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Seetharaman J, Poddar U, Srivastava A, Sarma MS, Yachha SK. Spectrum of Functional Abdominal Pain Disorders in Children and Their Clinical, Social Characteristics: A Cross-Sectional Study. JGH Open 2025; 9:e70162. [PMID: 40236936 PMCID: PMC11998175 DOI: 10.1002/jgh3.70162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 01/29/2025] [Accepted: 04/03/2025] [Indexed: 04/17/2025]
Abstract
Background/Aims Pediatric functional abdominal pain disorders (FAPDs) subtypes; functional dyspepsia (FD), irritable bowel syndrome (IBS), functional abdominal pain-not otherwise specified (FAP-NOS), and abdominal migraine (AM) are influenced by demographic and social factors. The study aimed to evaluate the spectrum and demographic and social factors associated with FAPD subtypes. Methods Consecutive children (< 18 years) diagnosed with FAPD subtypes according to ROME-IV criteria between April 2018 and March 2020 were included. The clinical, demographic, and social parameters were analyzed between various subtypes of FAPD, and factors responsible for severe symptoms were studied. Results A total of 479 children (mean age 12.34 ± 3.82 years, 60% boys) were included. FAP-NOS (63%) was the most commonly diagnosed subtype followed by IBS (17.4%) and FD (15%). The age at presentation, site of pain, duration of symptoms, and associated symptoms were significantly different among the three main subtypes (p < 0.001). Stressors could be identified in 39.3% and academic pressure (22.3%) was the most common. Family members with functional disorders (OR: 2.21, 95% CI: 1.31-3.42, p = 0.02), presence of stressors (OR: 2.03, 95% CI: 1.14-3.65, p = 0.016), and rural origin (OR: 1.75, 95% CI: 1.08-2.83, p = 0.023) predicted severe symptoms. Conclusions FAP-NOS is the most common FAPD subtype in children in India. Children with FAP-NOS are much younger than other subtypes of FAPD. The presence of stressors and functional disorders in family members could be associated with severe symptoms. However, it mandates more prospective studies to validate the findings.
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Affiliation(s)
- Jayendra Seetharaman
- Department of Pediatric GastroenterologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
| | - Ujjal Poddar
- Department of Pediatric GastroenterologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
| | - Anshu Srivastava
- Department of Pediatric GastroenterologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
| | - Moinak Sen Sarma
- Department of Pediatric GastroenterologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
| | - Surender Kumar Yachha
- Department of Pediatric GastroenterologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
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Frazier R, Ghoshal UC, Remes-Troche J, Robin D, Shun E, Aravind T. Exploring cyclic vomiting syndrome (CVS) worldwide: Current epidemiological insights and recent developments. Neurogastroenterol Motil 2025; 37:e14932. [PMID: 39370604 DOI: 10.1111/nmo.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/22/2024] [Accepted: 09/15/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS), a disorder of gut-brain interaction, presents with recurrent episodes of severe nausea and vomiting. It is often associated with missed or delayed diagnoses and substantial healthcare utilization. Despite historical recognition dating back to the 19th century, epidemiological insights remain limited, with research predominantly originating from specific regions, such as the US. CVS prevalence and incidence rates vary widely and are hindered by inconsistent methodologies and disease recognition. PURPOSE This review aims to provide a comprehensive overview of CVS prevalence and incidence rates. It reviews the currently available data and identifies gaps in knowledge. Understanding the global epidemiology of CVS, increasing awareness of the disease, and fostering global collaboration are crucial. Other pertinent issues include disparities in outcomes, particularly among African Americans and Hispanics in the United States, underscoring the need to understand the social determinants of health that drive disease outcomes. This understanding can inform targeted interventions to address these barriers and achieve equitable healthcare both in the United States and globally.
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Affiliation(s)
- Rosita Frazier
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jose Remes-Troche
- Digestive Physiology and Motility Lab, Veracruzana University, Xalapa, Mexico
| | - Dover Robin
- Cyclical Vomiting Syndrome Association, Letchworth, UK
| | - Emoto Shun
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Thavamani Aravind
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
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Vermeijden NK, de Silva L, Manathunga S, Spoolder D, Korterink J, Vlieger A, Rajindrajith S, Benninga M. Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis. Pediatrics 2025; 155:e2024067677. [PMID: 39761807 DOI: 10.1542/peds.2024-067677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 11/01/2024] [Indexed: 01/11/2025] Open
Abstract
CONTEXT Functional abdominal pain disorders (FAPDs) are debilitating disorders with unknown current prevalence. OBJECTIVE To estimate global prevalence rates of FAPDs, their entities, and variations by diagnostic criteria, geography, gender, and age. DATA SOURCES Medline, Embase, CINAHL, PsycInfo, and Cochrane Library were searched through October 14, 2024. STUDY SELECTION Epidemiological studies of birth cohorts, school based, and from general population samples reporting FAPD prevalence in children (aged 4-18 years) using the Rome criteria. DATA EXTRACTION Two researchers independently performed screening, data extraction, and quality assessment. RESULTS A total of 66 studies, encompassing 201 134 participants from 29 countries, were included. The estimated global pooled prevalence of FAPDs was 11.7% (95% CI, 10.5%-13.1%). The most prevalent type was irritable bowel syndrome (5.8%; 95% CI, 4.5-7.4%), while functional abdominal pain-not otherwise specified was least prevalent (1.2%; 95% CI, 0.7%-2.1%)). Prevalence was highest using Rome III (13.2%; 95% CI, 11.3%-15.3%) and lowest under Rome IV criteria (9.0%; 95% CI, 6.7%-12.0%; P = .05). Girls had higher prevalence (14.4%; 95% CI, 12.5%-16.6%) than boys (9.4%; 95% CI, 7.8%-11.4%; P < .01). FAPDs were nonsignificantly more prevalent in Asia (13.0%; 95% CI, 10.4%-16.3%) compared to Europe (8.3%; 95% CI, 6.4%-10.7%) and North America (7.7%; 95% CI, 4.3-13.6; P = .09). No differences by age (P = .14) were recorded. Contributing factors include anxiety, depression, stress, negative life events, and poor sleep. LIMITATIONS Language restrictions, significant interstudy heterogeneity, and underrepresentation from Africa. CONCLUSIONS AND RELEVANCE FAPDs affect over 1 in 9 children worldwide, with higher prevalence in girls and those with psychological stressors.
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Affiliation(s)
- Nicolaas Koen Vermeijden
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Center, Academic Medical Centre/Emma Children's Hospital, Amsterdam, the Netherlands
- Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Daphne Spoolder
- Knowledge and Information Centre, St Antonius Academy, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Judith Korterink
- Department of Pediatrics, Gelre Hospital, Zutphen, the Netherlands
| | - Arine Vlieger
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Marc Benninga
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Chambers CT, Dol J, Tutelman PR, Langley CL, Parker JA, Cormier BT, Macfarlane GJ, Jones GT, Chapman D, Proudfoot N, Grant A, Marianayagam J. The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis. Pain 2024; 165:2215-2234. [PMID: 38743558 PMCID: PMC11404345 DOI: 10.1097/j.pain.0000000000003267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 05/16/2024]
Abstract
ABSTRACT Chronic pain, defined as persistent or recurring pain or pain lasting longer than 3 months, is a common childhood problem. The objective of this study was to conduct an updated systematic review and meta-analysis on the prevalence of chronic pain (ie, overall, headache, abdominal pain, back pain, musculoskeletal pain, multisite/general pain, and other) in children and adolescents. EMBASE, PubMed, CINAHL, and PsycINFO were searched for publications between January 1, 2009, and June 30, 2023. Studies reporting population-based estimates of chronic nondisease related pain prevalence in children or adolescents (age ≤ 19 years) were included. Two independent reviewers screened articles based on a priori protocol. One hundred nineteen studies with a total of 1,043,878 children (52.0% female, mean age 13.4 years [SD 2.4]) were included. Seventy different countries were represented, with the highest number of data points of prevalence estimates coming from Finland and Germany (n = 19 each, 4.3%). The overall prevalence of chronic pain in children and adolescents was 20.8%, with the highest prevalence for headache and musculoskeletal pain (25.7%). Overall, and for all types of pain except for back pain and musculoskeletal pain, there were significant differences in the prevalence between boys and girls, with girls having a higher prevalence of pain. There was high heterogeneity (I 2 99.9%). Overall risk of bias was low to moderate. In summary, approximately 1 in 5 children and adolescents experience chronic pain and prevalence varies by pain type; for most types, there is higher pain prevalence among girls than among boys. Findings echo and expand upon the systematic review conducted in 2011.
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Affiliation(s)
- Christine T. Chambers
- Centre for Pediatric Pain Research, IWK Health, Halifax, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Justine Dol
- Centre for Pediatric Pain Research, IWK Health, Halifax, Canada
| | - Perri R. Tutelman
- Centre for Pediatric Pain Research, IWK Health, Halifax, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | | | | | | | - Gary J. Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - Gareth T. Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | | | | | - Amy Grant
- Maritime SPOR Support Unit, Halifax, Canada
| | - Justina Marianayagam
- Patient Partner and Resident Physician, Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Di Lorenzo C. Faecal incontinence: Retentive, non-retentive and when to suspect organic pathology. Aliment Pharmacol Ther 2024; 60 Suppl 1:S54-S65. [PMID: 38924573 DOI: 10.1111/apt.17832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 06/28/2024]
Abstract
BACKGROUND Faecal incontinence is a highly prevalent and very distressing condition that occurs throughout the entire paediatric age. AIM To summarise advances in the understanding of the epidemiology, pathophysiology, evaluation and treatment of children with faecal incontinence due to either disorders of gut-brain interaction or organic diseases. METHODS Literature review on prevalence, impact, diagnosis and treatment options for children with faecal incontinence, interspersed with observations from the author's lifelong career focused on evaluation of children with motility disorders. RESULTS Faecal incontinence in children is most commonly due to unrecognised or insufficiently treated functional constipation with overflow incontinence. Non-retentive faecal incontinence (NRFI) is probably more common than previously thought and is particularly challenging to treat. Organic diseases such as anorectal malformations (ARMs), Hirschsprung disease and spinal defects are often associated with faecal incontinence; in these conditions, faecal incontinence has a profound impact on quality of life. Recognition of the different pathophysiologic mechanisms causing the incontinence is essential for a successful treatment plan. A thorough physical examination and history is all that is needed in the diagnosis of the causes of faecal incontinence related to disorders of gut-brain interaction. Colonic transit studies or x-rays may help to differentiate retentive from NRFI. Manometry tests are helpful in determining the mechanisms underlying the incontinence in children operated on for ARMs or Hirschsprung diseases. Multiple behavioural, medical and surgical interventions are available to lessen the severity of faecal incontinence and its impact on the daily life of affected individuals. CONCLUSIONS Recent advances offer hope for children with faecal incontinence.
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Affiliation(s)
- Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Haworth JJ, Treadway S, Hobson AR. The prevalence of rumination syndrome and rumination disorder: A systematic review and meta-analysis. Neurogastroenterol Motil 2024; 36:e14793. [PMID: 38563201 DOI: 10.1111/nmo.14793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Rumination is characterized by the repeated regurgitation of food. Rumination syndrome is a disorder of gut-brain interaction diagnosed by Rome criteria, whereas rumination disorder is a feeding and eating disorder diagnosed by DSM-5 criteria. We aimed to determine the global prevalence of rumination according to these criteria across all age groups. METHODS We performed a systematic review and meta-analysis of studies reporting the prevalence of rumination syndrome according to Rome III and Rome IV and rumination disorder according to the following validated DSM-5 assessments: PARDI, EDA-5, EDY-Q, STEP, and STEP-CHILD. We searched MEDLINE, EMBASE, and PsychINFO (from January 1, 2006, to June 1, 2023) to identify studies reporting the prevalence of rumination in community settings in participants of any age. We did a meta-analysis to estimate the pooled prevalence and odds ratio (OR) of rumination according to diagnostic criteria, country, and characteristics such as age and sex. KEY RESULTS The search strategy generated 1243 studies, of which 147 studies appeared to be relevant. Thirty studies were included, with a total of 114,228 participants, of whom 61,534 of these were adults and 52,694 were children. The pooled prevalence of rumination syndrome in children of all ages according to Rome III criteria was 1.0% (95% CI 0.3-1.6; I2 91.1%), but no data were available for adults. According to Rome IV criteria, the pooled prevalence of rumination syndrome in children of all ages was 0.4% (95% CI 0.2-0.6; I2 56.4%) and 3.7% in adults (95% CI 2.3-5.1; I2 91.4%). The pooled prevalence of rumination disorder in children of all ages according to EDY-Q was 2.1% (95% CI 0.9-3.4; I2 = 78.1%), but only one study utilizing EDY-Q in adults was included (0.7% [95% CI 0.4-1.0]). No data were available for children or adults using any other validated DSM-5 assessments for rumination disorder. Irrespective of diagnostic criteria, the pooled prevalence of rumination was higher in adults compared to children and adolescents (3.0% [95% CI 1.4-4.7; I2 = 98.1%] vs. 0.8% [95% CI 0.4-1.3; I2 = 90.8%]), but higher in adolescents than in children (1.1% [95% CI 0.3-2.0; I2 = 92.8%] vs. 0.1% [95% CI 0.0-0.2; I2 = 24.5%]). In adults, factors independently associated with rumination were female gender (OR 1.4 [95% CI 1.0-2.0]), anxiety (OR 2.3 [95% CI 2.1-2.6]), and depression (OR 1.8 [95% CI 1.2-2.9]). No association between gender and rumination was seen in children. CONCLUSIONS AND INFERENCES The prevalence of rumination is more common in adults than in children. In adults, rumination is associated with female gender, anxiety, and depression. Future population studies should aim to better understand why this behavior is more common in adults and also compare validated DSM-5 assessments for rumination disorder with Rome criteria for rumination syndrome as prevalence may differ.
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Affiliation(s)
- Jordan J Haworth
- Newcastle University, Newcastle, United Kingdom
- Functional Gut Clinic, Manchester, United Kingdom
| | - Sam Treadway
- Functional Gut Clinic, Manchester, United Kingdom
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Djurijanto F, Lin SH, Vo NP, Le NQK, Nguyen-Hoang A, Shen SC, Wu CH, Chen JY, Nguyen NTK. Prevalence and determinants of constipation in children in Asia: a systematic review and meta-analysis. EClinicalMedicine 2024; 71:102578. [PMID: 38606167 PMCID: PMC11007433 DOI: 10.1016/j.eclinm.2024.102578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Background Constipation is prevalent worldwide, significantly increasing healthcare costs and diminishing the quality of life in children affected. Current studies have yielded mixed results regarding the factors associated with constipation, and mainly focusing on patients outside of Asia. Moreover, most of these studies lack focus on the paediatric population. This study aimed to identify the prevalence and associated factors of constipation among children in Asia. Methods In this systematic review and meta-analysis, we systematically searched PubMed, Scopus, and Cochrane for cohort and cross-sectional studies published from database inception up to October 12, 2022, and continued with manual searching until September 2, 2023. Eligible studies were those that included children in Asia aged 0-18 years old suffering from idiopathic constipation, with prevalence value provided in the English abstract. The analysis included clinical and general population. Children with organic constipation, who had undergone gastrointestinal surgery, or with congenital defects were excluded, as these factors affect the incidence of constipation. Data included in the analysis were extracted from published reports only. The extracted data were pooled using random-effects model to analyse the prevalence of constipation in children in Asia. This study is registered with PROSPERO, CRD42022367122. Findings Out of 4410 systematically searched studies and 36 manually searched ones, a total of 50 studies were included in the final analysis, encompassing data from 311,660 children residing in Asia. The pooled prevalence of constipation was 12.0% (95% CI 9.3-14.6%, I2 = 99.8%). There was no significant difference in constipation prevalence observed by sex and geographical location. Nonetheless, adolescents and children aged 1-9 years exhibited a significantly higher prevalence constipation compared to infants (p < 0.0001) Additionally, significant differences in constipation rates were observed across various diagnostic methods, population sources, and mental health conditions. Interpretation Despite the high heterogeneity resulting from varying diagnostic tools or definitions used among studies, our review adds to the literature on constipation among children in Asia. It reveals a notably high prevalence of constipation in this demographic. Diagnostic methods, age, and compromised mental health emerged as significant influencers of constipation among children in Asia, highlighting potential strategies to mitigate constipation prevalence in children in Asia. Funding The National Science and Technology Council, Taiwan.
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Affiliation(s)
- Felicia Djurijanto
- Programs of Nutrition Science, National Taiwan Normal University, Taipei, 106, Taiwan
| | - Shyh-Hsiang Lin
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, 110, Taiwan
- School of Food Safety, Taipei Medical University, Taipei, 110, Taiwan
| | - Nguyen-Phong Vo
- Department of Hepatobiliary and Pancreatic Surgery, Cho Ray Hospital, Vietnam
| | - Nguyen Quoc Khanh Le
- Research Centre for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, 110, Taiwan
- Translational Imaging Research Centre, Taipei Medical University, Taipei, 110, Taiwan
| | - Anh Nguyen-Hoang
- Faculty of Health Sciences and Sport, University of Stirling, Scotland, UK
| | - Szu-Chuan Shen
- Programs of Nutrition Science, National Taiwan Normal University, Taipei, 106, Taiwan
| | - Chung-Hsin Wu
- School of Life Science, National Taiwan Normal University, Taipei, 106, Taiwan
| | - Jian-Yu Chen
- Programs of Nutrition Science, National Taiwan Normal University, Taipei, 106, Taiwan
| | - Ngan Thi Kim Nguyen
- Programs of Nutrition Science, National Taiwan Normal University, Taipei, 106, Taiwan
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El Mouzan M, Kambal M, Alabdulkarim H, Alshammari NR, Alanazi R, Al Sarkhy A, Alhamid N, Assiri AM, Alzahrani A, Shaik SA, Alasmi M. Clinical profile of functional constipation in Saudi children. Ann Saudi Med 2024; 44:111-115. [PMID: 38615181 PMCID: PMC11016151 DOI: 10.5144/0256-4947.2024.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/01/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Functional constipation (FC) is a common condition in children, and information on the clinical characteristics of FC in Saudi children is scarce. OBJECTIVE Describe the clinical profile of FC in Saudi children. DESIGN Retrospective. SETTING Hospital that provides primary, intermediate and tertiary care. PATIENTS AND METHODS All children diagnosed with FC according to the Rome IV criteria were included and had at least one follow-up clinic visit. Demographic and clinical data collected from medical records included the age at onset, duration of constipation, clinical features, treatment modalities, and factors associated with clinical response. Descriptive statistics and Pearson's chi-squared test were used in the statistical analysis to see how categorical study variables were linked to clinical response. A P value of ≤.05 was used to report statistical significance. MAIN OUTCOME MEASURE Compliance and clinical response to polyethylene glycol (PEG) compared with lactulose. SAMPLE SIZE 370 children from 0.1 to 13 years of age. RESULTS The median (IQR) age of onset was 4 (5) years and less than one year in 14%. The median (IQR) duration of constipation was 4 months (11) and less than two months in 93/370 (25%). Abdominal pain was the most commonly associated feature (44%). Screening for celiac disease and hypothyroidism was negative. A Fleet enema was the most common disimpaction method (54%) and PEG was the most common maintenance medication (63.4%). PEG was significantly better tolerated (P=.0008) and more effective than lactulose (P<.0001). Compliance was the only variable significantly associated with clinical response. CONCLUSIONS PEG was better tolerated and more effective than lactulose in our study, a finding in agreement with the literature. Therefore, PEG should be the drug of choice in the initial management of FC in Saudi children. Prospective studies on the causes of noncompliance are needed to improve the response to treatment. LIMITATIONS The limitations of retrospective design are missing data, recall bias, and hospital-based limitation, such as missing milder cases treated at the outpatient level. However, the sample size of 370 may have minimized these limitations.
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Affiliation(s)
- Mohammad El Mouzan
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Kambal
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Hayfa Alabdulkarim
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | | | - Rehab Alanazi
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Al Sarkhy
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Alhamid
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | | | - Alhanouf Alzahrani
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Shaffi Ahamed Shaik
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Mona Alasmi
- From the Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
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Sundas A, Sampath H, Lamtha SC, Soohinda G, Dutta S. Psychosocial quality-of-life correlates in functional gastrointestinal disorders. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:11-18. [PMID: 35810093 DOI: 10.1016/j.rgmxen.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/22/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND AIM Functional gastrointestinal disorders (FGIDs) are complex illnesses characterized by gastrointestinal symptoms, with no underlying organic pathology. They are common, chronic, recurrent, and disabling disorders that significantly impair quality of life (QoL). The aim of the present cross-sectional analytical study was to assess QoL and its correlates in adult patients with FGIDs. MATERIALS AND METHODS A cross-sectional, observational, hospital-based study was conducted at the gastroenterology outpatient department of a tertiary care teaching hospital. The ROME IV diagnostic criteria were used to identify the FGIDs. Anxiety, depression, coping strategies, social support, and QoL were assessed by the hospital anxiety and depression scale, the coping strategies inventory, the multidimensional scale of perceived social support, and the functional digestive disorders quality-of-life questionnaire, respectively. RESULTS Of the 52 consecutive patients diagnosed with FGIDs, functional dyspepsia (51.92%) and irritable bowel syndrome (40.38%) were the most common. There were no significant associations between sociodemographic variables (age, sex, marital status, socioeconomic status, educational level, employment, occupation, dietary pattern) and QoL scores (all p values >0.05). Duration and social support were not significantly associated with QoL (all p values >0.05). In contrast, psychological variables, such as disengagement coping (r=-0.344, p=0.012), depression (r=-0.600, p=0.000), and anxiety (r=-0.590, p=0.000), were significantly correlated with QoL. CONCLUSIONS Despite advances in neurogastroenterology, patients continue to be disabled by FGIDs. Psychological factors, especially depression, significantly contribute to poor QoL in those patients and should be addressed in a holistic, multidisciplinary way. The biopsychosocial framework, as it applies to FGIDs, should lead to the inclusion of psychosocial assessments in the clinical management and research of those disorders.
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Affiliation(s)
- A Sundas
- Instituto Central de Psiquiatría, Ranchi, India
| | - H Sampath
- Departamento de Psiquiatría, Hospital Central de Referencias, Instituto de Ciencias Médicas de Sikkim Manipal, Universidad de Sikkim Manipal, Gangtok, Sikkim, India.
| | - S C Lamtha
- Departamento de Gastroenterología, Nuevo Hospital de Gobierno STNM, Gangtok, Sikkim, India
| | - G Soohinda
- Departamento de Psiquiatría, Hospital Central de Referencias, Instituto de Ciencias Médicas de Sikkim Manipal, Universidad de Sikkim Manipal, Gangtok, Sikkim, India
| | - S Dutta
- Departamento de Psiquiatría, Hospital Central de Referencias, Instituto de Ciencias Médicas de Sikkim Manipal, Universidad de Sikkim Manipal, Gangtok, Sikkim, India
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Zhou Q, Tang Y, Yuan L, Xu L, Yu L, Yu Z, Zhang Q. Establishment of a nomogram for predicting functional constipation among children in China: Using the Rome IV criteria. Arab J Gastroenterol 2023; 24:204-210. [PMID: 37532661 DOI: 10.1016/j.ajg.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND STUDY AIMS Childhood functional constipation (FC) is gradually becoming an emerging public health problem. This study aimed to develop a personalized nomogram for the prediction of incident FC among Chinese children, and the diagnosis of FC was based on the Rome IV criteria. PATIENTS AND METHODS This cross-sectional study was conducted from Nov. 2020 to Jan. 2021 among children residing in Anhui province, China. An electronic questionnaire regarding the general demographic and clinical characteristics of all children was completed by their primary caregivers. The multivariate logistic regression analysis was applied to identify risk factors for FC. Moreover, a nomogram was constructed for FC based on the risk factors identified from the multivariate analysis. RESULTS In this study, a total of 901 electronic questionnaires were collected, of which 832 (92.3%) questionnaires were properly completed and included in the final analysis. The prevalence of FC among Chinese children was 11.3% based on the Rome IV criteria. After controlling for potential confounding factors, the multivariate logistic regression analysis showed that inadequate sleep, picky eating, and positive family history of FC were identified as key risk factors of FC. The area under the receiver operating characteristic curve of the nomogram was 0.694 (95 %CI: 0.6412-0.7459). Further, a calibration curve drawn illustrated that the predicted probabilities reasonably approximately the actual prevalence of FC in this population. CONCLUSION Inadequate sleep, picky eating, and positive family history of FC were identified as risk factors of FC. An easy-to-use nomogram was constructed based on these three significant factors. Besides, this nomogram was validated to have acceptable discrimination and calibration capabilities. Hence, this nomogram may enable clinical professionals to predict the risk of FC among Chinese children and further provide optimized disease prevention and intervention for this population.
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Affiliation(s)
- Qilian Zhou
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Yuxia Tang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Liping Yuan
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Lingling Xu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Lijuan Yu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Zhuchun Yu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Qianqian Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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Efficacy of Oral Psyllium in Pediatric Irritable Bowel Syndrome: A Double-Blind Randomized Control Trial. J Pediatr Gastroenterol Nutr 2023; 76:14-19. [PMID: 36136861 DOI: 10.1097/mpg.0000000000003622] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Pediatric irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with variable response to various therapeutic agents. Psyllium has been proven to be effective in adults; however, there is no study in children. The objective of this study is to evaluate the efficacy of psyllium husk as compared to placebo in pediatric IBS patients. METHODS In this double-blind randomized controlled trial, 43 children were assigned to psyllium arm (Group A) and 38 into placebo arm (Group B). Severity is assessed at baseline and after 4 weeks of treatment using IBS severity scoring scale (IBS-SSS) and classified into mild, moderate, and severe categories. Categorical data was compared with chi-square test and paired categorical variable was compared with McNemer test. RESULTS Mean ages (±SD; in years) of Groups A and B were 9.87 (2.7) and 9.82 (3.17), respectively, with median duration of illness of 12 months. At baseline, type, severity, and parameters (IBS-SSS) of IBS were equally distributed in 2 groups. There was a significant reduction in median interquartile range (IQR) of total IBS-SSS in psyllium versus placebo [75 (42.5-140) vs 225 (185-270); P < 0.001] at 4 weeks. Similarly 43.9% in Group A versus 9.7% in Group B attained remission [IBS-SSS < 75 ( P < 0.0001)]. The mean difference in IBS-SSS between Group A and Group B was -122.85 with risk ratio of 0.64 (95% CI; 0.42-0.83; P = 0.001) and absolute risk reduction of 32% (NNT = 3). CONCLUSIONS Psyllium husk is effective for the therapy of pediatric IBS when compared with placebo in short term.
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12
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Malik ZI, Umer MF, Ali KN, Kawish AB, Arshed M, Zofeen S, Farid A. Functional Gastrointestinal Diseases and Dietary Practices among Pakistani Children-A Schools Based Cross-Sectional Study. Diseases 2022; 10:103. [PMID: 36412597 PMCID: PMC9680336 DOI: 10.3390/diseases10040103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Functional gastrointestinal diseases (FGIDs) are an important yet highly under explored area among public health issues. FGIDs' complex etiology makes them of interest along with their prevalence in children steadily increasing, especially in the developing world. We aimed to determine the burden FGIDs pose on school-going children, and to determine its association with the dietary intake patterns in Pakistani children. METHODOLOGY The study included 385 school-children from public and private schools in Pakistan through multistage random sampling, from March to August 2022. We used the Food Frequency Questionnaire (FFQ) and Rome IV Criteria for a comprehensive exploration of the issue. Associations between the FGIDs and dietary factors were analyzed using chi-square and Fischer's exact tests in SPSS version 26.0. RESULTS Females constituted 77.4% (n = 298) of all respondents, while 44.9% (n = 173) of the total reported a family history of gastrointestinal diseases. FFQ analysis showed varying consumption frequencies for different food groups. Functional abdominal pain and irritable bowel syndrome (IBS) were the highest reported FGIDs with a prevalence of 38.7% (n = 149) and 24.9% (n = 96), respectively. Statistical associations were found between different FGIDs and gender, age, household income, family members, and dietary variables such as fruit, vegetable, beverage and pulse consumption. CONCLUSION FGIDs were found to be associated with a number of socio-demographic and dietary factors which calls for small scale and large scale attention to the issue. Results from the current study and further studies may help develop guidelines to manage these disorders in Pakistan.
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Affiliation(s)
| | | | | | | | - Muhammad Arshed
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
| | - Shumaila Zofeen
- School of Public Health, Xi’an Jiaotong University, Xi’an 710049, China
| | - Awais Farid
- Division of Environment and Sustainability, Hong Kong University of Technology, Hong Kong, China
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13
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Rajindrajith S, Gunawardane D, Kuruppu C, Dharmaratne SD, Gunawardena NK, Devanarayana NM. Epidemiology of aerophagia in children and adolescents: A systematic review and meta-analysis. PLoS One 2022; 17:e0271494. [PMID: 35905055 PMCID: PMC9337652 DOI: 10.1371/journal.pone.0271494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Aerophagia is a common functional gastrointestinal disorder among children. The disease leads to symptoms related to air in the intestine leading to burping, abdominal distension, and excessive flatus. We aimed to perform a systematic review and a meta-analysis to assess the epidemiology of aerophagia in children. METHODS We conducted a thorough electronic databases (MEDLINE, EMBASE, PsycINFO and Web of Science) search for all epidemiological surveys conducted in children on aerophagia. All selected studies were assessed for their scientific quality and the extracted data were pooled to create a pooled prevalence of aerophagia. RESULTS The initial search identified 76 titles. After screening and in depth reviewing, 19 studies representing data from 21 countries with 40129 children and adolescents were included in the meta-analysis. All studies have used standard Rome definitions to diagnose aerophagia. The pooled prevalence of aerophagia was 3.66% (95% Confidence interval 2.44-5.12). There was significant heterogeneity between studies [I2 98.06% with 95% Confidence interval 97.70-98.37). There was no gender difference in prevalence of aerophagia in children. The pooled prevalence of aerophagia was highest in Asia (5.13%) compared to other geographical regions. CONCLUSION In this systematic review and meta-analysis, we found aerophagia has a significant prevalence across the world.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- The Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | - Damitha Gunawardane
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chandrani Kuruppu
- Medical Library, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Samath D. Dharmaratne
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nipul K. Gunawardena
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Alshehri DB, Sindi HH, AlMusalami IM, Rozi IH, Shagrani M, Kamal NM, Alahmadi NS, Alfuraikh SS, Vandenplas Y. Saudi Experts Consensus on Diagnosis and Management of Pediatric Functional Constipation. Pediatr Gastroenterol Hepatol Nutr 2022; 25:163-179. [PMID: 35611377 PMCID: PMC9110844 DOI: 10.5223/pghn.2022.25.3.163] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/02/2022] [Accepted: 03/07/2022] [Indexed: 11/14/2022] Open
Abstract
Although functional gastrointestinal disorders (FGIDs) are very common in pediatric patients, there is a scarcity of published epidemiologic data, characteristics, and management patterns from Saudi Arabia, which is the 2nd largest Arabic country in terms of area and the 6th largest Arabic country in terms of population, with 10% of its population aged <5 years. Functional constipation (FC) is an FGID that has shown a rising prevalence among Saudi infants and children in the last few years, which urges us to update our clinical practices. Nine pediatric consultants attended two advisory board meetings to discuss and address current challenges, provide solutions, and reach a Saudi national consensus for the management of pediatric constipation. The pediatric consultants agreed that pediatricians should pay attention to any alarming signs (red flags) found during history taking or physical examinations. They also agreed that the Rome IV criteria are the gold standard for the diagnosis of pediatric FC. Different therapeutic options are available for pediatric patients with FC. Dietary treatment is recommended for infants with constipation for up to six months of age. When non-pharmacological interventions fail to improve FC symptoms, pharmacological treatment with laxatives is indicated. First, the treatment is aimed at disimpaction to remove fecal masses. This is achieved by administering a high dose of oral polyethylene glycol (PEG) or lactulose for a few days. Subsequently, maintenance therapy with PEG should be initiated to prevent the re-accumulation of feces. In addition to PEG, several other options may be used, such as Mg-rich formulas or stimulant laxatives. However, rectal enemas and suppositories are usually reserved for cases that require acute pain relief. In contrast, infant formulas that contain prebiotics or probiotics have not been shown to be effective in infant constipation, while the use of partially hydrolyzed formula is inconclusive. These clinical practice recommendations are intended to be adopted by pediatricians and primary care physicians across Saudi Arabia.
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Affiliation(s)
- Dhafer B. Alshehri
- Department of Pediatrics, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | | | | | | | - Mohamed Shagrani
- King Faisal Specialist Hospital and Research Centre, Pediatric Gastroenterology, Riyadh, Saudi Arabia
| | - Naglaa M. Kamal
- Pediatric Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
- Pediatric Hepatology, Gastroenterology and Nutrition, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Najat Saeid Alahmadi
- Pediatric Department, King Salman Medical City, Ministry of Health, Almadinah Almonawarah, Saudi Arabia
| | - Samia Saud Alfuraikh
- King Abdul Aziz Hospital, Ministry of National Guard Health Affairs, Eastern Region, Saudi Arabia
| | - Yvan Vandenplas
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle, Brussels, Belgium
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Seetharaman J, Poddar U, Yachha SK, Srivastava A, Sen Sarma M. Efficacy of amitriptyline in pediatric functional abdominal pain disorders: A randomized placebo-controlled trial. J Gastroenterol Hepatol 2022; 37:685-691. [PMID: 34935191 DOI: 10.1111/jgh.15765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/22/2021] [Accepted: 12/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Amitriptyline improves symptoms in functional abdominal pain disorders (FAPD) in adults with variable results in pediatric studies. The study aims to evaluate the efficacy of amitriptyline in pediatric FAPD. METHODS In this open-label trial, children (≤ 18 years) diagnosed as FAPD based on ROME IV criteria were randomized to amitriptyline or placebo for 12 weeks. Post-treatment improvement of pain and quality of life (QOL) from the baseline were compared between the two groups. RESULTS The mean age of 149 children (amitriptyline 75, placebo 74) was 11.3 ± 3.5 years (79 boys). There was a significant difference in pain improvement in terms of reduction in scores for intensity (3.4 vs 0.9), frequency (3.6 vs 0.6), duration (3.5 vs 0.9), and QOL (2.3 vs 0.9) between amitriptyline and placebo group (P < 0.001 in all). Responders (> 50% reduction) in pain was seen in 76% in amitriptyline compared with 14.9% in the placebo group (P < 0.001). On multivariate analysis, the use of amitriptyline was the only factor predictive of response (odds ratio 24.1, 95% confidence interval: 9.1-64.6, P < 0.001). Minor adverse events were comparable between the groups (25.3% vs 13.5%, respectively, P = 0.07). Eighty-nine percent of children (24/27) who had extended treatment duration (6.8 ± 1.8 months) had pain improvement. After discontinuation of amitriptyline, 70% had sustained response over a mean follow up of 15.84 ± 5.6 months. CONCLUSIONS A 3-month trial of amitriptyline gives sustained relief of pain in two-thirds of children with FAPD. The safety profile of the drug and its efficacy necessitate more frequent use in the clinical settings.
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Affiliation(s)
- Jayendra Seetharaman
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Aerophagia Study in Indonesia: Prevalence and Association With Family-related Stress. J Clin Gastroenterol 2021; 55:772-777. [PMID: 33009193 DOI: 10.1097/mcg.0000000000001434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/31/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND Aerophagia is a functional gastrointestinal disorder characterized by repeated air swallowing leading to chronic abdominal distension. Symptoms can be long lasting, lead to frustration, and distress. This study describes prevalence, related factors, and symptomatology of aerophagia, together with its relationship with emotional stress. MATERIALS AND METHODS Cross-sectional study. Adolescents aged 10 to 17 years from selected state schools by convenient sampling from Jakarta, Indonesia, were recruited. Rome III self-administered questionnaire was used to compile data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal and extraintestinal symptoms, and stressful life events were collected using a separate questionnaire. RESULTS A total of 1796 questionnaires were included in the analysis [males 732 (40.8%), mean age 13.58 (SD 0.992) years]. There were 81 (4.5%) subjects diagnosed with aerophagia. When the criterion of belching was removed from the diagnosis of aerophagia, the prevalence drops to only 2 (0.1%). subjects. Bivariate analysis showed that sociodemographic factors have no correlation with aerophagia. In subjects with aerophagia, among the intestinal-related and extraintestinal symptoms, only loss of appetite was significantly more common in the aerophagia population (33.3%) when compared with controls (22.8%). Death of a close family member [adjusted odds ratio (OR), 2.78; 95% confidence interval (CI), 1.46-5.31; P=0.002], divorce or separation of parents (adjusted OR, 2.54; 95% CI, 1.38-4.66; P=0.003), and divorce followed by separate individual remarriage of parents (adjusted OR, 2.01; 95% CI, 1.01-3.98; P=0.046) were found to be significantly associated with aerophagia by multivariate analysis. CONCLUSIONS The prevalence of aerophagia was found in 4.5% of Indonesian school-aged children according to Rome III criteria, but the prevalence was found only 0.1% if the belching is removed from the criteria. Besides the main symptoms, only loss of appetite was significantly more common in aerophagia among intestinal-related and extraintestinal symptoms. Family-related stress showed a significant correlation with aerophagia.
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17
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Martinez M, Rathod S, Friesen HJ, Rosen JM, Friesen CA, Schurman JV. Rumination Syndrome in Children and Adolescents: A Mini Review. Front Pediatr 2021; 9:709326. [PMID: 34490165 PMCID: PMC8416921 DOI: 10.3389/fped.2021.709326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Rumination syndrome involves recurrent regurgitation of food and is believed to be underdiagnosed with patients experiencing long delays in diagnosis. It can be associated with significant social consequences, high rates of school absenteeism, and medical complications such as weight loss. The primary aims of the current review are to assess the literature regarding prevalence, pathophysiology, and treatment outcomes with a focus on neurotypical children and adolescents. Results: Population studies in children/adolescents, 5 years of age or older, range from 0 to 5.1%. There are fewer studies in clinical settings, but the prevalence appears to be higher in patients with other gastrointestinal symptoms, particularly chronic vomiting. While physiologic changes that occur during a rumination episode are well-described, the underlying cause is less well-defined. In general, rumination appears to have similarities to other functional gastrointestinal disorders including dysmotility, possibly inflammation, and an interaction with psychologic function. While diaphragmatic breathing is considered the mainstay of treatment, pediatric data demonstrating efficacy is lacking, especially as an isolated treatment. Conclusion: Pediatric rumination syndrome remains greatly understudied, particularly regarding treatment. There is a need to better define prevalence in both the primary care and subspecialty clinical settings, especially in patients presenting with vomiting or apparent gastroesophageal reflux. There is a need to determine whether treatment of co-morbid conditions results in improvement of rumination. Diaphragmatic breathing needs to be studied and compared to other competing responses.
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Affiliation(s)
- Marc Martinez
- Kansas City University of Medicine and Biosciences, Kansas City, MO, United States
| | - Sandeep Rathod
- Kansas City University of Medicine and Biosciences, Kansas City, MO, United States
| | - Hunter J. Friesen
- University of Kansas School of Medicine, Kansas City, MO, United States
| | - John M. Rosen
- Division of Gastroenteology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, United States
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
| | - Craig A. Friesen
- Division of Gastroenteology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, United States
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
| | - Jennifer V. Schurman
- Division of Gastroenteology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, United States
- Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
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Rahman MM, Ghoshal UC, Kibria MG, Sultana N, Yusuf MA, Nahar S, Ahmed F, Rowshon AHM, Hasan M. Functional Dyspepsia, Peptic Ulcer, and Helicobacter pylori Infection in a Rural Community of South Asia: An Endoscopy-Assisted Household Survey. Clin Transl Gastroenterol 2021; 12:e00334. [PMID: 33878048 PMCID: PMC8052092 DOI: 10.14309/ctg.0000000000000334] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Functional dyspepsia (FD), although commoner than organic dyspepsia (OD) in-hospital studies, community data, particularly from rural areas, are lacking. We performed a rural community study in Bangladesh with the primary aims to evaluate (i) the prevalence of uninvestigated dyspepsia (UD), FD, and OD and (ii) the risk factors for UD. METHODS This house-to-house survey was performed using a translated-validated enhanced Asian Rome III questionnaire and endoscopy with Helicobacter pylori tests, including genotyping. RESULTS Of 3,351/3,559 responders ([94.15%], age 40.41 ± 16.05 years, female 1924 [57.4%]), 547 (16.3%) had UD (female 346 [18%] vs male 201 [14%]; P = 0.002); 201 (6%), 88 (2.6%), and 258 (7.7%) had postprandial distress (PDS), epigastric pain syndromes (EPS) and PDS-EPS overlap, respectively. On multivariate analysis, age >50 years (adjusted odds ratio [AOR] 1.34 [1.07-1.68]), female sex (AOR 1.42 [1.17-1.74]), being married (AOR 1.57 [1.21-2.07]), lower family income (AOR 1.79 [1.43-2.26]), nonsteroidal anti-inflammatory drug use (AOR 7.05 [2.11-23.55]), previous acute gastroenteritis (AOR 5.42 [1.83-16]), and psychological distress (AOR 5.02 [2.87-8.76]) were risk factors for UD. Of 346/547 (63.25%) undergoing endoscopy, 232 (67.05%) and 114 (32.95%) had FD and OD (peptic ulcers [PU] 99 [28.61%] and erosive esophagitis 13 [3.76%]). About 53% of FD subjects had EPS-PDS overlap, 32% had PDS, and only 15% had EPS. H. pylori was detected in 266/342 (78%) dyspeptics (FD 173/230 [75.2%], vs OD 92/114 [82.1%], P = 0.169). DISCUSSION Sixteen percent, 11% and 5% of rural Bangladeshi Asian adults had UD, FD, and PU, respectively. One-third of UD subjects had OD, mostly PU.JOURNAL/cltg/04.03/01720094-202104000-00016/inline-graphic1/v/2021-04-15T161418Z/r/image-tiff.
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Affiliation(s)
- M. Masudur Rahman
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Uday C. Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Md. Golam Kibria
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Nigar Sultana
- Department of Gastroenterology, Delta Medical College and Hospital, Dhaka, Bangladesh
| | - M. Abdllah Yusuf
- Department of Microbiology, National Institute of Neuroscience and Hospital, Dhaka, Bangladesh
| | - Shamsun Nahar
- Laboratory Science and Service Division, icddr,b, Dhaka, Bangladesh
| | - Faruque Ahmed
- Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - AHM Rowshon
- Department of Gastroenterology, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh
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Axelrod CH, Saps M. Global Dietary Patterns and Functional Gastrointestinal Disorders. CHILDREN-BASEL 2020; 7:children7100152. [PMID: 32992448 PMCID: PMC7601251 DOI: 10.3390/children7100152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 12/01/2022]
Abstract
Functional Gastrointestinal Disorders (FGIDs) are common. In the United States alone, approximately 25 million Americans are estimated to have at least one FGID. Nonpharmacological treatment options include psychological/behavioral approaches, and dietary interventions that can vary across countries. The aim of this review is to evaluate the available evidence for dietary interventions for the treatment of childhood FGIDs amongst various cultures and regions of the world. This review includes clinical trials of dietary therapies for the treatment of FGIDs in children posted on or before 13 July 2020 in PubMed. Overall, the consensus view suggests that the westernization of diets is linked to the development of FGIDs, and diets low in Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPs) may reduce abdominal symptoms. However, more work is needed to confirm these findings.
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Major J, Ádám S. Self-reported specific learning disorders and risk factors among Hungarian adolescents with functional abdominal pain disorders: a cross sectional study. BMC Pediatr 2020; 20:281. [PMID: 32505201 PMCID: PMC7275532 DOI: 10.1186/s12887-020-02167-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite its increasing clinical significance and diagnostic challenges, little is known about functional abdominal pain disorders (FAPDs) in Central-Eastern Europe. In this paper, the prevalence and potential sociodemographic correlates of FAPDs among Hungarian adolescents are explored. METHODS A cross-sectional, nationwide, questionnaire study in a representative sample of 657 adolescents has been conducted. With a response rate of 80.2%, 522/527 (99.1%) questionnaires were eligible for data analysis (N = 267, 51.1% girls, mean age 14.8, SD 2.4 years). The questionnaire included sociodemographic variables (age, sex, place of residence, marital status of the parents, family income, religion, educational level of parents), questions regarding self-reported specific learning disorders and the Questionnaire for Paediatric Gastrointestinal Symptoms Rome ΙΙΙ Edition. RESULTS The prevalence of FAPDs was 11.9% (N = 62). FAPDs were significantly associated with female sex. Living in a county town showed a negative correlation with FAPD. Adolescents with self-reported arithmetic learning disorders had an 8.7-fold likelihood of FAPD (OR, 8.7; 95% CI (3.5-21.9). Adolescent girls reported pain in all subtypes of FAPDs more frequently than adolescent boys except functional abdominal pain syndrome. The most prevalent FAPD was abdominal migraine (N = 32, 6.1%), followed by irritable bowel syndrome (N = 24, 4.6%). CONCLUSIONS The prevalence of FAPDs in Hungary is similar to that reported worldwide, however, contrary to international data, abdominal migraine is the most frequently encountered FAPD in Hungary. In addition to well-known correlates of FAPDs, such as female sex and place of residence, arithmetic learning disorders have also been identified as correlating with the prevalence of FAPDs. Our results suggest culture-specific differences in the distribution of FAPDs, and confirm the significance of school performance indicators such as specific learning disorders as a correlate of FAPDs.
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Affiliation(s)
- János Major
- Károly Rácz School of PhD Studies, Semmelweis University, Üllői str. 26., Budapest, H-1085, Hungary. .,HRC Bethesda Children's Hospital, Bethesda str. 3., Budapest, H-1146, Hungary.
| | - Szilvia Ádám
- Faculty of Health and Public Services, Health Services Management Training Centre, Semmelweis University, Kútvölgyi str. 2., Budapest, H-1125, Hungary
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Chronic vomiting in children: Etiology, diagnosis, and management. Indian J Gastroenterol 2020; 39:117-122. [PMID: 32385612 DOI: 10.1007/s12664-020-01035-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Oswari H, Alatas FS, Hegar B, Cheng W, Pramadyani A, Benninga MA, Rajindrajith S. Functional abdominal pain disorders in adolescents in Indonesia and their association with family related stress. BMC Pediatr 2019; 19:342. [PMID: 31554509 PMCID: PMC6761710 DOI: 10.1186/s12887-019-1682-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 08/21/2019] [Indexed: 12/17/2022] Open
Abstract
Background Functional abdominal pain disorders (FAPD) have been widely reported as a major group of gastrointestinal disorders across the world. This study describes the prevalence, related factors, symptomatology and its relationship to emotional stress in Indonesian adolescents. Methods This is a cross-sectional study. Adolescents aged 10 to 17 years from nine randomly selected state schools from five districts of Jakarta, Indonesia, were invited to participate. A translated and validated Rome-III self-administered-questionnaire was used to collect data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal as well as extra-intestinal symptoms, and exposure to stressful life events were also collected using a separate validated questionnaire. Results A total of 1813 questionnaires were included in the analysis [males 739 (40.8%) mean age of 13.54 years + 0.89]. Of them, 209 children (11.5%) fulfilled Rome III criteria of FAPD. Functional abdominal pain (FAP) was reported as the most prevalent subtype (5.8%), followed by functional dyspepsia (3.3%), irritable bowel syndrome (2%) and abdominal migraine (0.4%). The prevalence was higher in girls (p < 0.05) and those exposed to family-related stressful life events (p < 0.05). They include divorce or separation of parents (adjusted OR 2.55, 95% CI 1.75–3.7, p = < 0.001), death of a close family member (adjusted OR 2.24, 95% CI 1.39–3.59, P = 0.001), and father’s alcoholism (adjusted OR 1.94, 95% CI 1.22–3.1, P = 0.005). Conclusions FAPD are common paediatric entities among Indonesian adolescents with a prevalence of 11.5%. FAPD were noted to be higher in girls and adolescents exposed to family-related stressful life events.
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Affiliation(s)
- Hanifah Oswari
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia.
| | - Fatima Safira Alatas
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - Badriul Hegar
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - William Cheng
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - Arnesya Pramadyani
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - Marc Alexander Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's, Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Okuda M, Kunitsugu I, Yoshitake N, Sasaki S. The Relationship between Functional Constipation and Dietary Habits in School-Age Japanese Children. J Nutr Sci Vitaminol (Tokyo) 2019; 65:38-44. [PMID: 30814410 DOI: 10.3177/jnsv.65.38] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Functional constipation negatively affects school-related quality of life for children and adolescents. We investigated the association between functional constipation, defined according to the Rome criteria version III, and dietary habits. The subjects of this cross-sectional study were 1,140 5th graders and 1,054 8th graders attending schools in Shunan City, Japan in 2012. Functional constipation was defined as having two or more symptoms of constipation. Dietary habits were assessed using a brief questionnaire. Self-reported biological, demographic and lifestyle information was obtained. Using multiple logistic models, dose-dependent associations among subgroups stratified with quintiles of nutrient and food intake were examined. The prevalence of functional constipation ranged from 3.7% to 8.3% across the grades. The most prevalent symptom was pain or hard stools. There was a link between higher rates of functional constipation and lower levels of dietary fiber intake, vegetables, and fruits (ptrend=0.010-0.030). Associations with vegetables and fruits attenuated when controlling for dietary fiber intake (ptrend=0.074-0.150). When 5th and 8th graders were separately analyzed, intake of dietary fiber, water from foods, and vegetables had beneficial effects on functional constipation in 8th graders (ptrend=0.005-0.038), and fruit intake had a beneficial effect in 5th graders (ptrend=0.012). Modification of dietary habits may have a positive effect in reducing functional constipation in school-age children. Diets rich in fiber, vegetables, and fruits, have the potential to improve functional constipation in Japanese children and adolescents.
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Affiliation(s)
- Masayuki Okuda
- Graduate School of Sciences and Engineering for Innovation, Yamaguchi University
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24
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Peralta-Palmezano JJ, Guerrero-Lozano R. Prevalence of Functional Gastrointestinal Disorders in School Children and Adolescents. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:207-212. [DOI: 10.4166/kjg.2019.73.4.207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 12/31/2022]
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Ye Z, Xue A, Huang Y, Wu Q. Children with cyclic vomiting syndrome: phenotypes, disease burden and mitochondrial DNA analysis. BMC Gastroenterol 2018; 18:104. [PMID: 29969994 PMCID: PMC6029397 DOI: 10.1186/s12876-018-0836-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 06/26/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) is characterized by repeated, stereotypical vomiting episodes. It is possibly associated with mitochondrial DNA (mtDNA) variants. We examined the phenotype, disease burden, treatment and performed mtDNA analysis in pediatric CVS. METHODS This retrospective study included 42 children with CVS in a tertiary care center. Information regarding medical history, clinical features, laboratory tests, and treatment were collected. mtDNA sequencing was performed among 13 patients. RESULTS Mean age of onset among patients was 4.0±3.4 years, and mean age at diagnosis was 6.7±4.2 years. CVS episodes in onset and features were stereotypic. Recognizable prodromes were reported in 54.8% patients. Neuroimaging showed previously unknown intracranial abnormalities. Gastrointestinal infection was found in four patients. Mean duration of hospitalization was 7.0±2.4 days, and mean hospitalization cost was 10,891 RMB. Sequencing showed that 4/13 patients had C16519T mtDNA polymorphism, and 2/13 patients had G3010A mtDNA polymorphism. CONCLUSIONS Cyclic vomiting syndrome is a disabling disorder, which causes huge disease burdens to the patients and their families. Early clinical suspicion and prompt diagnosis are crucial. mtDNA polymorphisms were found in some patients, but they were not significantly associated with pediatric CVS.
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Affiliation(s)
- Ziqing Ye
- Department of Gastroenterology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102 China
| | - Aijuan Xue
- Department of Gastroenterology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102 China
| | - Ying Huang
- Department of Gastroenterology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102 China
| | - Qiye Wu
- Department of Gastroenterology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102 China
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26
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Prevalence of Functional Defecation Disorders in Children: A Systematic Review and Meta-Analysis. J Pediatr 2018; 198:121-130.e6. [PMID: 29656863 DOI: 10.1016/j.jpeds.2018.02.029] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/19/2018] [Accepted: 02/13/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To systematically review the literature regarding the epidemiology of functional constipation and functional nonretentive fecal incontinence (FNRFI) in children. Secondary objectives were to assess the geographical, age, and sex distribution of functional constipation and FNRFI and to evaluate associated factors. STUDY DESIGN The Cochrane Library, PubMed, and Embase databases were searched from 2006 until September 2017. The following inclusion criteria were applied: (1) prospective studies of population-based samples; (2) reporting on the prevalence of functional constipation or FNRFI according to the Rome III/IV criteria; (3) in children aged 0-18 years; and (4) published in full manuscript form. A quality assessment of included studies was conducted. Random effect meta-analyses with meta-regression analyses of study characteristics were performed. RESULTS Thirty-seven studies were included, of which 35 reported on the prevalence of functional constipation and 15 of FNRFI. The reported prevalence of functional constipation ranged from 0.5% to 32.2%, with a pooled prevalence of 9.5% (95% CI 7.5-12.1). The prevalence of FRNFI ranged from 0.0% to 1.8%, with a pooled prevalence of 0.4% (95% CI 0.2-0.7). The prevalence of functional constipation was 8.6% in boys compared with 8.9% in girls (OR 0.99, 95% CI 0.9-1.4). Geographical location, dietary habits, and exposure to stressful life events were reported to be associated with the prevalence of functional constipation. Data on FNRFI were scarce and no associated factors were identified. CONCLUSION Functional constipation is common in childhood and is associated with geographical location, lifestyle factors, and stressful life events. FNRFI is rare, and no associated factors were identified.
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Robin SG, Keller C, Zwiener R, Hyman PE, Nurko S, Saps M, Di Lorenzo C, Shulman RJ, Hyams JS, Palsson O, van Tilburg MAL. Prevalence of Pediatric Functional Gastrointestinal Disorders Utilizing the Rome IV Criteria. J Pediatr 2018; 195:134-139. [PMID: 29398057 DOI: 10.1016/j.jpeds.2017.12.012] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/07/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the prevalence of functional gastrointestinal (GI) disorders in children 0-18 years old according to the newly established Rome IV diagnostic criteria as reported by parents in a representative community sample. STUDY DESIGN A cross-sectional study in which mothers (n = 1255) of children aged 0-18 years old in the US were recruited to complete an online survey about their child's GI symptoms, quality of life (QoL), and other health conditions. RESULTS Based on the Rome IV criteria, 24.7% of infants and toddlers aged 0-3 years and 25.0% of children and adolescents aged 4-18 years fulfilled symptom-based criteria for a functional GI disorder. The most common functional GI disorders were infant regurgitation among infants (24.1%) and functional constipation among both toddlers (18.5%) and children and adolescents (14.1%). QoL was diminished in pediatric patients with functional GI disorders (median = 71.69 vs median = 87.60; z = -11.41; P < .001). Children were more likely to qualify for a functional GI disorder if their parent qualified for a functional GI disorder (35.4% vs 23.0%; P < .001). CONCLUSIONS Based on Rome IV criteria, functional GI disorders are common in pediatric populations of all ages and are associated with decreased QoL.
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Affiliation(s)
- Samantha G Robin
- Department of Medicine, Division of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | - Catherine Keller
- Department of Medicine, Division of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | - Russell Zwiener
- Department of Pediatrics, Louisiana State University, New Orleans, LA
| | - Paul E Hyman
- Department of Pediatrics, Louisiana State University, New Orleans, LA
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA
| | - Miguel Saps
- Division of Gastroenterology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Carlo Di Lorenzo
- Division of Gastroenterology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Robert J Shulman
- Children's Nutrition Research Center, Baylor College of Medicine Department of Pediatrics, Texas Children's Hospital, Houston, TX
| | - Jeffrey S Hyams
- Division of Digestive Diseases,Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT
| | - Olafur Palsson
- Department of Medicine, Division of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | - Miranda A L van Tilburg
- Department of Medicine, Division of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC; College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC; School of Social Work, University of Washington, Seattle, WA.
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Tan TK, Saps M, Lin CL, Wei CC. Risks of irritable bowel syndrome in children with infantile urinary tract infection: a 13-year nationwide cohort study. J Investig Med 2018; 66:998-1003. [DOI: 10.1136/jim-2017-000703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 12/27/2022]
Abstract
Early life events play a crucial role in the development of irritable bowel syndrome (IBS). Some evidence suggests the phenomenon of cross-organ sensitization between bladder and colon. Whether urinary tract infection (UTI) during infancy is a risk factor of childhood IBS remains to be elucidated. In this retrospective cohort study, we selected 31 788 infants who had UTI between 2000 and 2011 as a UTI cohort and selected 127 152 infants without UTI as a comparison cohort, matched by age, sex and level of urbanization of living area. Incidence density and HRs with CIs of IBS between UTI and non-UTI cohorts were calculated by the end of 2012. The incidence density of IBS during the study period was 1.52-fold higher in the UTI cohort (95% CI 1.38 to 1.67) compared with the non-UTI cohort (2.05 vs 1.32 per 10 000 person-years). The HR of IBS was slightly higher for boys (1.53; 95% CI 1.34 to 1.73) than for girls (1.50; 95% CI 1.29 to 1.73). The HRs for IBS in children with UTI were greater for those with more UTI-related medical visits/per year (>5 visits, HR 61.3; 95% CI 51.8 to 72.6), with longer length of stay of hospitalization (>7 days, HR 1.75; 95% CI 1.36 to 2.24) and with vesicoureteral reflux (VUR) (HR 1.73; 95% CI 1.35 to 2.22) (p<0.0001, the trend test). Infants with UTI had higher risks of childhood IBS and the risks elevated further with recurrent UTI or UTI with concurrent VUR.
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29
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Sagar RC, Sood R, Gracie DJ, Gold MJ, To N, Law GR, Ford AC. Cyclic vomiting syndrome is a prevalent and under-recognized condition in the gastroenterology outpatient clinic. Neurogastroenterol Motil 2018; 30. [PMID: 28745840 DOI: 10.1111/nmo.13174] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/30/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder (FGID) characterized by intermittent episodes of nausea and vomiting. Our aim was to report its prevalence and associated features. METHODS Data concerning demographics, symptoms, and psychiatric comorbidity were collected. Symptoms compatible with CVS were classified as per Rome III criteria. We recorded whether a diagnosis of CVS was considered in patients after negative investigation. We compared demographics and association with other FGIDs in patients with and without CVS. KEY RESULTS 920 of 1002 patients provided data. Of the 920 patients, 112 (12.2%) had symptoms compatible with CVS. Thirteen (11.6%) of these had an organic cause for their symptoms, but 99 patients (88.4%) were deemed to have CVS (prevalence=10.8%). Organic causes for symptoms compatible with CVS included gastroparesis, large hiatus hernia, achalasia, and small bowel obstruction. Only 39.4% of patients with CVS were asked about vomiting symptoms at their initial consultation, and a diagnosis of CVS was considered in only four (4.0%) of the 99 patients. CVS was associated with younger age, tobacco smoking, never having married, psychiatric comorbidity, and presence of symptoms compatible with other FGIDs (P≤.01). CONCLUSIONS AND INFERENCES Prevalence of CVS in this outpatient gastroenterology adult population was 10.8%. Identified associations included younger age, tobacco smoking, psychiatric comorbidity, and symptoms compatible with other FGIDs. The condition was considered as a possible diagnosis in <5% of patients who met the diagnostic criteria.
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Affiliation(s)
- R C Sagar
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - R Sood
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - D J Gracie
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - M J Gold
- School of Medicine, University of Leeds, Leeds, UK
| | - N To
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - G R Law
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - A C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Gastrointestinal manifestations of pelvic floor disorders in adolescents: a diagnostic framework for the general practitioner. Curr Opin Pediatr 2017; 29:420-425. [PMID: 28537946 DOI: 10.1097/mop.0000000000000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Pelvic floor disorders (PFDs) can present with gastrointestinal complaints in the adolescent patient, and identification of PFDs is aided by clues in the history and physical examination apparent to the knowledgeable clinician. The aim of this article is to provide a framework for the diagnostic evaluation of the adolescent patient with a PFD and introduce management strategies. RECENT FINDINGS Patients with PFDs can present with gastrointestinal symptoms, including abdominal pain, constipation, incomplete evacuation, and fecal incontinence or nongastrointestinal complaints around genitourinary symptoms or sexual health. Although such symptoms can be attributed to a variety of diagnoses, PFDs should be considered in the adolescent patient based on history and physical examination findings, including a careful digital rectal examination. Adolescent patients in high-risk groups may be especially susceptible to PFDs. Such groups include postpartum women, victims of sexual abuse, those with congenital anorectal malformations, or acquired spinal cord or pelvic floor injuries. Biofeedback can be beneficial in patients with PFDs. SUMMARY PFDs may present with a spectrum of symptoms, but a familiarity with the clinical characteristics and understanding of the digital rectal examination may guide the skillful clinician in diagnosis, initial management, and subspecialist referral if needed.
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Boronat AC, Ferreira-Maia AP, Matijasevich A, Wang YP. Epidemiology of functional gastrointestinal disorders in children and adolescents: A systematic review. World J Gastroenterol 2017; 23:3915-3927. [PMID: 28638232 PMCID: PMC5467078 DOI: 10.3748/wjg.v23.i21.3915] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the prevalence of functional gastrointestinal disorders (FGIDs) in children and adolescents. METHODS PubMed, EMBASE, and Scopus databases were searched for original articles from inception to September 2016. The literature search was made in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For inclusion, each study had to report epidemiological data on FGIDs in children between 4 and 18 years old and contain standardized outcome based on Rome II, III or IV criteria. The overall quality of included epidemiological studies was evaluated in accordance with Loney's proposal for prevalence studies of health literature. Two reviewers assessed each study for data inclusion and extraction. Discrepancies were reconciled through discussion with seniors. RESULTS A total of 659 articles were identified from the databases and 16 through manual search. A total of 43 articles fulfilled the eligibility criteria for full-text reading, with 26 remaining to be included in the final analysis. All studies were written in English and published between 2005 and 2016. Eight (30.8%) articles were performed in North America, five (19.2%) in Latin America, five (19.2%) in Europe, seven (27%) in Asia, and one (3.8%) in Africa. Sample size varied between 114 and 99416 subjects, totaling 132600 individuals. Fourteen (53.9%) studies recruited their target samples from schools, 11 (42.3%) from healthcare settings and the remaining one (3.8%) from online panel community. The overall FGID prevalence rates for student samples ranged from 9.9% to 29% to as high as 87% in clinical samples. Cyclic vomiting, irritable bowel syndrome and functional constipation were the most researched conditions, with a prevalence ranging from 0.2% to 6.2%, 0% to 45.1% and 0.5% to 86.9%, respectively. The qualitative appraisal revealed that most of the studies showed average or below average generalizability. CONCLUSION The heterogeneity of the studies on FGIDs must be improved in order to allow comparison. Improvements should include appropriate sampling of representative population, comparable study setting, and consistent data collection.
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Recurrent Gastrointestinal Disturbance: Abdominal Migraine and Cyclic Vomiting Syndrome. Curr Neurol Neurosci Rep 2017; 17:21. [DOI: 10.1007/s11910-017-0731-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Levy EI, Lemmens R, Vandenplas Y, Devreker T. Functional constipation in children: challenges and solutions. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:19-27. [PMID: 29388621 PMCID: PMC5774595 DOI: 10.2147/phmt.s110940] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review intends to update what is known about and what is still a challenge in functional constipation (FC) in children regarding epidemiology, pathophysiology, diagnosis, and management. Although FC is a common childhood problem, its global burden remains unknown as data from parts of the world are missing. Another problem is that there is a large variation in prevalence due to differences in study methods and defining age groups. The pathophysiology of FC remains unclear to date but is probably multifactorial. Withholding behavior is likely to be the most important factor in toddlers and young children. Genetics may also play a role since many patients have positive family history, but mutations in genes associated with FC have not been found. Over the past years, different diagnostic criteria for FC in infants and children have been proposed. This year, Rome IV criteria have been released. Compared to Rome III, it eliminates two diagnostic criteria in children under the age of 4 who still wear diapers. Physical examination and taking a thorough medical history are recommended, but other investigations such as abdominal radiography, transabdominal recto-ultrasonography, colonic transit time, rectal biopsies, and colon manometry are not routinely recommended. Regarding treatment, guidelines recommend disimpaction and maintenance therapy with polyethylene glycol (PEG) with or without electrolytes. But experience shows that acceptability, adherence, and tolerance to PEG are still a challenge. Counseling of parents and children about causes of FC is often neglected. Recent studies suggest that behavior therapy added to laxative therapy improves the relief of symptoms. Further homogeneous studies, better-defined outcomes, and studies conducted in primary care are needed.
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Affiliation(s)
- Elvira Ingrid Levy
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Roel Lemmens
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yvan Vandenplas
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thierry Devreker
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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