age and socioeconomic characteristics. Compliance with the Mediterranean diet was assessed using the KIDMED index score. Multivariable logistic regression analysis was used to analyses the data. Results: KIDMED index scores in cases and controls were 4.0 (SD = 2.5) and 6.3 (SD = 2.4), respectively (P &lt; 0.001). Odds ratios for functional constipation were 0.23 (95% confidence interval (CI): 0.13–0.38) for KIDMED index score 4–7 and 0.05 (95% CI: 0.03–0.11) for score ≥ 8 compared with the lowest category (score ≤ 3; P &lt; 0.001). A negative correlation was observed between age and adherence to the Mediterranean diet. Conclusion: Good adherence to the Mediterranean diet was associated with a lower risk of functional constipation, and adherence to the Mediterranean diet decreased with age. Education on nutrition and health is warranted to help maintain and improve the health of young people in Turkey.

Ultrasound Evaluation of Gallbladder Mobility in Children with Chronic Functional Constipation

Introduction: The causes of chronic functional constipation are largely unknown and may be a multifactorial disorder. Gallbladder dysfunction in chronic idiopathic constipation may be an underlying cause of idiopathic constipation. Methods: Children between the ages of 3 to 13 years in Imam Khomeini Hospital of Ahvaz, who suffered from functional constipation, From pediatric gastroenterology clinic were referred to us for conducting gallbladder ultrasound. In this study, 50 patients with chronic functional constipation and 50 healthy individuals (control group) were studied.Results: The mean volume of gallbladder in fasting mode (preprandial) and after meal (postprandial) in individuals of the case group was 5.66 and 4.17 cm3 with standard deviation of 0.80 and 0.64, respectively, and in the control group was 6.08 and 3.06 cm3 with standard deviation of 0.97 and 0.75, respectively. The thickness of the gallbladder wall in fasting mode (preprandial) and after meal (postprandial) in the case group is 1.50 and 1.67 mm with a standard deviation of 0.24 and 0.29 mm, respectively, and in the control group, it is equal to 1.39 and 1.69 with a standard deviation of 0.22 and 0.28, respectively.It was observed a significant relationship in terms of gallbladder volume after meals between case and control groups (P 0.05).Discussion: Due to the slow mobility of the gallbladder in patients with chronic functional constipation, it can be concluded that gallbladder dysfunction can be a cause of chronic functional constipation.

The Relationship between Primary Duodenogastric Reflux and Helicobacter pylori Gastritis in Children

Background: Most studies of the relationship between duodenogastric reflux (DGR) and Helicobacter pylori have reported that the presence of DGR decreases H. pylori colonization, while H. pylori infection increases the frequency of DGR by impairing antroduodenal motility. The present study aimed to investigate the relationship between primary DGR and the prevalence of H. pylori in children, as well as the degree of colonization and the presence and severity of gastritis. Methods: Included in the study were 410 patients between the ages of 2 and 18 years, referred to the pediatric gastroenterology clinic with complaints of dyspepsia, abdominal pain, and nausea/vomiting, who underwent upper gastrointestinal system endoscopic examination and stomach biopsy. The study group included 60 patients with DGR, while 350 non-DGR patients formed the control group. Results: The mean age of patients with DGR was 15.7 ± 2.1 years, while the mean age of the control group was 14.2 ± 3.8 years (p = 0.02). Of those with DGR, 50 (83.3%) were girls, while in the control group, 215 (61.4%) were girls (p = 0.001). Of patients with DGR, 16 were H. pylori (+) (26.7%), while in the control group, 168 were H. pylori (+) (48%) (p = 0.002). There was no significant difference between the 2 groups with respect to H. pylori degree of colonization (p = 0.08). Gastritis was present in 56 (93.3%) patients in the DGR group and 322 (92%) patients in the control group (p = 0.72). A significant difference was found between the 2 groups in terms of gastritis severity (p = 0.01). Conclusions: The mean age of patients with DGR was significantly higher than that of patients without DGR, and DGR was found to be more common in girls. In patients with DGR, H. pylori prevalence was significantly lower than in those without DGR; however, no significant difference was found between the 2 groups with respect to the colonization degree.

Pediatric and Maternal Anxiety at First Visit to a Turkish Gastroenterology Clinic Compared to Anxiety Prior to Pediatric Endoscopy Procedure.

The aim of this study was the prospective comparison of pediatric and maternal anxiety at the first visit to a gastroenterology clinic with anxiety prior to a pediatric endoscopy procedure. A total of 101 children aged 4-18 years plus their mothers who were referred to an outpatient pediatric gastroenterology clinic were included in the first group. The second group consisted of 101 different children aged 4-18 years undergoing pediatric endoscopy. The Hospital Anxiety and Depression Scale (HADS) was administered to mothers. Visual analog scale scores were obtained from the children to measure anxiety. The demographic characteristics of the groups were similar. The mean HADS anxiety score was 3.83 in mothers of the first group. The same score was significantly higher as (6.96) in the mothers whose children underwent an endoscopy (p < .001). The comparison of the depression scores revealed significantly higher scores in the endoscopy group. Visual analog scale values of the children revealed remarkably higher anxiety scores in the endoscopy group. About 5% of mothers in the first group and almost half of the mothers in the endoscopy group developed remarkable anxiety (>8 HADS anxiety). The rate of significant depression (>8 HADS depression) was 2% and 17.82% in the first and second groups, respectively. The current prospective trial concluded that particularly anxiety is a major concern for mothers and children when endoscopy is required.

Stigma Moderates the Relation Between Peer Victimization, Thwarted Belongingness, and Depressive Symptoms in Youth with Inflammatory Bowel Disease

PurposeThe stigmatizing nature of IBD symptoms may place youth at risk for being targets of peer victimization, potentially resulting in a decreased sense of social belongingness and poorer emotional adjustment. The present study tested a series of mediation and moderated mediation models examining the associations among peer victimization, thwarted social belongingness, and depressive symptoms, as well as the moderating role of IBD stigma in these associations. We hypothesized peer victimization would have an indirect effect on youth depressive symptoms through thwarted belongingness, and this effect would be amplified for youth endorsing greater IBD stigma. Design and methodsSeventy-five youth (10–18 yrs.) diagnosed with IBD were recruited from a pediatric gastroenterology clinic. Participants completed self-report measures of IBD stigma, peer victimization, thwarted belongingness, and depressive symptoms. ResultsAs anticipated, mediation analyses revealed a significant peer victimization → thwarted belongingness → depressive symptoms indirect path. Moderated mediation analyses indicated that this indirect effect was moderated by IBD stigma and was significantly greater among youth reporting higher IBD stigma. ConclusionsYouth who experience higher levels of IBD-related stigma are at increased risk for depressive symptoms as a function of the socially isolating effects of peer victimization. Practice implicationsOur findings highlight the need for routine screening and identification of the socioemotional challenges faced by youth with IBD. Clinical interventions that incorporate coping strategies aimed at minimizing youths' stigmatizing self-perceptions and improving overall social skills and social engagement may lessen the negative impact of peer victimization on youths' social and emotional adjustment.

Gut Microbiome of Children and Adolescents With Primary Sclerosing Cholangitis in Association With Ulcerative Colitis.

Few studies reported the relation of intestinal microbiome composition and diversity in pediatric patients with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). In this cross-sectional study, we selected patients younger than 19 years old from the pediatric gastroenterology and hepatology outpatient clinic of a tertiary hospital to describe the intestinal microbiome of pediatric patients with PSC associated or not to UC. Patients were divided in PSC, PSC+UC, and UC diagnosis. A stool sample was collected from each patient (n=30) and from a healthy relative/neighbor (n=23). The microbiome composition was assessed using MiSeq (Illumina) platform. Differences in microbial composition were found between PSC and PSC+UC groups. The relative abundance of Veillonella and Megasphaera genera were increased depending on patients’ age at diagnosis. Veillonella was also increased in patients who were in an active status of the disease. Both genera were positively correlated to total bilirubin and gamma-glutamyl transferase. As a conclusion, the disease, the age and the disease activity status seem to influence the intestinal microbiome, highlighting the difference of intestinal microbiome profile for patients depending on age at diagnosis. We also showed an increase of Veillonella in patients with PSC and PSC+UC, and a positive correlation of dysbiosis and higher gamma-glutamyl transferase and total bilirubin in PSC+UC patients. Our findings are promising in the diagnosis, prognosis, and future therapeutic perspectives for PSC patients.

Impact of a Medical Scribe Program on Outpatient Pediatric Gastroenterology Clinic.

Medical scribes may offer a route to improve physician productivity and workflow efficiency with reduced physician time for documentation. To our knowledge, there is no prior literature on medical scribe impact on outpatient pediatric gastroenterology clinic operations. The primary aim of our study was to address this knowledge gap. Data were collected on encounters conducted by pediatric gastroenterology physicians at a tertiary center, during a summer scribe program. Scribes were trained and attended clinics in a nonrandomized fashion. Clinic efficiency was assessed by patient flow, tracked via the electronic medical record system. Medical note complexity codes, associated work relative value units (wRVUs), and note delinquency were compared between encounters with and without scribes. Patient satisfaction survey scores were compared between groups. One thousand nine hundred seventy encounters were included. Documented medical note complexity (and wRVUs), note delinquency, patient satisfaction, and perceived overall quality of service were similar between groups. Clinic time for established encounters was statistically shorter with scribes (median 18 vs 21 minutes, P = 0.01), a 14% reduction. No significant difference was noted in new encounter clinic time. The time to note completion was shorter for new encounters with scribes (2 vs 3 days, P = 0.048). More notes were finalized by the third day postencounter when a scribe was present (63% vs 57%, P = 0.02). The presence of medical scribes was associated with significantly more efficient clinic flow for established encounters and modest improvements in note completion rate. There were no measurable negative effects on documented medical note complexity or patient satisfaction scores.

Use of faecal immunochemical testing as an alternative to faecal calprotectin in children.

Faecal calprotectin has been widely used as a non-invasive marker of intestinal inflammation in children. Measurement of faecal haemoglobin using faecal immunochemical test is well established in adults for detection of colorectal cancer. In adults, faecal haemoglobin has been recommended as a reliable tool to aid identification of those at low risk of significant bowel disease and has also been used in inflammatory bowel disease to assess mucosal healing. We aimed to evaluate the performance of faecal haemoglobin in the paediatric population and compare it with faecal calprotectin. Children being assessed in the paediatric gastroenterology clinic for bowel symptoms had a sample sent for both faecal calprotectin and faecal haemoglobin. Samples were collected over a 10-month period from November 2018 to September 2019. Faecal haemoglobin was measured using an OC-Sensor. Faecal calprotectin was measured using Liason®Calprotectin. One hundred forty three samples were returned for faecal haemoglobin and in 107 a paired faecal calprotectin was also available. Faecal haemoglobin correlated with faecal calprotectin, Spearman's rank coefficient 0.656 (P < 0.0001). There were 35 patients with faecal haemoglobin >20 μg/g and in 32 of these patients faecal calprotectin was >200 μg/g; 74 patients with faecal haemoglobin and 38 patients with faecal calprotectin underwent colonoscopy. Patients with normal histology had faecal haemoglobin <4 μg/g; faecal haemoglobin >20 µg/g was associated with signification inflammation. Our study is the first to compare faecal haemoglobin and faecal calprotectin in a paediatric population. Results suggest that faecal haemoglobin correlates with faecal calprotectin and, as in adults, may be useful to rule out significant bowel disease. A faecal haemoglobin >20 μg/g was consistent with significant histological inflammation.

Gallstone Frequency in Children With Celiac Disease.

IntroductionCeliac disease (CD) is a chronic autoimmune systemic disease caused by the T cell-driven immune mechanism, which is triggered by gluten in cereals such as wheat, barley, and rye in individuals who have a genetic predisposition. The purpose of the present study was to investigate the frequency of gallstones in children with CD.MethodsA total of 120 patients who were diagnosed with CD and who were followed-up by the pediatric gastroenterology clinic of the hospital and 100 healthy children were included in the study. The age, gender, hemogram, biochemistry, and abdominal ultrasonography images of the patients were compared. Cases that had gallstones were evaluated in terms of fasting serum lipids, glucose-6-P dehydrogenase, and pyruvate kinase, osmotic fragility, hemoglobin electrophoresis, and peripheral smears. Cases diagnosed with a hematological or metabolic disease were excluded from the study. Celiac serology was examined in terms of CD diagnosis in cases who had gallstones for the first time.ResultsThe median age of the patients with CD who were included in the study was eight years (5-12), and the median age of the control group was 10 years (6-13). A total of 48% of the Control Group was female, and 52% were male. No significant differences were detected between the age and gender distribution of the cases. There were no differences between hemogram and biochemical parameters. Gallstones were detected in six (5%) of CD-diagnosed cases, and in three (3%) of the cases in the control group. Two (2/160; 1.3%) of the patients who were referred to our clinic with the diagnosis of gallstones were diagnosed with CD.Conclusions: Early diagnosis and treatment of CD is important to avoid gallstone development because a gluten-free diet corrects enteropathy significantly in CD. CD must be considered in cases with gallstones.

Incidence of Depression and Anxiety in a Cohort of Adolescents With Nonalcoholic Fatty Liver Disease.

To determine the incidence of clinically diagnosed depression and anxiety in adolescents with nonalcoholic fatty liver disease (NAFLD). This was a prospective, longitudinal cohort study between January 1, 2012 and July 1, 2018 conducted in a Children's Hospital Pediatric Gastroenterology Clinic. Participants included adolescents 12 to 17 years old at baseline with biopsy-confirmed NAFLD. The primary outcomes were having depression and/or anxiety based upon a clinical diagnosis established by a physician or psychologist. The rates of depression and anxiety were measured at baseline and longitudinally throughout follow-up. A total of 160 adolescents with NAFLD were followed for a mean of 3.8 years. At baseline, 8.1% had a diagnosis of depression. During follow-up, an additional 9.5% (95% confidence interval, 4.7-14.3) developed depression. The incidence density of depression was 27 new cases per 1000 person-years at risk. In adolescents with NAFLD, 6.3% had anxiety at baseline and 6.7% (95% confidence interval, 2.6-10.7) developed anxiety during follow-up. The incidence density of anxiety was 18 new cases per 1000 person-years at risk. The change in alanine aminotransferase was significantly worse for adolescents with NAFLD who developed depression compared to those who did not develop depression (P < 0.01). Adolescents with NAFLD had a high incidence of clinically diagnosed depression and anxiety. The rates were higher than expected relative to the available data in the general population. Addressing this mental health burden will require efforts at both the patient level and the systems level.

The use of biofeedback for children with fecal incontinence secondary to retentive constipation: Experience of a French Pediatric Center

Fecal incontinence (FI) secondary to chronic retentive constipation is a frequent demand in pediatric gastroenterology clinics. The management of constipation in children includes laxatives (polyethylene glycol, PEG), enhanced toilet training, and dietary advice. Biofeedback is a possible treatment for children above the age of 7 years with resistant FI. To analyze any changes in volume to trigger defecation (VTD) and envy score over the course of biofeedback sessions according to clinical response. In this retrospective study, we reviewed the medical records of 23 children diagnosed with FI according to the Rome IV criteria and treated with biofeedback. For each biofeedback session, a mean VTD by subject was measured. At the end, therapy was considered a success if soiling disappeared and a failure if any persisted. The need to defecate expressed by the child was described as an envy score. A 0-10 visual analog scale was used to express the intensity of this sensation. Follow-up involved calling the parents 12 months after the biofeedback sessions had ended to assess symptoms remotely. The study included 19 boys and 4 girls with a median age of 10 years. Patients' ages ranged between 7 and 17 years. None of them had any associated neurological disorders. All children had FI for >1 year. The median number of soiling episodes per week was 7. The average number of biofeedback sessions was 3 (range 1-5). At the end of the rehabilitation sessions, 12 children (52%) were in the "success" group. In the latter, median VTD decreased from 97 ml to 70 ml between the first and last session. In the "failure" group, VTD decreased from 120 ml to 100 ml. The between-group difference in the median VTD at the first session was not statistically significant. The last observation carried forward (LOCF) VTD was significantly lower in the "success" group compared to the "failure" group (70 ml versus 100 ml, p = 0.03). Median envy scores decreased during the biofeedback sessions with no statistical difference between the groups at the last session. Follow-up of children in the "success" group one year after the last biofeedback session revealed that 10 patients had no relapse (83%) and 2 were lost to follow-up. Biofeedback might be an effective tool for the management of FI resistant to medical treatment in children.

Illness Stigma, Worry, Intrusiveness, and Depressive Symptoms in Youth With Inflammatory Bowel Disease.

Youth who experience IBD-associated stigma may manifest increased worry about aversive symptoms that can intrude on their participation in routine activities (eg, school, social events), potentially resulting in limited opportunities for reinforcement and increased depressive symptoms. The present study examined an IBD stigma → IBD worry → illness intrusiveness → depressive symptoms serial mediation model, in which stigma was hypothesized to confer an indirect effect on youth depressive symptoms through the serial effects of stigma on IBD worry and illness intrusiveness. Youth with IBD (N = 90) between the ages of 10 and 18 years were recruited from a pediatric gastroenterology clinic and completed measures of IBD stigma, IBD worry, illness intrusiveness, and depressive symptoms. In addition to several independent direct effects among the modeled variables, results revealed a significant IBD stigma → IBD worry → illness intrusiveness → depressive symptoms serial mediation path (effect = 0.63, 95% CI = 0.22 to 1.20), controlling for youth sex and IBD severity. The experience of IBD-related stigma may prompt increased worry about IBD symptoms, independent of the influence of disease activity. Further, heightened worry appears to amplify youths' experience of IBD-imposed limitations on routine and rewarding activities, increasing their risk for experiencing depressive symptoms. Our findings highlight the importance of regular screening for depressive symptoms, as well as the identification of potential risk factors associated with emotional adjustment difficulties. Stigma-specific treatment modules could be integrated within existing cognitive-behavioral approaches for reducing worry and depressive symptoms in youth with IBD.

Functional Abdominal Pain and Nutritional Status of Children. A School-Based Study.

Functional abdominal pain disorders (FAPD) are the most common chronic pain conditions in pediatric gastroenterology. They account for 50% of all pediatric gastroenterology clinic visits. The pathophysiology of FAPDs is poorly understood, but there is growing understanding of the role of food and the patient’s nutritional state in both their treatment and prognosis. Clinic-based studies have shown a higher prevalence of FAPDs, and worse prognosis among obese children with FAPDs. We aimed to assess the nutritional status of children with FAPD to determine if there is increased prevalence of FAPDs in obese or underweight patients. We conducted a cross sectional study of schoolchildren in Colombia. We enrolled 1030 patients from five schools and screened them for FAPDs using Rome IV criteria. Data on weight, height, abdominal circumference and BMI were collected for each child. Cases (FAPDs) were compared with a control group of enrolled children who did not meet diagnostic criteria for any functional gastrointestinal disorders (FGID). We diagnosed 58 (5.8%) children with FAPDs based on Rome IV criteria. When we compared to participants who were not diagnosed with FGIDs by screening, there was no statistically significant difference in children who were obese (OR 0.34 CI: 0.03–1.34, p = 0.124) or overweight (OR 1.00 CI: 0.46–2.02, p = 0.984) or those with increased abdominal circumference (OR 0.94, CI: 0.10–3.90, p = 0.943). FAPDs are not more common among obese children compared with healthy controls at a community level. Obese children may have been overrepresented in previous studies which were done at a clinical level due to comorbidities and a more severe phenotype that makes them more likely to consult. Nutritional status is not a useful predictor for the occurrence of FAPDs in children in the general population.

Evaluation of Gastrointestinal and Hepatological Problems in Obese Patients Evaluated in the Pediatric Gastroenterology Clinic with the Diagnosis of Hepatosteatosis

Evaluation of Gastrointestinal and Hepatological Problems in Obese Patients Evaluated in the Pediatric Gastroenterology Clinic with the Diagnosis of Hepatosteatosis

"My Body Hates Me": A Qualitative Analysis of the Experience of Functional Nausea in Adolescent Girls and Their Mothers.

Nausea is a somatic sensation typically associated with the need to vomit in order to remove a toxin from the body. When nausea occurs in the absence of a specific structural cause or toxin, it is classified as a functional gastrointestinal disorder (FGID). Functional nausea was newly recognized in 2016 as a FGID in children and little is known about its prevalence, course or patient experiences. Nausea co-occurring with functional abdominal pain in childhood has been associated with long-term risk for anxiety and ongoing somatic symptoms into young adulthood. However, few studies have focused uniquely on the experience and impact of nausea on youth. The present study aimed to qualitatively understand the experiences of adolescent girls with functional nausea and their parents. Five mother–daughter dyads were recruited from a specialized pediatric gastroenterology clinic focused on nausea and completed semi-structured interviews. Interviews were transcribed and coded using interpretive phenomenological analysis (IPA). Four main themes emerged: nausea interference, body frustration, misunderstanding of symptoms, and maternal helplessness and guilt. These themes were similar to prior studies on the experiences of youth with chronic pain but also indicated unique challenges due to nausea, such as significant food restriction and subsequent weight loss.

Association Between Duration of Constipation and Frequency of Urinary Tract Infection in Children

Background: Constipation and Urinary Tract Infection (UTI) are common problems in children. The gastrointestinal tract and the urinary system are related together anatomically and functionally. Constipation is one of the possible causes of UTI and its recurrence. Objectives: The purpose of this study was to evaluate the association between the duration of constipation and the frequency of upper and lower UTI in children in Sanandaj. Methods: A descriptive-analytical study was performed on children with chronic constipation aged less than 12 years, referring to the Pediatric Gastroenterology Clinic of Besat Hospital in Sanandaj in 2018-2019. Urine analysis and culture were performed for all the patients. Data were recorded in separate questionnaires. Results: There were 220 children in this study. Most cases of constipation and UTI belonged to the group of 3-6 years. Constipation was more common in boys and UTI in girls. Lower UTI was more common than upper UTI. Besides, 45% of the patients had constipation for less than a year. There was no significant relationship between the duration of constipation and the prevalence and type of UTI (upper or lower) (P = 0.405, P = 0.911). Conclusions: Urinary tract infection was common in children with chronic constipation. There was no relationship between the duration of constipation and the frequency and type of UTI.