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Garr K, Odar Stough C, Flannery M, Yacob D, Bali Puri N, Kroon Van Diest A. The Impact of Pediatric Disorders of Gut-Brain Interaction on the Family: The Mediating Role of Child Somatic Symptoms. Neurogastroenterol Motil 2025; 37:e70014. [PMID: 40032810 DOI: 10.1111/nmo.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 01/27/2025] [Accepted: 02/10/2025] [Indexed: 03/05/2025]
Abstract
BACKGROUND It is important to identify modifiable factors to reduce the negative impact of pediatric disorders of gut-brain interaction (DGBIs) on the family. The current study examined whether child somatic symptoms and caregiver mental health negatively influenced caregiver and family functioning. METHODS Participants were 84 children (8-17 years old) with DGBI symptoms and their caregivers presenting to a specialty DGBI clinic. Participants completed measures assessing demographics, child somatic symptoms, caregiver anxiety and depressive symptoms, and the impact of the child's illness on the family. Regression analyses examined if child somatic symptoms and caregiver and mental health were associated with family outcomes (i.e., Caregiver Health-Related Quality of Life [HRQoL], Family Functioning, Total Family Impact). Mediation analyses examined if child somatic symptoms mediated the association between caregiver mental health and Total Family Impact. KEY RESULTS Child somatic symptoms (self- and caregiver-report) were negatively related to Caregiver HRQoL, Family Functioning, and Total Family Impact (ps < 0.01). Caregiver anxiety was related to poorer Caregiver HRQoL (p < 0.001) and Total Family Impact (p = 0.01), while caregiver depression was negatively related to Family Functioning (p = 0.01). Self-report of child somatic symptoms partially mediated the association between caregiver anxiety and depressive symptoms and the Total Family Impact. CONCLUSIONS AND INFERENCES Findings indicate that child somatic symptoms are one pathway by which caregiver mental health may amplify the impact of pediatric DGBIs on the family. This highlights the importance of screening for child somatic symptoms and caregiver mental health in pediatric DGBI treatment.
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Affiliation(s)
- Katlyn Garr
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Meghan Flannery
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Desale Yacob
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Neetu Bali Puri
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ashley Kroon Van Diest
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
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Vandenplas Y, Darma A, Indrio F, Aw M, Vieira MC, Vivatvakin B, Treepongkaruna S, Cruchet S, Acharyya BC, Vázquez R, Yeung CY, Gutiérrez P. Understanding functional abdominal pain disorders among children: a multidisciplinary expert consensus statement. Front Pediatr 2025; 13:1576698. [PMID: 40433476 PMCID: PMC12108103 DOI: 10.3389/fped.2025.1576698] [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: 02/14/2025] [Accepted: 04/11/2025] [Indexed: 05/29/2025] Open
Abstract
Introduction Functional abdominal pain disorders (FAPDs) are pediatric gastrointestinal conditions marked by chronic or recurrent abdominal pain without anatomical and/or biochemical abnormalities. This position paper guides primary care providers in the early diagnosis and management of FAPDs to improve the well-being of affected children and their families. Methods A 12-member expert advisory board reviewed current approaches to diagnosing and managing FAPDs in children. Based on literature and discussions, 23 statements were drafted and voted on to achieve an acceptable level of agreement. Results First-line healthcare professionals are key in diagnosing FAPDs, using ROME diagnostic criteria and recognizing red flags for accurate assessment and referrals. Comprehensive evaluation, including medical, dietary, and psychosocial history, physical exams, and basic tests helped to identify the initial triggers. Probiotics such as Limosilactobacillus (L. reuteri) DSM 17938 and Lacticaseibacillus rhamnosus (L. rhamnosus) help in alleviating functional abdominal pain (FAP) in children along with primary measures, such as dietary modifications [a balanced diet advocating moderation in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)-rich foods] and physical activity. Probiotics should be given for 6-8 weeks and can be resumed if symptoms recur. Cognitive-behavioral and hypnotic therapy also help, with remote options such as web-based, compact disk (CD)-based or application-based tools available. Discussion This position paper provides expert insights to guide primary care providers in diagnosing and managing FAPDs, equipping them to make informed decisions for effective management of FAPDs.
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Affiliation(s)
- Yvan Vandenplas
- Department of KidZ Health Castle, UZ Brussel, Vrije Universitiet Brussels, Brussels, Belgium
| | - Andy Darma
- Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Flavia Indrio
- Department of Experimental Medicine, University of Salento, Lecce, Italy
| | - Marion Aw
- Department of Paediatrics, National University Health System, Singapore, Singapore
| | - Mario C. Vieira
- Centre for Paediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Boosba Vivatvakin
- Department of Pediatrics, Chulalongkorn University, Thai Red Cross Society, Bangkok, Thailand
| | - Suporn Treepongkaruna
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sylvia Cruchet
- Human Nutrition Unit, INTA, University of Chile, Santiago, Chile
| | - Bhaswati C. Acharyya
- Department of Paediatric Gastroenterology and Hepatology, Institute of Child Health, Manipal Hospital, Kolkata, India
| | - Rodrigo Vázquez
- Department of Research, Hospital Infantil de México Federico Gómez, Mexico City, México
| | - Chun Yan Yeung
- Department of Gastroenterology and Hepatology, Hsinchu Municipal MacKay Children's Hospital, MacKay Medical College, Taipei, Taiwan
| | - Pedro Gutiérrez
- Pediatric Research Division, Universidad Juarez del Estado de Durango, Durango, Mexico
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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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Giorgio V, Quatrale G, Mennini M, Piccirillo M, Furio S, Stella G, Ferretti A, Parisi P, Evangelisti M, Felici E, Quitadamo P, Di Nardo G. Bifidobacterium adolescentis PRL2019 in Pediatric Irritable Bowel Syndrome: A Multicentric, Randomized, Double-Blind, Placebo-Controlled Trial. Microorganisms 2025; 13:627. [PMID: 40142519 PMCID: PMC11945947 DOI: 10.3390/microorganisms13030627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 03/04/2025] [Accepted: 03/07/2025] [Indexed: 03/28/2025] Open
Abstract
The gut microbiota plays a pivotal role in gastrointestinal inflammation and immune response since changes in microbiota may result in abnormal neurotransmitter expression, inducing changes in gastrointestinal sensory-motor function and leading to symptom onset in irritable bowel syndrome (IBS) patients. The Bifidobacterium adolescentis species has a documented immunomodulatory effect through its ability to produce γ-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the mammalian central nervous system, which is reduced in IBS patients. This is a multicentric, randomized, double-blind, placebo-controlled, parallel-arm trial aimed at evaluating the effectiveness of Bifidobacterium adolescentis PRL2019 in children with IBS. IBS children diagnosed according to Rome IV criteria were enrolled and randomized into two groups to receive one stick containing 20 × 109 colony-forming unit of Bifidobacterium adolescentis PRL2019 (Gabapral, Pontenure, Italy) or an equivalent placebo once a day, in a 1:1 ratio, for 12 weeks. Clinical evaluation of symptoms was performed every four weeks using validated scores. Bowel habit characteristics were assessed using the Bristol Stool Chart (BSC). Seventy-two subjects (mean age 12.2 ± 1.8 years, 30 males) were enrolled and randomized into two groups, each of thirty-six patients. No significant differences were observed between the two groups regarding demographic characteristics, distribution of IBS subtypes, or baseline measures of IBS severity and BSC. The proportion of patients achieving complete remission was significantly higher in the BA Group (19/36; 52.8%) than in the Placebo Group (7/36; 19.4%, p = 0.003, odds ratio [OR] 0.216, 95% confidence interval [CI] 0.075-0.619). Both groups obtained a reduction in Total IBS Symptom Severity Scale (IBS SSS), Pain Intensity Score (PIS), Pain Frequency Score (PFS), and Life Interference Score (LIS) from T0 to T12. However, upon intergroup comparison, only in the BA group did the IBS-SSS (p = 0.001), PIS (p = 0.001), LIS (p = 0.015), and PFS (p = 0.005) significantly improve between T0 and T12. BSC showed a greater representation of normal stools (type 3-4) at the end of treatment in the BA group compared with baseline (25% vs. 58.3%, p = 0.004), especially in patients who presented an IBS-constipation subtype at T0 (44.5% vs. 19.4%, p = 0.02). In our study, Bifidobacterium adolescentis PRL2019 reduces the severity and frequency of symptoms in children with IBS, positively affecting bowel habits in children with the IBS-constipation subtype.
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Affiliation(s)
- Valentina Giorgio
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Giovanna Quatrale
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Pediatric Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Maurizio Mennini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Pediatric Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Marisa Piccirillo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Pediatric Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Silvia Furio
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Pediatric Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Giuseppe Stella
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Alessandro Ferretti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Pediatric Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Pasquale Parisi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Pediatric Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Melania Evangelisti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Pediatric Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
| | - Enrico Felici
- Pediatric Unit, Children’s Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Paolo Quitadamo
- Pediatric Gastroenterology and Hepatology Unit, Santobono-Pausilipon Children’s Hospital, 80122 Naples, Italy
| | - Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
- Pediatric Unit, Sant’Andrea University Hospital, 00189 Rome, Italy
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Rexwinkel R, Vermeijden NK, Zeevenhooven J, Kelder J, Groeneweg M, Hummel T, Goede J, Hurkmans P, Stapelbroek J, Benninga M, Vlieger A. Mebeverine and the Influence of Labeling in Adolescents With Irritable Bowel Syndrome or Functional Abdominal Pain Not Otherwise Specified: A 2 × 2 Randomized, Placebo-Controlled Trial. Gastroenterology 2025:S0016-5085(25)00493-7. [PMID: 40074185 DOI: 10.1053/j.gastro.2025.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 02/12/2025] [Accepted: 02/13/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND & AIMS Pediatric irritable bowel syndrome and functional abdominal pain-not otherwise specified lack effective pharmacologic interventions. The efficacy of mebeverine, an antispasmodic agent, and the effect of labeling within a pediatric cohort were evaluated. METHODS This randomized trial was conducted across 13 hospitals. Participants (12-17 years) with irritable bowel syndrome or functional abdominal pain-not otherwise specified received mebeverine (200 mg twice daily) or placebo for 8 weeks. Treatment was labeled as "mebeverine or placebo" (blinded trial label) or "mebeverine" (mebeverine label), creating the following 4 groups: (1) mebeverine-blinded trial label, (2) mebeverine-mebeverine label, (3) placebo-blinded trial label, and (4) placebo-mebeverine label. Randomization (1:1:1:1) was masked to physicians, except for drug labeling. Primary end point was treatment success (>50% reduction of abdominal pain intensity and frequency) after 8 weeks. The key secondary end point was adequate relief of symptoms. RESULTS Of the 269 randomized patients, treatment success was similar between those receiving mebeverine (groups 1 and 2) (n = 31 [23.4%]) and placebo (groups 3 and 4) (n = 30 [22.0%]; odds ratio [OR], 1.08; 95% CI, 0.59-1.99; P = .81). Treatment success was higher in groups with the mebeverine label (groups 2 and 4) (n = 42 [31.6%]) compared with the blinded trial label (groups 1 and 3) (n = 19 [14.1%]; OR, 2.84; 95% CI, 1.52-5.34; P = .001). Adequate relief rates were similar between mebeverine (n = 55 [41.0%]) and placebo groups (n = 61 [45.5%]; OR, 0.83; 95% CI, 0.51-1.35; P = .46), but higher in mebeverine-labeled groups (n = 67 [50.4%]) compared with blinded trial-labeled groups (n = 49 [36.3%]; OR, 1.78; 95% CI, 1.1-2.9; P = .02). Adverse events were mild and infrequent. CONCLUSIONS Mebeverine was ineffective in treatment of pediatric irritable bowel syndrome and functional abdominal pain-not otherwise specified. However, a positive drug label significantly enhanced treatment outcomes compared with a blinded trial label. (International Clinical Trials Registry Platform, Number: NL-OMON55563.).
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Affiliation(s)
- Robyn Rexwinkel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Amsterdam, Emma's Children Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands; Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicolaas Koen Vermeijden
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Amsterdam, Emma's Children Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands; Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Pediatrics, St Antonius Hospital, Nieuwegein, the Netherlands.
| | - Judith Zeevenhooven
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Amsterdam, Emma's Children Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Johannes Kelder
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Michael Groeneweg
- Department of Pediatrics, Maasstad Hospital, Rotterdam, the Netherlands
| | - Thalia Hummel
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Joery Goede
- Department of Pediatrics, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Pamela Hurkmans
- Department of Pediatrics, Amphia Hospital, Breda, the Netherlands
| | | | - Marc Benninga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Amsterdam, Emma's Children Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Arine Vlieger
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, the Netherlands
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Li R, Tham SW, Basu A, Palermo TM, Dang TT, Groenewald CB. Medical expenditures associated with abdominal and pelvic pain in the United States, 2017-2021. THE JOURNAL OF PAIN 2025; 28:104793. [PMID: 39894379 DOI: 10.1016/j.jpain.2025.104793] [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: 07/31/2024] [Revised: 12/20/2024] [Accepted: 01/22/2025] [Indexed: 02/04/2025]
Abstract
Abdominal and pelvic pain are common symptoms prompting medical care, yet little is known about their associated medical expenditures in the U.S. This study estimated the overall and age-specific incremental medical expenditures associated with abdominal and pelvic pain, and compared if the incremental expenditures differ by sex and presence of comorbid overlapping pain conditions. Using data from the 2017-2021 Medical Expenditure Panel Surveys (MEPS), a nationally representative cross-sectional survey on medical expenditures in the U.S., we estimated the incremental medical expenditures associated with abdominal and pelvic pain (ICD-10 indexed) for children (6-17 years), adults (18-64 years), and older adults (65-85 years), controlling for Andersen Behavioral Model factors. In our sample, 1.2% (1779/135,983) were classified with abdominal or pelvic pain. Adjusted incremental expenditures for abdominal and pelvic pain were $4325 (95% CI: $2670-$5981) per person, totaling $16.0 billion annually. Incremental expenditures were $1465 for children, $3439 for adults, and $9301 for older adults. In children, incremental expenditures were concentrated on office-based, outpatient, and emergency department visits. In adults, incremental expenditures were concentrated on office-based, outpatient, emergency department visits, and inpatient admissions. The estimated incremental medical expenditures were higher in males across all age groups. In individuals with abdominal or pelvic pain, comorbid pain conditions were associated with much higher additional incremental medical expenditures across all age groups ($6790 in children, $5262 in adults, and $6040 in older adults). Abdominal and pelvic pain substantially increased medical expenditures for children and adults, especially for those with comorbid overlapping pain conditions. PERSPECTIVE: Our nationwide study quantified the economic burden of abdominal and pelvic pain in the U.S., identifying key demographic and clinical cost drivers. Findings highlight the significant lifetime burden, the importance of pain management, the need to reduce costs for patients with overlapping pain, and the necessity of ongoing cost surveillance.
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Affiliation(s)
- Rui Li
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA; Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - See Wan Tham
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA; Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Anirban Basu
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA; Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Thanh T Dang
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Cornelius B Groenewald
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Rexwinkel R, Vermeijden NK, Zeevenhooven J, Kelder J, Groeneweg M, Hummel T, Goede J, van Wering H, Stapelbroek J, Benninga M, Vlieger A. The low FODMAP diet in adolescents functional abdominal in a non-guided setting: a prospective multicenter cohort study. Eur J Pediatr 2025; 184:189. [PMID: 39934502 PMCID: PMC11814023 DOI: 10.1007/s00431-025-05999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 12/23/2024] [Accepted: 01/20/2025] [Indexed: 02/13/2025]
Abstract
The purpose of this study is to evaluate the efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) in adolescents with irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) in a non-guided setting, resembling clinical practice. This prospective multicenter cohort study conducted in 13 centers included patients aged 12-18 years diagnosed with IBS or FAP-NOS. Patients received educational material on FODMAPs, including extensive lists of high and low FODMAP foods and additional online information. They were instructed to replace high FODMAP foods with low FODMAP alternatives for the duration of 4 weeks. No dietician was consulted. The primary end point was the proportion of patients with treatment success (≥ 30% reduction of abdominal pain intensity) at 4 weeks. The key secondary outcome was adequate relief of IBS/FAP-NOS symptoms. Of the 325 included patients, 81 patients (24.9%) achieved treatment success (≥ 30% reduction of abdominal pain intensity) after 4 weeks, with higher rates in patients with IBS (29.3%) than FAP-NOS (16.8%, OR 2.16 (1.04-4.48)). Adequate relief was reported in 51 patients (15.7%). There was a significant decrease in abdominal pain intensity (2.2 (1.1) vs. 2.5 (1.0), P < 0.001), daily bloating (2.4 (2.1) vs. 2.8 (2.3), P < 0.001), and flatulence (2.4 (2.1) vs. 2.8 (2.3), P = 0.001). Adverse events were mild and infrequent. CONCLUSION The low FODMAP diet in a non-guided setting, mimicking clinical practice, yielded treatment success in almost 30% adolescents with IBS and 17% in FAP-NOS, suggesting it may not be the first treatment option for these patients. TRIAL REGISTRATION EUCTR2015-003293-32-NL. WHAT IS KNOWN • Irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) are common disorders in children which negatively impact quality of life. • While a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has demonstrated effectiveness in adult IBS, its efficacy in pediatric IBS and FAP-NOS remains uncertain. • Clinical application of the low FODMAP diet often occurs without dietician consultation, contrary to controlled trial settings. WHAT IS NEW • The low FODMAP diet, without dietician guidance, resulted in treatment success in almost 30% of adolescents with IBS and only 17% with FAP-NOS. • With only 15.7% of participants achieving adequate relief of IBS/FAP-NOS symptoms, the non-guided low FODMAP diet may not be the first treatment option for pediatric IBS and FAP-NOS.
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Affiliation(s)
- Robyn Rexwinkel
- Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands
- Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute,, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas Koen Vermeijden
- Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, The Netherlands.
- Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.
- Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute,, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, The Netherlands.
| | - Judith Zeevenhooven
- Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Johannes Kelder
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Michael Groeneweg
- Department of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Thalia Hummel
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Joery Goede
- Department of Pediatrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | | | - Marc Benninga
- Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Pediatric Gastroenterology, Hepatology and Nutrition, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Arine Vlieger
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, The Netherlands
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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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9
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Bükülmez A, Köroğlu A, Baş MT. Parents' preferences for herbal supplements in managing functional gastrointestinal disorders. BMC Complement Med Ther 2025; 25:5. [PMID: 39780195 PMCID: PMC11716407 DOI: 10.1186/s12906-024-04733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 12/12/2024] [Indexed: 01/11/2025] Open
Abstract
Gastrointestinal diseases in children and adolescents lead to a considerable impairment of the quality of life of children and parents. Accordingly, there are considerable socio-economic consequences for the family and society. Parents concerned about their children may seek alternative treatments and opt for traditional herbal supplements. This study aimed to determine the utilization status and variety of herbal supplements by parents of children with functional gastrointestinal disorders. 216 study participants were given a socio-demographic questionnaire, a diagnostic questionnaire based on the ROME-IV criteria and a questionnaire with 20 herb names used in traditional treatments. 33.3% of parents reported using "ginger; Zingiber officinale" for their children who were infants and suffered from infantile regurgitation. The herb most preferred by parents for their children with functional gastrointestinal disorders in childhood and adolescence was "spearmint; Mentha spicata" (28.9%). 57.9% of the parents participating in the study stated that they preferred herbal supplements for their children. In addition, 40% of the participants stated that they use the herbs with the advice of the referral. As a result, it has been shown that parents tend to use herbs or herbal supplements, that they need to be educated in the use of these supplements, and that they need access to the right herb and to reliable supplements derived from the right herb.
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Affiliation(s)
- Ayşegül Bükülmez
- Faculty of Medicine, Department of Pediatric Gastroenterology, Afyonkarahisar Health Scıences University, Afyonkarahisar, Türkiye.
| | - Ayşegül Köroğlu
- Department of Pharmaceutical Botany, Faculty of Pharmacy, Ankara University, Tandoğan, Ankara, Türkiye
| | - Melike Taşdelen Baş
- Department of Nursing, Selcuk University, Akşehir Kadir Yallagöz School of Health, Konya, Türkiye
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10
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Calcaterra V, Cena H, Loperfido F, Porri D, Basilico S, Gazzola C, Ricciardi Rizzo C, Conti MV, Luppino G, Wasniewska MG, Zuccotti G. Functional Gastrointestinal Disorders and Childhood Obesity: The Role of Diet and Its Impact on Microbiota. Nutrients 2024; 17:123. [PMID: 39796556 PMCID: PMC11722901 DOI: 10.3390/nu17010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Revised: 12/24/2024] [Accepted: 12/28/2024] [Indexed: 01/13/2025] Open
Abstract
Introduction Emerging evidence suggests an association between obesity and Functional Gastrointestinal Disorders (FGIDs). Childhood obesity and FGIDs share many common features, such as high prevalence in the pediatric population, risk factors related to diet and lifestyle, gut microbiota impairments, and psychological distress. This narrative review aims to summarize the main evidence regarding FGIDs in childhood obesity, with a specific focus on the role of diet and its impact on the microbiota. Additionally, the review highlights potential common-ground solutions for preventing and managing both obesity and FGIDs. Methods A comprehensive PubMed search was conducted. Keywords used included terms related to children and adolescents, obesity, functional gastrointestinal disorders, and microbiota. Results The review emphasizes the importance of holistic, multidisciplinary approaches to managing symptoms. In addition to nutrition education, physical activity, and medical care, complementary strategies such as psychological interventions and personalized dietary modifications (e.g., low-FODMAP and fiber-enriched diets) are critical. Given the interplay between gut microbiota alterations, obesity, and FGIDs, microbiota modulation through probiotics, prebiotics, and integrative support shows significant promise. However, the variability in current evidence underlines the need for robust longitudinal studies to develop standardized protocols and maximize treatment efficacy. Conclusions Bridging gaps in knowledge and practice with an integrated, evidence-based framework could improve patient outcomes and deepen understanding of the complex relationship between metabolic and gastrointestinal health in children and adolescents.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (C.G.); (G.Z.)
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (H.C.); (F.L.); (S.B.); (C.R.R.); (M.V.C.)
- Clinical Nutrition and Dietetics Unit, ICS Maugeri IRCCS, 27100 Pavia, Italy
| | - Federica Loperfido
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (H.C.); (F.L.); (S.B.); (C.R.R.); (M.V.C.)
| | - Debora Porri
- Pediatric Unit, AOU Policlinico “G. Martino”, 98122 Messina, Italy; (D.P.); (G.L.); (M.G.W.)
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98122 Messina, Italy
| | - Sara Basilico
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (H.C.); (F.L.); (S.B.); (C.R.R.); (M.V.C.)
| | - Cassandra Gazzola
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (C.G.); (G.Z.)
| | - Cecilia Ricciardi Rizzo
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (H.C.); (F.L.); (S.B.); (C.R.R.); (M.V.C.)
| | - Maria Vittoria Conti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (H.C.); (F.L.); (S.B.); (C.R.R.); (M.V.C.)
| | - Giovanni Luppino
- Pediatric Unit, AOU Policlinico “G. Martino”, 98122 Messina, Italy; (D.P.); (G.L.); (M.G.W.)
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98122 Messina, Italy
| | - Malgorzata Gabriela Wasniewska
- Pediatric Unit, AOU Policlinico “G. Martino”, 98122 Messina, Italy; (D.P.); (G.L.); (M.G.W.)
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98122 Messina, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milano, Italy; (C.G.); (G.Z.)
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milano, Italy
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11
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Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP, Miró J. Immigration background as a risk factor of chronic pain and high-impact chronic pain in children and adolescents living in Spain: differences as a function of age. Pain 2024; 165:1372-1379. [PMID: 38189183 DOI: 10.1097/j.pain.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/30/2023] [Indexed: 01/09/2024]
Abstract
ABSTRACT The number of people immigrating from one country to another is increasing worldwide. Research has shown that immigration background is associated with chronic pain (CP) and pain disability in adults. However, research in this issue in children and adolescents has yielded inconsistent results. The aims of this study were to examine (1) the association between immigration background, CP, high-impact chronic pain (HICP) in a community sample of children and adolescents; and (2) the extent these associations differed as a function of sex and age. Participants of this cross-sectional study were 1115 school children and adolescents (mean age = 11.67; 56% girls). Participants were asked to provide sociodemographic information and respond to a survey including measures of pain (location, extension, frequency, intensity, and interference). Results showed that having an immigration background was associated with a greater prevalence of CP (OR = 1.91, p <.001) and HICP (OR = 2.55, p <. 01). Furthermore, the association between immigration background and CP was higher in children (OR = 6.92, p <.001) and younger adolescents (OR = 1.66, p <.05) than in older adolescents. Children and adolescents with an immigration background are at higher risk for having CP -especially younger children- and HICP. More resources should be allocated in the prevention of CP and HICP in children and adolescents with an immigration background.
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Affiliation(s)
- Josep Roman-Juan
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
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12
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Di Nardo G, Bernardo L, Cremon C, Barbara G, Felici E, Evangelisti M, Ferretti A, Furio S, Piccirillo M, Coluzzi F, Parisi P, Mauro A, Di Mari C, D'Angelo F, Mennini M. Palmitoylethanolamide and polydatin in pediatric irritable bowel syndrome: A multicentric randomized controlled trial. Nutrition 2024; 122:112397. [PMID: 38479039 DOI: 10.1016/j.nut.2024.112397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/03/2024] [Accepted: 02/12/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of co-micronized palmitoylethanolamide (PEA)/polydatin (PD) in the treatment of abdominal pain symptoms in pediatric patients with irritable bowel syndrome (IBS). METHODS This was a multicenter trial conducted at three Italian pediatric gastroenterology centers, employing a double-blind, placebo-controlled, parallel-arm design. Participants were ages 10 to 17 y and met Rome IV criteria for pediatric IBS. They were randomly allocated to receive either co-micronized PEA/PD or placebo, administered three times daily in a 1:1 ratio, over a 12-wk period. The study assessed baseline severity using the IBS-Severity Scoring System (IBS-SSS) at enrollment and after 4, 8, and 12 wk of treatment. Abdominal pain frequency was assessed on a scale from 1 to 7 d/wk, while stool consistency was classified using the Bristol Stool Scale (BSS) to categorize various IBS subtypes. The primary outcome was the percentage of patients who achieved complete remission, defined as IBS-SSS score <75 points after 12 wk of therapy. RESULTS The study involved 70 children with IBS. Of the participants, 34 received co-micronized PEA/PD, and 36 received a placebo. As compared with the placebo group, the co-micronized therapy group had significantly more patients achieving complete remission after 12 wk (P = 0.015), with particular benefit in the IBS-diarrhea subtype (P = 0.01). The treatment group also experienced a significant reduction in abdominal pain intensity and frequency compared with the placebo group. No adverse events were recorded during the study period. CONCLUSIONS Co-micronized PEA/PD is a safe and effective treatment to treat abdominal pain symptoms in pediatric IBS.
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Affiliation(s)
- Giovanni Di Nardo
- Sapienza University of Rome, NESMOS Department, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Luca Bernardo
- Pediatric Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Melania Evangelisti
- Sapienza University of Rome, NESMOS Department, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Alessandro Ferretti
- Sapienza University of Rome, NESMOS Department, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Silvia Furio
- Sapienza University of Rome, NESMOS Department, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Marisa Piccirillo
- Sapienza University of Rome, NESMOS Department, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Flaminia Coluzzi
- Sapienza University of Rome, Department of Medical and Surgical Sciences and Biotechnologies, Polo Pontino, Latina, Italy; Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Pasquale Parisi
- Sapienza University of Rome, NESMOS Department, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Angela Mauro
- Pediatric Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
| | - Clelia Di Mari
- Pediatric Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
| | - Francesco D'Angelo
- Sapienza University of Rome, NESMOS Department, General Surgery Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Mennini
- Sapienza University of Rome, NESMOS Department, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.
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13
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Delin M, Berglund SK. Validation of red flags in the workup of children with long-term abdominal pain - A retrospective study. Acta Paediatr 2024; 113:1095-1102. [PMID: 38400768 DOI: 10.1111/apa.17169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/15/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
AIM To evaluate red flags as an instrument to distinguish other medical conditions from Functional Gastrointestinal Disorders (FGID) in children with long-term abdominal pain. METHODS In a retrospective follow-up, data were collected from 317 children who were referred for medical assessment due to long-term abdominal pain between the years 2011 and 2012 at three Swedish paediatric open clinic units in Sweden. Throughout the review of medical records, any documented red flags at the primary consultation and finally set diagnosis after 1 year were noted for all cases. RESULTS A non-FGID disease was diagnosed in 32 cases (10.1%). The sensitivity of red flags to predict inflammatory bowel disease (IBD) was 100% and the specificity 64.1%. The sensitivity of red flags to predict celiac disease was 45.5% and the specificity 63.7%. The sensitivity of red flags to predict any non-FGID disease was 59.4%, and the specificity was 65.6%. CONCLUSION The use of red flags is a sensitive instrument to identify patients with IBD but less applicable when identifying celiac disease and other organic diseases. Specificity is generally low and future biomarkers for assessing children with long-term abdominal pain is needed.
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Affiliation(s)
- Malin Delin
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Staffan K Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
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14
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Chogle A, El-Chammas K, Santucci N, Grimm M, Dorfman L, Graham K, Kelly DR, Dranove JE, Rosen R, Nurko S, Croffie J, Balakrishnan K, Chiou EH, Zhang L, Simpson P, Karrento K. A multicenter registry study on percutaneous electrical nerve field stimulation for pediatric disorders of gut-brain interaction. J Pediatr Gastroenterol Nutr 2024; 78:817-826. [PMID: 38451058 DOI: 10.1002/jpn3.12174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/02/2024] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Percutaneous electrical nerve field stimulation (PENFS) has demonstrated promise in single-center trials for pediatric abdominal pain-related disorders of gut-brain interaction (DGBI). Our aim was to explore efficacy of PENFS as standard therapy for DGBI in a registry involving multiple pediatric gastroenterology referral centers. METHODS This was a multicenter, prospective open-label registry of children (8-18 years) undergoing PENFS for DGBI at seven tertiary care gastroenterology clinics. DGBI subtypes were classified by Rome IV criteria. Parents and patients completed Abdominal Pain Index (API), Nausea Severity Scale (NSS), and Functional Disability Inventory (FDI) questionnaires before, during therapy and at follow-up visits up to 1 year later. RESULTS A total of 292 subjects were included. Majority (74%) were female with median (interquartile range [IQR]) age 16.3 (14.0, 17.7) years. Most (68%) met criteria for functional dyspepsia and 61% had failed ≥4 pharmacologic therapies. API, NSS, and FDI scores showed significant declines within 3 weeks of therapy, persisting long-term in a subset. Baseline (n = 288) median (IQR) child-reported API scores decreased from 2.68 (1.84, 3.58) to 1.99 (1.13, 3.27) at 3 weeks (p < 0.001) and 1.81 (0.85, 3.20) at 3 months (n = 75; p < 0.001). NSS scores similarly improved from baseline, persisting at three (n = 74; p < 0.001) and 6 months later (n = 55; p < 0.001). FDI scores displayed similar reductions at 3 months (n = 76; p = 0.01) but not beyond. Parent-reported scores were consistent with child reports. CONCLUSIONS This large, comprehensive, multicenter registry highlights efficacy of PENFS for gastrointestinal symptoms and functionality for pediatric DGBI.
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Affiliation(s)
- Ashish Chogle
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Orange County, Orange, California, USA
| | - Khalil El-Chammas
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Neha Santucci
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Monica Grimm
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lev Dorfman
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kahleb Graham
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel R Kelly
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Jason E Dranove
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Rachel Rosen
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Joseph Croffie
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keshawadhana Balakrishnan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Eric H Chiou
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Liyun Zhang
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katja Karrento
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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15
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Opp J, Schürmann M, Jenke A, Job B. Drawing the abdominal pain: A powerful tool to distinguish between organic and functional abdominal pain. J Pediatr Gastroenterol Nutr 2024; 78:846-852. [PMID: 38385706 DOI: 10.1002/jpn3.12165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Abdominal pain (AP) in children imposes a large economic burden on the healthcare system. Currently, there are no reliable diagnostic tools to differentiate between organic and functional disorders. We hypothesized from previous research that the analysis of patients' graphic expression of subjective symptoms as well as their interactional behavior adds new ways to differentiate between functional and organic AP. METHODS Conversation analyses of physician-patient-encounters and graphical expression of AP-based pain were performed. RESULTS Twenty-two interactions were recorded and analyzed. Fifteen children were diagnosed with organic AP and seven with functional AP. We found marked differences between children with organic and functional AP. For example, all 15 children with organic AP saw the task of drawing a picture of the pain during the interview as a duty, whereas the seven children with functional AP took this as an opportunity to provide detailed descriptions about the nature of the pain, the circumstances, and how the AP impaired their quality of life. CONCLUSION Analysis of patients' interaction strategies in response to the painting task provides relevant clues as to whether AP is functional or requires further workup for organic causes.
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Affiliation(s)
- Joachim Opp
- Sozialpädiatrisches Zentrum, Evangelisches Krankenhaus Oberhausen, Oberhausen, Germany
| | - Mia Schürmann
- Leibniz-Institut für Deutsche Sprache, Mannheim, Germany
| | - Andreas Jenke
- Zentrum für Kinder- und Jugendmedizin, Klinikum Kassel, Universität Witten/Herdecke, Kassel, Germany
| | - Barbara Job
- Fakultät für Linguistik und Literaturwissenschaft, Universität Bielefeld, Bielefeld, Germany
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16
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Di Nardo G, Barbara G, Borrelli O, Cremon C, Giorgio V, Greco L, La Pietra M, Marasco G, Pensabene L, Piccirillo M, Romano C, Salvatore S, Saviano M, Stanghellini V, Strisciuglio C, Tambucci R, Turco R, Zenzeri L, Staiano A. Italian guidelines for the management of irritable bowel syndrome in children and adolescents : Joint Consensus from the Italian Societies of: Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP), Pediatrics (SIP), Gastroenterology and Endoscopy (SIGE) and Neurogastroenterology and Motility (SINGEM). Ital J Pediatr 2024; 50:51. [PMID: 38486305 PMCID: PMC10938778 DOI: 10.1186/s13052-024-01607-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/11/2024] [Indexed: 03/18/2024] Open
Abstract
The irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID), whose prevalence has widely increased in pediatric population during the past two decades. The exact pathophysiological mechanism underlying IBS is still uncertain, thus resulting in challenging diagnosis and management. Experts from 4 Italian Societies participated in a Delphi consensus, searching medical literature and voting process on 22 statements on both diagnosis and management of IBS in children. Recommendations and levels of evidence were evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was reached for all statements. These guidelines suggest a positive diagnostic strategy within a symptom-based approach, comprehensive of psychological comorbidities assessment, alarm signs and symptoms' exclusion, testing for celiac disease and, under specific circumstances, fecal calprotectin and C-reactive protein. Consensus also suggests to rule out constipation in case of therapeutic failure. Conversely, routine stool testing for enteric pathogens, testing for food allergy/intolerance or small intestinal bacterial overgrowth are not recommended. Colonoscopy is recommended only in patients with alarm features. Regarding treatment, the consensus strongly suggests a dietary approach, psychologically directed therapies and, in specific conditions, gut-brain neuromodulators, under specialist supervision. Conditional recommendation was provided for both probiotics and specific fibers supplementation. Polyethylene glycol achieved consensus recommendation for specific subtypes of IBS. Secretagogues and 5-HT4 agonists are not recommended in children with IBS-C. Certain complementary alternative therapies, antispasmodics and, in specific IBS subtypes, loperamide and rifaximin could be considered.
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Affiliation(s)
- Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Barbara
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, 40126, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Osvaldo Borrelli
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK
| | - Cesare Cremon
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, 40126, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Valentina Giorgio
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Greco
- General Pediatrician, Heath Care Agency of Bergamo, Bergamo, Italy
| | | | - Giovanni Marasco
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, 40126, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, Magna Graecia University, Catanzaro, Italy
| | - Marisa Piccirillo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Silvia Salvatore
- Pediatric Department, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Michele Saviano
- General Pediatrician, Heath Care Agency of Naples, Naples, Italy
| | - Vincenzo Stanghellini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, 40126, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rossella Turco
- Department of Pediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Letizia Zenzeri
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University Federico II, Via S. Pansini 5, Naples, 80131, Italy.
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Shah E, Eswaran S, Harer K, Lee A, Nojkov B, Singh P, Chey WD. Percutaneous electrical nerve field stimulation for adolescents with irritable bowel syndrome: Cost-benefit and cost-minimization analysis. J Pediatr Gastroenterol Nutr 2024; 78:608-613. [PMID: 38284690 PMCID: PMC10954403 DOI: 10.1002/jpn3.12118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 01/30/2024]
Abstract
Abdominal pain drives significant cost for adolescents with irritable bowel syndrome (IBS). We performed an economic analysis to estimate cost-savings for patients' families and healthcare insurance, and health outcomes, based on abdominal pain improvement with percutaneous electrical nerve field stimulation (PENFS) with IB-Stim® (Neuraxis). We constructed a Markov model with a 1-year time horizon comparing outcomes and costs with PENFS versus usual care without PENFS. Clinical outcomes were derived from a sham-controlled double-blind trial of PENFS for adolescents with IBS. Costs/work-productivity impact for parents were derived from appropriate observational cohorts. PENFS was associated with 18 added healthy days over 1 year of follow-up, increased annual parental wages of $5,802 due to fewer missed work days to care for the child, and $4744 in cost-savings to insurance. Percutaneous electrical field nerve stimulation for adolescents with IBS appears to yield significant cost-savings to patients' families and insurance.
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Affiliation(s)
- Eric Shah
- Michigan Medicine, Ann Arbor, Michigan, USA
| | | | | | - Allen Lee
- Michigan Medicine, Ann Arbor, Michigan, USA
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Salvatore S, Carlino M, Sestito S, Concolino D, Agosti M, Pensabene L. Nutraceuticals and Pain Disorders of the Gut-Brain Interaction in Infants and Children: A Narrative Review and Practical Insights. Nutrients 2024; 16:349. [PMID: 38337634 PMCID: PMC10856962 DOI: 10.3390/nu16030349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Different nutraceuticals are often considered by parents of infants and children with abdominal pain and disorders of the gut-brain interaction. Herb extracts and natural compounds have long been used in traditional medicine, but clinical pediatric trials are very limited. This narrative review based on relevant studies identified through a search of the literature in Pubmed and Medline updated to October 2023 focused on the effect of nutraceuticals in infantile colic, functional abdominal pain, and irritable bowel syndrome in children and adolescents. Significant reductions in colic episodes and crying time were reported in two studies on fennel (seeds oil or tea), in three studies on different multiple herbal extracts (all including fennel), in one study on Mentha piperita, and in at least two double-blind randomized controlled studies on Lactobacillus reuteri DSM 17938 and Bifidobacterium lactis BB-12 (108 CFU/day for at least 21 days) in breast-fed infants. Compared to a placebo, in children with functional abdominal pain or irritable bowel syndrome, a significant reduction in pain was reported in two studies supplementing peppermint oil capsules or psyllium fibers, and in one study on corn fiber cookies, partial hydrolyzed guar gum, a specific multiple herbal extract (STW-5), or vitamin D supplementation. To date, there is moderate-certainty evidence with a weak grade of recommendation on Lactobacillus reuteri DSM 17938 (108 CFU/day) in reducing pain intensity in children with functional abdominal pain and for Lactobacillus rhamnosus GG (1-3 × 109 CFU twice daily) in reducing pain frequency and intensity in children with IBS. Further large and well-designed pediatric studies are needed to prove the efficacy and safety of different herbal extracts and prolonged use of studied products in infants and children with pain disorders of the gut-brain interaction.
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Affiliation(s)
- Silvia Salvatore
- Pediatric Department, Hospital “F. Del Ponte”, University of Insubria, 21100 Varese, Italy; (S.S.); (M.A.)
| | - Mariagrazia Carlino
- Pediatric Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.C.); (S.S.); (D.C.)
| | - Simona Sestito
- Pediatric Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.C.); (S.S.); (D.C.)
| | - Daniela Concolino
- Pediatric Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.C.); (S.S.); (D.C.)
| | - Massimo Agosti
- Pediatric Department, Hospital “F. Del Ponte”, University of Insubria, 21100 Varese, Italy; (S.S.); (M.A.)
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (M.C.); (S.S.); (D.C.)
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Skelly CL, Stiles-Shields C, Goldenthal H, Bohr N, Feldman E, Mak GZ, Drossos T. Median arcuate ligament syndrome: a cost analysis to determine the economic burden of a rarely diagnosed disease. Front Psychol 2024; 14:1166744. [PMID: 38292522 PMCID: PMC10824967 DOI: 10.3389/fpsyg.2023.1166744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Background Chronic abdominal pain (CAP) is a medical condition resulting in enormous economic burden and healthcare utilization costs. One understudied source of CAP is the median arcuate ligament syndrome (MALS). MALS is often not diagnosed and treated for a variety of reasons, including the fact that MALS is highly comorbid with psychological symptoms and psychiatric disorders similar to CAP. To better inform future work on the study of MALS, we undertook a pilot study to estimate the economic impact and public health burden of this condition. We hypothesized that MALS imposes a significant public health burden. Methods Pediatric and adult patients enrolled in a prospective study undergoing multidisciplinary evaluation and treatment for MALS at a tertiary care facility were invited to participate in a brief self-report survey, the Direct and Indirect Medical Care Impact of MALS Form, to capture health care resources including procedures, surgeries, health care visits, and absenteeism (school and work). To estimate costs from the Direct and Indirect Medical Care Impact of MALS Form, the medical care usage data self-reported by patients were converted to dollar value utilizing FSC-93 billing data and corresponding current procedural terminology (CPT) codes for procedures and provider visits one year prior to surgery and then following surgery. Descriptive analyses were conducted to characterize the sample in terms of demographics and reported absences from school and work. Results One hundred and nineteen patients (mean age = 30.9 ± 13.0) completed the questionnaires, yielding a 57% response rate. 82.4% (n = 98) of the participants were female and 90.8% (n = 108) were non-Hispanic/Latine white. The mean and median surgical follow-up periods were 5.3 and 5.4 years, respectively. Overall, median cost of provider and ancillary healthcare provider visits for each patient was (US)$19,119 including the pre-operative and post-operative visits. The mean cost for providers alone was (US)$28,908. Wilcoxon signed-ranks tests indicated that the postoperative missed number of days of school were significantly lower than the pre-surgical number of missed school days (Z = -3.36, p = 0.001). Similarly, there were significantly less missed work-days following surgery than before for the entire sample (Z = -2.86, p = 0.004). Conclusion Median arcuate ligament syndrome imposes a large economic burden on patients and the healthcare system. The current findings, although reflective of a homogenous population, are adding to a growing body of literature suggesting that healthcare disparities play a role in the low rates of diagnosis and treatment of MALS.
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Affiliation(s)
- Christopher L. Skelly
- Department of Surgery, Section of Vascular and Endovascular Surgery, University of Chicago Medicine, Chicago, IL, United States
| | - Colleen Stiles-Shields
- Institute for Juvenile Research, Department of Psychiatry, The University of Illinois at Chicago, Chicago, IL, United States
| | - Hayley Goldenthal
- Department of Psychiatry and Behavioral Sciences, University of Chicago Medicine, Chicago, IL, United States
| | - Nicole Bohr
- Department of Surgery, Section of Vascular and Endovascular Surgery, University of Chicago Medicine, Chicago, IL, United States
- Department of Nursing Research, University of Chicago Medicine, Chicago, IL, United States
| | - Estee Feldman
- Department of Psychiatry and Behavioral Sciences, University of Chicago Medicine, Chicago, IL, United States
| | - Grace Zee Mak
- Department of Surgery, Section of Pediatric Surgery, University of Chicago Medicine, Chicago, IL, United States
| | - Tina Drossos
- Department of Psychiatry and Behavioral Sciences, University of Chicago Medicine, Chicago, IL, United States
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20
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de Bruijn CMA, Rexwinkel R, Vermeijden NK, Hoffman I, Tack J, Benninga MA. The Use of Pictograms in the Evaluation of Functional Abdominal Pain Disorders in Children. J Pediatr 2023; 263:113647. [PMID: 37517644 DOI: 10.1016/j.jpeds.2023.113647] [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: 11/07/2022] [Revised: 06/21/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To evaluate whether the use of pictograms improves symptom evaluation for children with functional abdominal pain disorders (FAPDs). STUDY DESIGN This survey study was conducted in 2 academic centers and included patients aged 8-18 years visiting the outpatient clinic for FAPD symptom evaluation. Patients were randomized to fill out the questionnaire without or with accompanying pictograms to assess gastrointestinal symptoms. Afterwards, patients underwent clinical health assessment by the healthcare professional (HCP). Subsequently, the HCP filled out the same questionnaire without pictograms, while blinded to the questionnaire completed by the patient. Primary outcome was the level of agreement between identified symptoms as assessed by patients and HCP. RESULTS We included 144 children (questionnaire without accompanying pictograms [n = 82] and with accompanying pictograms [n = 62]). Overall agreements rates were not significantly different (without pictograms median, 70% vs with pictograms median, 70%). Accompanying pictograms did not significantly improve the assessment of abdominal pain symptoms. Accompanying pictograms were beneficial for concordance rates for nausea and vomiting symptoms (without pictograms median, 67% vs with pictograms median, 100%; P = .047). Subgroup analyses for children aged 8-12 years of age revealed similar results (concordance on the presence of nausea and vomiting without pictograms median, 67% vs with pictograms median, 100%; P = .015). Subgroup analyses for children ages 12-18 years showed no significant differences in concordance rates. CONCLUSIONS Pictograms do not seem to improve the assessment of FAPDs. However, the use of pictograms improves the evaluation of nausea and vomiting, especially for children aged 8-12 years. Therefore, HCPs could consider using pictograms in that setting during consultations.
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Affiliation(s)
- Clara M A de Bruijn
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands
| | - Robyn Rexwinkel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands
| | - Nicolaas K Vermeijden
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands; Department of Pediatrics, St Antonius Ziekenhuis, Nieuwegein, The Netherlands.
| | - Ilse Hoffman
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Bedree H, Tran ST, Koven ML, Wershil SJ, Fortunato JE, Essner BS. Impact of Sleep Disturbance on Fatigue, Nausea, and Pain: Mediating Role of Depressive Symptoms Among Youth With Disorders of Gut-Brain Interaction. J Pediatr Gastroenterol Nutr 2023; 77:468-473. [PMID: 37434286 DOI: 10.1097/mpg.0000000000003887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVES A high degree of sleep disturbance is reported among youth with disorders of gut-brain interaction (DGBIs). Given that sleep quality impacts a range of pediatric health outcomes including somatic sensations (eg, pain) and depressive mood occurs relatively frequently among youth with DGBIs, there is a dire need to disentangle the unique contributions of sleep and depressive mood on the somatic sensations experienced by youth with DGBIs. We aimed to examine whether depressive mood mediates the relations among sleep disturbance and pain intensity, nausea, and fatigue among youth with DGBIs. METHODS One hundred eighteen patients aged 8-17 years ( Mage = 14.05, SD = 2.88; 70.34% female), 83.05% White/non-Hispanic recruited at a pediatric neurogastroenterology clinic completed measures of sleep disturbance, nausea, fatigue, pain intensity, and depressive mood. Three mediation models examined the effect of sleep disturbance on nausea, fatigue, and pain, with depressive mood as a mediator. RESULTS Participants reported moderate sleep disturbance. Depressive mood partially mediated the significant, respective relations between greater sleep disturbance and more severe nausea and fatigue. Sleep disturbance was significantly associated with higher pain intensity; however, depressive mood was not a significant mediator of this relation. CONCLUSIONS Sleep quality is a major concern among youth with DGBIs. Low sleep quality may worsen nausea and fatigue via co-occurring increases in depressive mood symptoms. In contrast, sleep disturbance may directly increase pain, regardless of youths' depressive mood symptoms. Future research should explore these relations through prospective studies leveraging a combination of subjective and objective assessment approaches.
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Affiliation(s)
- Helen Bedree
- From the Department of Psychology, DePaul University, Chicago, IL
| | - Susan T Tran
- From the Department of Psychology, DePaul University, Chicago, IL
| | - Marissa L Koven
- From the Department of Psychology, DePaul University, Chicago, IL
| | - Sarah J Wershil
- From the Department of Psychology, DePaul University, Chicago, IL
- the Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- the Pritzker Department of Psychiatry & Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John E Fortunato
- the Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bonnie S Essner
- the Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Pritzker Department of Psychiatry & Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- the Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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22
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Bouënel M, Lefebvre V, Trouillet C, Diesnis R, Pouessel G, Karaca-Altintas Y. Determining clinical predictors to identify non-specific abdominal pain and the added value of laboratory examinations: A prospective derivation study in a paediatric emergency department. Acta Paediatr 2023; 112:2218-2227. [PMID: 37463102 DOI: 10.1111/apa.16911] [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: 03/13/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023]
Abstract
AIM To develop a model to discriminate non-specific abdominal pain (NSAP) from organic pain in the paediatric emergency department (PED) and evaluate the added value of laboratory markers. METHODS Prospective cohort study in an urban French PED including all patients aged ≥4 years with abdominal pain between November 2020 and May 2021. The outcome was the discrimination between NSAP (patients coded to have only "pain" or "constipation") and organic pain (all other diagnoses) using stepwise backward multivariate logistic regression method with bootstrap resampling. RESULTS The study enrolled 246 patients. Overall, 163 patients (66.2%) had NSAP. Four variables associated with organic pain: pain in the epigastric region (OR 0.48 [0.23-0.99]), worsening pain (0.57 [0.32-0.99]), pain migration (0.42 [0.17-0.99]) and vomiting (0.47 [0.26-0.84]) were integrated in a clinical model. To discriminate NSAP with a probability of 65%, model sensitivity was 71.8% (64.9-78.7), specificity was 53.0% (42.3-63.7), and the Net Benefit (NB) was 15.4%. White Blood Count and C-reactive protein results improved discriminative capacity of the model (AUC 0.708 [0.643-0.773] vs. 0.654 [0.585-0.723], p = 0.01) with a supplementary NB of 12%. Patient follow-up showed 95% diagnostic accuracy. CONCLUSION This study reveals a four-clinical predictor model with a NB of 15% in predicting NSAP. Validation studies are necessary.
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Affiliation(s)
| | - Victoire Lefebvre
- Department of Pediatrics, Children's Hospital, CH Roubaix, Roubaix, France
| | | | - Remy Diesnis
- Department of Emergency Medicine, CH Roubaix, Roubaix, France
| | - Guillaume Pouessel
- Department of Pediatrics, Children's Hospital, CH Roubaix, Roubaix, France
| | - Yasemin Karaca-Altintas
- Department of Pediatrics, Children's Hospital, CH Roubaix, Roubaix, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
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23
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Chen JY, Chen SN, Lee CH, Huang YJ. A systematic review and meta-analysis of randomized control trials: efficacy of cognitive behavioral therapies for the management of functional and recurrent abdominal pain disorders in children and adolescents. Cogn Behav Ther 2023; 52:438-459. [PMID: 37102319 DOI: 10.1080/16506073.2023.2200562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/30/2023] [Indexed: 04/28/2023]
Abstract
Cognitive behavioral therapy (CBT) is effective for pain relief in children and adolescents with functional abdominal pain disorders (FAPDs). However, few studies have focused on the FAPDs specifically and the medium-term or long-term results of CBT. In this meta-analysis, we investigated the efficacy of CBT in pediatric FAPDs and unclassified chronic or recurrent abdominal pain (CAP and RAP, respectively). We searched the PubMed, Embase, and Cochrane Library databases for related randomized controlled trials until August 2021. Eventually, 10 trials with 872 participants were included. The methodological quality of the studies was assessed, and data on two primary and four secondary outcomes of interest were extracted. We used the standardized mean difference (SMD) to measure the same outcome, and precisions of effect sizes were reported as 95% confidence intervals (CIs). We found that CBT had significantly positive effects on reducing pain intensity immediately (SMD: -0.54 [CI: -0.9, -0.19], p = 0.003), 3 months after the intervention (SMD: -0.55; [CI: -1.01, -0.1], p = 0.02) and 12 months after the intervention (SMD: -0.32; [CI: -0.56, -0.08], p = 0.008). CBT also reduced the severity of gastrointestinal symptoms, depression, and solicitousness, improved the quality of life and decreased the total social cost. Future studies should consider uniform interventions in the control group and comparing different CBT delivery methods.
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Affiliation(s)
- Jia-Yi Chen
- Department of Education Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Ni Chen
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Che-Hsiung Lee
- Department of Plastic and Reconstructive Surgery, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yu-Jui Huang
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
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Ganzevoort IN, Fokkema T, Mol-Alma HJ, Heida A, Van der Veen AL, Vermeulen K, Benninga MA, Vlieger AM, Berger MY, Holtman GA. Home-based guided hypnotherapy for children with functional abdominal pain and irritable bowel syndrome in primary care: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e069653. [PMID: 37156587 PMCID: PMC10173965 DOI: 10.1136/bmjopen-2022-069653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Children often present to primary care with functional abdominal pain (FAP) or irritable bowel syndrome (IBS), and around half still have abdominal complaints 1 year later. Hypnotherapy is an evidence-based treatment that is used in specialist care, but it lacks evidence in primary care. This study will investigate the (cost) effectiveness of home-based guided hypnotherapy for children with FAP or IBS in primary care. METHODS AND ANALYSIS We report the design of a pragmatic randomised controlled trial among children aged 7-17 years, diagnosed with FAP or IBS by their general practitioner (GP), with assessments over 12 months. The control group will receive care as usual (CAU) by their GP (eg, communication, education and reassurance), while the intervention group will receive CAU plus 3 months of home-based guided hypnotherapy via a website. The primary outcome will be the proportion of children with adequate relief from abdominal pain/discomfort at 12 months, analysed on an intention-to-treat basis. Secondary outcomes will include the adequacy of pain relief at 3 and 6 months, pain/discomfort severity, pain frequency and intensity, daily functioning and impact on function, anxiety and depression, pain beliefs, sleep disturbances, school absence, somatisation, and healthcare use and costs. We must include 200 children to determine a 20% difference in those with adequate relief (55% control vs 75% intervention). ETHICS AND DISSEMINATION The Medical Ethics Review Committee of the University Medical Center Groningen, the Netherlands, approved this study (METc2020/237). The results will be disseminated to patients, GPs and other stakeholders via email, a dedicated website, peer-reviewed publications and presentations at national and international conferences. We plan to collaborate with the Dutch Society of GPs to implement the results in clinical practice. TRIAL REGISTRATION NUMBER NCT05636358.
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Affiliation(s)
- Ilse Nadine Ganzevoort
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Tryntsje Fokkema
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Harma J Mol-Alma
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anke Heida
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Adriëlla L Van der Veen
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Karin Vermeulen
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Arine M Vlieger
- Department of Paediatrics, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - G A Holtman
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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Philipson A, Duberg A, Hagberg L, Högström S, Lindholm L, Möller M, Ryen L. The Cost-Effectiveness of a Dance and Yoga Intervention for Girls with Functional Abdominal Pain Disorders. PHARMACOECONOMICS - OPEN 2023; 7:321-335. [PMID: 36646863 PMCID: PMC10043117 DOI: 10.1007/s41669-022-00384-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Functional abdominal pain disorders (FAPDs) affect children worldwide, being more prevalent among girls. The individual and societal burdens of the disease are substantial, and evidence-based interventions are needed. Non-pharmacological treatments have generally produced promising results, with dance and yoga specifically having potential as an effective treatment option. Beside efficacy, the cost-effectiveness of interventions is important when prioritizing and allocating public resources. OBJECTIVE This study evaluated the cost-effectiveness of an 8-month dance and yoga intervention for girls with functional abdominal pain or irritable bowel syndrome, based on a randomized control trial called 'Just in TIME'. METHODS The intervention, performed in Sweden, was studied using a decision analysis tool, i.e., a decision tree within the trial followed by a Markov model with a time horizon of 10 years. The base case considered healthcare costs as well as productivity losses, measuring the effects in gained quality-adjusted life-years (QALYs) and presenting an incremental cost-effectiveness ratio (ICER). RESULTS The base case results show that the intervention, compared with current practice, was the dominant strategy from both the 12-month and long-term perspectives. The sensitivity analyses indicated that the long-term, but not the short-term, findings were robust for different assumptions and changes in parameter estimates, resulting in ICERs similar to those of the base case scenario. CONCLUSIONS Offering dance and yoga to young girls with FAPDs generates small QALY gains and monetary savings compared with standard healthcare and is likely cost-effective. These findings make a valuable contribution to an area where evidence-based and cost-effective treatment interventions are needed. CLINICAL TRIALS REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT02920268; Name: Just in TIME-Intervention With Dance and Yoga for Girls With Recurrent Abdominal Pain.
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Affiliation(s)
- Anna Philipson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Universitetssjukhuset Örebro, S-huset, vån 2, 701 85, Örebro, Sweden.
| | - Anna Duberg
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Universitetssjukhuset Örebro, S-huset, vån 2, 701 85, Örebro, Sweden
| | - Lars Hagberg
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Universitetssjukhuset Örebro, S-huset, vån 2, 701 85, Örebro, Sweden
| | - Sofie Högström
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Universitetssjukhuset Örebro, S-huset, vån 2, 701 85, Örebro, Sweden
| | - Lars Lindholm
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Margareta Möller
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Universitetssjukhuset Örebro, S-huset, vån 2, 701 85, Örebro, Sweden
| | - Linda Ryen
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Universitetssjukhuset Örebro, S-huset, vån 2, 701 85, Örebro, Sweden
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Di Nardo G, Cremon C, Staiano A, Stanghellini V, Borrelli O, Strisciuglio C, Romano C, Mallardo S, Scarpato E, Marasco G, Salvatore S, Zenzeri L, Felici E, Pensabene L, Sestito S, Francavilla R, Quitadamo P, Baldassarre M, Giorgio V, Tambucci R, Ziparo C, Parisi P, Barbaro MR, Barbara G. Role of inflammation in pediatric irritable bowel syndrome. Neurogastroenterol Motil 2023; 35:e14365. [PMID: 35340083 DOI: 10.1111/nmo.14365] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/09/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND IBS affects a large number of children throughout the world and is thought to be the result of disturbed neuroimmune function along with the brain-gut axis. Although the underlying pathophysiologic mechanisms are not clear, the role of low-grade inflammation and mucosal immune activation in IBS symptom generation has become evident also in subsets of pediatric patients. Animal models provided meaningful insight in the causal relationship between abnormal mucosal immune activation and changes in gastrointestinal (GI) sensory-motor function. Likewise, the development of long-standing GI symptoms fulfilling the current criteria for functional GI disorders after infection gastroenteritis and in patients with IBD or celiac disease in remission further supports this hypothesis. Immune activation, its impact on gut sensory-motor function, and potential implications for symptom generation emerged in both children and adults with IBS. PURPOSE The aim of this review is to summarize the main evidence on the presence of low-grade inflammation and immune activation in children with IBS, its possible role in symptom generation, and its potential implication for new therapeutic strategies.
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Affiliation(s)
- Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Cesare Cremon
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, "Federico II", University of Naples, Naples, Italy
| | | | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Saverio Mallardo
- Pediatric Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Elena Scarpato
- Department of Translational Medical Science, "Federico II", University of Naples, Naples, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
- Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Simona Sestito
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Ruggiero Francavilla
- Pediatric Section, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Mariella Baldassarre
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Ziparo
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Barbara
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Zhang C, Ren W, Sun C, Liu L, Li M, Wang W, Fang Y, Liu L, Yang X, Zhang X, Li S. Associations between gastrointestinal infection and urinary phthalate metabolite concentrations in US children and adolescents from NHANES 2005-2016. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:4582-4591. [PMID: 35972658 DOI: 10.1007/s11356-022-22327-y] [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: 06/02/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to evaluate at the link between gastrointestinal illness and urine phthalate metabolite concentrations in children and adolescents in the United States between 2005 and 2016. A total of 4008 National Health and Nutrition Examination Survey (NHANES) participants had urine samples obtained during the survey and self-reported their gastrointestinal functional status over the previous week. High performance liquid chromatography/tandem mass spectrometry (HPLC/MS-MS) was used to identify twelve phthalate metabolites in urine samples. The link between PAE concentrations and gastrointestinal illnesses was investigated using logistic regression, which was controlled for possible confounders. The combined and independent effects of PAEs on gastrointestinal illnesses were investigated using Bayesian Kernel Machine Regression (BKMR) and quantile-based g-computation (qgcomp). In children and adolescents, the prevalence of gastrointestinal infection was 9.0%. One log-unit increase in urinary concentrations was associated with an increased risk of gastrointestinal infection for monocarboxyoctyl phthalate (MCOP) (adjusted odd ratio (aOR) = 1.36, 95 percent confidence interval (95%ci): 1.08, 1.62), mono(2-ethylhexyl) phthalate (MEHP) (aOR = 1.18, 95 percent CI: 1.05, 1.32) and mono(2-eth The mixed exposure model findings revealed that the combined effect of PAEs was substantially linked with gastrointestinal infection; exposure to the combination of PAEs was positively associated with the risk of gastrointestinal infection. In the BKMR model, the exposure to the mixture of PAEs was positively associated with the risk of gastrointestinal infection. In qgcomp, a substantial positive correlation between PAEs and gastrointestinal illnesses was identified (OR = 1.16, 95 percent CI: 1.05, 1.28). MCOP and MEHP may be the major contributors after controlling for other PAE homologs. These associations were more pronounced in overweight and obese children and adolescents. Mixed exposure to phthalates (PAEs) in children and adolescents was significantly associated with gastrointestinal infections, with MCOP and MEHP accounting for the major proportions. These associations were more pronounced in overweight and obese children and adolescents.
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Affiliation(s)
- Chuang Zhang
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Weirui Ren
- Department of Gastroenterology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Chi Sun
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Lin Liu
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Meng Li
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Wenbo Wang
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Yanbin Fang
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Lin Liu
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiaofeng Yang
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiangjian Zhang
- Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-Cerebrovascular Disease, Shijiazhuang, 050000, China
| | - Suolin Li
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Xu S, Chen C, Ouyang Z, Duan C, Xu Z, Bai T, Hou X. Association between multiple sleep dimensions and functional bowel disorders among Chinese college freshmen. Sleep Med 2022; 98:168-173. [PMID: 34312082 DOI: 10.1016/j.sleep.2021.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although sleep disorder is thought as a risk factor for functional bowel disorders, its impact role in adolescents remains unknown and the contribution of different sleep dimensions may deserve further attention. This study aimed to evaluate the relationship between multiple sleep dimensions and functional bowel disorders among Chinese college freshmen. METHODS A cross-sectional survey was conducted in college freshmen from Huazhong University of Science and Technology in Wuhan, China in September 2019 with random cluster sampling method. All participants completed questionnaires about living habits, sleep and digestive symptoms. Diagnosis of irritable bowel syndrome and functional constipation were based on the Rome IV criteria. Univariate and multivariate logistic regression models were applied to assess the association of sleep dimensions with irritable bowel syndrome or functional constipation. RESULTS Based on the 3335 individuals who completed the questionnaire, the overall prevalence of irritable bowel syndrome and functional constipation in college freshmen were 2.5% and 1.7%, respectively. Multivariate analysis revealed that compared with individuals reporting good sleep quality, those reporting poor (OR = 7.269, 95%CI: 2.876-18.370) were associated with increased risk of irritable bowel syndrome. Similarly, those reporting fair (OR = 2.068, 95%CI: 1.010-4.236) and poor (OR = 5.664, 95%CI: 1.864-17.205) were associated with increased risk of functional constipation. There was no statistically significant association between other sleep dimensions (sleep duration, sleep timing, or sleep latency) and irritable bowel syndrome or functional constipation. CONCLUSION Self-reported poor sleep quality was a stronger independent predictor of functional bowel disorders than other sleep dimensions among Chinese college freshmen. Future intervention studies should consider the role of sleep quality for the prevention of FBDs in adolescents.
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Affiliation(s)
- Shu Xu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 1277 Jiefang Avenue, 430022, Hubei Province, China.
| | - Can Chen
- Huazhong University of Science and Technology, 1037 Luoyu road, Wuhan, 430074, Hubei Province, China.
| | - Zhen Ouyang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China.
| | - Chaofan Duan
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 1277 Jiefang Avenue, 430022, Hubei Province, China.
| | - Zhiyue Xu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 1277 Jiefang Avenue, 430022, Hubei Province, China.
| | - Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 1277 Jiefang Avenue, 430022, Hubei Province, China.
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 1277 Jiefang Avenue, 430022, Hubei Province, China.
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Kaul I, Staggs VS, Bagherian A, Ali A, Shulman RJ, Colombo JM, Schurman JV, Chumpitazi BP, Friesen CA. Pediatric Rome IV diagnosis agreement is greater than agreement on diagnostic testing. Neurogastroenterol Motil 2022; 34:e14355. [PMID: 35279913 DOI: 10.1111/nmo.14355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/11/2021] [Accepted: 01/30/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pediatric Rome IV criteria are used to diagnose childhood functional gastrointestinal disorders (FGIDs). This study of pediatric gastroenterology physicians measured their agreement in (1) Making a pediatric Rome IV FGID diagnosis; and (2) Diagnostic testing for patients with FGIDs. METHODS Pediatric gastroenterologists and pediatric gastroenterology fellows at two medical centers completed a survey containing clinical FGID vignettes. For each vignette, raters identified the most likely Rome IV diagnosis(es) and selected which diagnostic test(s) (if any) they typically would obtain. The survey was re-administered within 3 months. Inter-rater and intra-rater weighted percent agreement was determined. Linear mixed modeling identified sources of variability in diagnostic testing. KEY RESULTS Thirty-four raters completed the initial survey of whom thirty-one (91%) completed the repeat survey. Overall inter-rater agreement on Rome IV diagnoses was 68% for initial and repeat surveys whereas intra-rater agreement was 76%. In contrast, overall inter-rater agreement on diagnostic testing was <30% for both initial and repeat surveys and intra-rater agreement was only 57%. Between-physician differences accounted for 43% of the variability in the number of tests selected. Rater identified use of Rome criteria in clinical practice was associated with 1.1 fewer diagnostic tests on average (95% CI 0.2-2.0, p = 0.015). Higher intra-rater agreement was noted for diagnostic testing in faculty when compared to fellows (p = 0.009). CONCLUSIONS & INFERENCES In a multicenter evaluation among pediatric gastroenterology physicians, pediatric Rome IV diagnostic agreement was higher than that reported for previous Rome versions, and higher than agreement on diagnostic testing.
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Affiliation(s)
- Isha Kaul
- Section of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Vincent S Staggs
- Biostatistics & Epidemiology, Health Services & Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Amber Bagherian
- Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Amna Ali
- The Wiess School of Natural Sciences, Rice University, Houston, Texas, USA
| | - Robert J Shulman
- Section of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Children's Nutrition Research Center, Agriculture Research Service, United States Department of Agriculture, Houston, Texas, USA
| | - Jennifer M Colombo
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Jennifer V Schurman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Bruno P Chumpitazi
- Section of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Children's Nutrition Research Center, Agriculture Research Service, United States Department of Agriculture, Houston, Texas, USA
| | - Craig A Friesen
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri, USA
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Hollier JM, Salemi JL, Shulman RJ. United States Healthcare Burden of Pediatric Functional Gastrointestinal Pain Disorder Hospitalizations from 2002 to 2018. Neurogastroenterol Motil 2022; 34:e14288. [PMID: 34796594 PMCID: PMC9117572 DOI: 10.1111/nmo.14288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/02/2021] [Accepted: 10/14/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The healthcare burden of pediatric functional gastrointestinal pain disorders (FGIDs) is unclear. Our study aimed to characterize the burden of these hospitalizations in the United States (US). METHODS We utilized the US National Inpatient Sample from 2002 to 2018 to capture pediatric hospitalizations (ages 4 to 18 years old) with a primary discharge diagnosis of abdominal pain, constipation, irritable bowel syndrome, dyspepsia, abdominal migraine, cyclic vomiting syndrome, or fecal incontinence. We calculated the FGID hospitalization prevalence rate, length of stay (LOS), and inflation-adjusted costs annually and assessed for statistically significant trend changes using joinpoint analyses. KEY RESULTS 22.3 million pediatric hospitalizations were captured, and 1 in 64 pediatric hospitalizations were attributed to a primary FGID hospitalization. The overall FGID hospitalization prevalence rate initially remained stable but decreased significantly from 2013 to 2018. Constipation and abdominal pain hospitalization rates, respectively, increased and decreased significantly over time. Constipation hospitalizations were more prevalent for younger non-Hispanic Blacks and Hispanics. FGID hospitalization rates stratified by sex were similar. Mean LOS was 2.3 days; average LOS increased significantly from 2002 to 2013 and then stabilized. FGID hospitalization costs averaged $6,216 per admission and increased significantly for all FGIDs except dyspepsia. Endoscopic procedures were the most common interventions. CONCLUSIONS & INFERENCES FGID hospitalization prevalence rates decreased recently, possibly due to national healthcare policy implementation. Nonetheless, constipation admissions increased. LOS was stable in recent years but associated costs-per-hospitalization were increasing over time, probably due to endoscopic procedures. More studies are needed to explain these prevalence and cost trends.
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Affiliation(s)
- John M. Hollier
- Baylor College of Medicine, Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Houston, Texas,Texas Children’s Hospital, Houston, Texas
| | - Jason L. Salemi
- University of South Florida, College of Public Health, Tampa, Florida,University of South Florida, Morsani College of Medicine, Department of Obstetrics and Gynecology, Tampa, Florida
| | - Robert J. Shulman
- Baylor College of Medicine, Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Houston, Texas,Texas Children’s Hospital, Houston, Texas,United States Department of Agriculture/Agricultural Research Services Children’s Nutrition Research Center, Houston, Texas
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31
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The Belgian consensus on irritable bowel syndrome: the paediatric gastroenterologist view. Acta Gastroenterol Belg 2022; 85:384-386. [DOI: 10.51821/85.2.10298] [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: 11/11/2022]
Abstract
The Belgian consensus on irritable bowel syndrome (IBS) in adults published in this issue offered us, as Belgian paediatric gastroenterologists, an opportunity to underline the differences in approach between adults and children and adolescents with IBS. Prevalence of IBS in childhood is reported between 1.2 and 5.4 %. A more recent article communicates a worldwide pooled prevalence of 13.8% (1,2). Bias exists since not all studies differentiate between the different Functional Abdominal Pain Disorders (FAPDs) (IBS, functional dyspepsia, abdominal migraine and functional abdominal pain not otherwise specified) or apply the same ROME criteria (II, III, IV) (Table 1) (2).
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Gordon M, Sinopoulou V, Tabbers M, Rexwinkel R, de Bruijn C, Dovey T, Gasparetto M, Vanker H, Benninga M. Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:560-568. [PMID: 35404394 PMCID: PMC9002716 DOI: 10.1001/jamapediatrics.2022.0313] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022]
Abstract
Importance Functional abdominal pain disorders (FAPDs) can severely affect the life of children and their families, with symptoms carrying into adulthood. Management of FADP symptoms is also a financial and time burden to clinicians and health care systems. Objective To systematically review various randomized clinical trials (RCTs) on the outcomes of cognitive behavioral therapy (CBT), educational support, yoga, hypnotherapy, gut-directed hypnotherapy, guided imagery, and relaxation in the management of FAPDs. Data Sources PubMed, MEDLINE, Embase, PsycINFO, and Cochrane Library. Study Selection All RCTs that compared psychosocial interventions with any control or no intervention, for children aged 4 to 18 years with FAPDs. Data Extraction and Synthesis Pairs of the authors independently extracted data of all included studies, using a predesigned data extraction sheet. One author acted as arbitrator. Risk of bias was assessed using the Cochrane risk of bias tool, and certainty of the evidence for all primary outcomes was analyzed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Main Outcomes and Measures Primary outcomes were treatment success, pain frequency, pain intensity, and withdrawal owing to adverse events. Dichotomous outcomes were expressed as risk ratio (RR) with corresponding 95% CIs. Continuous outcomes were expressed as mean difference (MD) or standardized MD with 95% CI. Results A total of 33 RCTs with 2657 children (median [range] age, 12 [7-17] years; 1726 girls [67.3%]) were included. Twelve studies compared CBT with no intervention, 5 studies compared CBT with educational support, 3 studiescompared yoga with no intervention, 2 studies compared hypnotherapy with no intervention, 2 studies compared gut-directed hypnotherapy with hypnotherapy, and 2 studies compared guided imagery with relaxation. Seven studies evaluated other unique comparisons (eg, visceral osteopathy vs normal osteopathy). Per the GRADE framework, owing to risk of bias, there was moderate certainty in evidence that CBT was associated with higher treatment success numbers (n = 324 children; RR, 2.37; 95% CI 1.30-4.34; number needed to treat [NNT] = 5), lower pain frequency (n = 446 children; RR, -0.36; 95% CI, -0.63 to -0.09), and lower pain intensity (n = 332 children; RR, -0.58; 95% CI, -0.83 to -0.32) than no intervention. Owing to high imprecision, there was low certainty in evidence that there was no difference between CBT and educational support for pain intensity (n = 127 children; MD, -0.36; 95% CI, -0.87 to 0.15). Owing to risk of bias and imprecision, there was low certainty in evidence that hypnotherapy resulted in higher treatment success compared with no intervention (n = 91 children; RR, 2.86; 95% CI, 1.19-6.83; NNT = 5). Owing to risk of bias and imprecision, there was low certainty in evidence that yoga had similar treatment success to no intervention (n = 99 children; RR, 1.09; 95% CI, 0.58-2.08). Conclusions and Relevance Results of this systematic review and meta-analysis suggest that CBT and hypnotherapy may be considered as a treatment for FAPDs in childhood. Future RCTs should address quality issues to enhance the overall certainty of the results, and studies should consider targeting these interventions toward patients who are more likely to respond.
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Affiliation(s)
- Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | | | - Merit Tabbers
- Department of Pediatric Gastroenterology, Emma Children’s Hospital/Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Robyn Rexwinkel
- Department of Pediatric Gastroenterology, Emma Children’s Hospital/Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Clara de Bruijn
- Department of Pediatric Gastroenterology, Emma Children’s Hospital/Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Terence Dovey
- Department of Life Sciences, Brunel University London, London, United Kingdom
| | - Marco Gasparetto
- Department of Pediatric Gastroenterology, The Royal London Children’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Marc Benninga
- Department of Pediatric Gastroenterology, Emma Children’s Hospital/Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Abstract
Neuromodulation, also known as bioelectric neuromodulation or neurostimulation, is the therapeutic use of electrical stimulation of nerves or brain centers. Neuromodulation has been trialed in an increasing range of human diseases as well as gastrointestinal disorders. The application of neuromodulation to treat pediatric motility and functional disorders is an exciting recent development. This review aims to briefly discuss the use of neuromodulation for the treatment of pediatric gastroparesis, constipation, and visceral hyperalgesia.
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Affiliation(s)
- Khalil I. El-Chammas
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA,Address for correspondence: Dr. Khalil I. El-Chammas, 3333 Burnet Ave, Cincinnati, Ohio - 45229, USA. E-mail:
| | - Neha R. Santucci
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Sherief Mansi
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Ajay Kaul
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
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de Bruijn CM, Rexwinkel R, Gordon M, Sinopoulou V, Benninga MA, Tabbers MM. Dietary interventions for functional abdominal pain disorders in children: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2022; 16:359-371. [PMID: 35311425 DOI: 10.1080/17474124.2022.2055547] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Functional abdominal pain disorders (FAPDs) are common among children and are associated with decreased quality of life and school attendance. Several dietary interventions have been suggested to improve symptoms of FAPDs. This systematic review assessed the efficacy and safety of dietary interventions for pediatric FAPDs. DESIGN AND METHODS Electronic databases were searched (inception-October 2021). Systematic reviews or RCTs were included if children (4-18 years) with FAPDs were treated with dietary interventions and compared to placebo, no diet or any other diet. Data extraction and assessment of quality of evidence based on GRADE system was independently performed by two review authors. Outcomes were treatment success, pain intensity and frequency, and withdrawal due to adverse events. RESULTS Twelve articles were included, representing data of 819 pediatric FAPD patients. Trials investigating fibers, FODMAP diet, fructans, fructose-restricted diet, prebiotic (inulin), serum-derived bovine immunoglobulin, and vitamin D supplementation were included. We found very low-certainty evidence that the use of fibers leads to higher treatment success (NNT = 5). CONCLUSION Based on current evidence, the use of fibers can be discussed in daily practice. High-quality intervention trials are highly needed to investigate if other dietary interventions are effective in the treatment of pediatric FAPD.
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Affiliation(s)
- Clara Ma de Bruijn
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands
| | - Robyn Rexwinkel
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
| | | | - Marc A Benninga
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Klimenko ES, Belkova NL, Romanitsa AI, Pogodina AV, Rychkova LV. Diversity and Metabolic Potential of the Gut Microbiome in Adolescents with Functional Bowel Disorder. Bull Exp Biol Med 2022; 172:681-685. [PMID: 35501656 DOI: 10.1007/s10517-022-05456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Indexed: 10/18/2022]
Abstract
The article presents the results of a pilot study of the diversity and metabolic potential of the gut microbiome in adolescents with various forms of functional bowel disorder. The participants were the patients of the Clinic of Research Center for Family Health and Human Reproduction Problems. Biological material was studied using metagenomic sequencing of V3-V4 variable regions of the 16S rRNA gene. We showed that the composition of the minor component of the intestinal microbiome in adolescents with functional bowel disorder differs from that in the healthy subjects (control). Different types of transit disturbances in functional bowel disorder also differ from each other. According to the metabolic potential, adolescents can be divided into two groups irrespective of the pathophysiological manifestations: for one group, a more intensive metabolism in amino acid and lipid biosynthesis pathways was predicted than for the other.
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Affiliation(s)
- E S Klimenko
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia.
| | - N L Belkova
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - A I Romanitsa
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - A V Pogodina
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
| | - L V Rychkova
- Research Center for Family Health and Human Reproduction Problems, Irkutsk, Russia
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Friesen AS, Livitz M, Glynn EF, Schurman JV, Colombo JM, Friesen CA. High Rate of Emergency Department Care in Youth With Abdominal Pain-Associated Functional Gastrointestinal Disorders. Pediatr Emerg Care 2022; 38:e1041-e1045. [PMID: 35226628 DOI: 10.1097/pec.0000000000002647] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The primary objective was to describe patterns of care delivery locations in youth with abdominal pain-associated functional gastrointestinal disorders (AP-FGID) and assess for differences in patterns of care delivery by sex and race. A secondary objective was to describe cost variability within the emergency department (ED). METHODS Data were obtained using a large, single-vendor database that extracts and deidentifies data from the electronic health record across the outpatient, ED, and inpatient continuum of care. We evaluated patients 8 to 17 years of age seen over an 8-year period for a priority 1 diagnosis of an AP-FGID. Data collected included age, sex, race, encounter location, and total cost of ED encounters. We specifically assessed how often patients seen in the ED were also seen in outpatient or inpatient settings. RESULTS A total of 53,750 patients (64% female; mean age, 13.3 ± 2.8 years) were identified and assessed. The most common location of care was the ED (48.8%) followed by the outpatient setting (46.2%). Of patients seen for a priority 1 AP-FGID diagnosis in the ED, only 3.7% were seen for a priority 1 diagnosis in the outpatient setting, and only 1% were seen in an inpatient setting. Overall, females received 42.5% of their care and males received 44.8% of their care in the ED. The overall rate of ED care was 66.9% for Hispanic, 61.5% for African American, 55.1% for Asian, 46.6% for Native American, and 36.9% for Caucasian patients. CONCLUSIONS The ED is the most common location for care for youth with AP-FGIDs and, for the majority, seems to be the only location. This seems to be particularly true for Hispanic and African American patients. Given the often complex psychosocial needs of this patient group, processes need to be developed to transition these patients into the outpatient setting, ideally to programs specializing in chronic pain.
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Affiliation(s)
| | | | | | - Jennifer V Schurman
- Children's Mercy Kansas City, University of Missouri Kansas-City School of Medicine, Kansas City, MO
| | - Jennifer M Colombo
- Children's Mercy Kansas City, University of Missouri Kansas-City School of Medicine, Kansas City, MO
| | - Craig A Friesen
- Children's Mercy Kansas City, University of Missouri Kansas-City School of Medicine, Kansas City, MO
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37
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Piriyakitphaiboon V, Sirinam S, Noipayak P, Sirivichayakul C, Pornrattanarungsri S, Limkittikul K. Risk Factors for Recurrent Abdominal Pain in Children with Nonorganic Acute Abdominal Pain. Pediatr Gastroenterol Hepatol Nutr 2022; 25:129-137. [PMID: 35360380 PMCID: PMC8958051 DOI: 10.5223/pghn.2022.25.2.129] [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: 09/01/2021] [Revised: 11/22/2021] [Accepted: 02/06/2022] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The purpose of this study was to identify the risk factors for recurrent abdominal pain (RAP) in children who presented with nonorganic acute abdominal pain. METHODS A retrospective, single study was conducted on 2-15-year-old children diagnosed with nonorganic acute abdominal pain at the pediatric outpatient department of Vajira Hospital, Nawamindradhiraj University, between January 2015 and December 2019. The potential risk factors were analyzed using univariate and multivariate analyses. RESULTS Of the 367 patients with nonorganic acute abdominal pain, 94 (25.6%) experienced RAP within three months. In this group with RAP, 76 patients (80.8%) were diagnosed with functional gastrointestinal disorders, including functional dyspepsia, irritable bowel syndrome, functional abdominal pain-not otherwise specified, and functional constipation. History of gastrointestinal infection (p=0.011), mental health problems (p=0.022), abdominal pain lasting ≥7 days (p<0.001), and change in stool frequency (p=0.001) were the independent risk factors associated with RAP in children with nonorganic acute abdominal pain; their odds ratios and 95% confidence intervals were 3.364 (1.314-8.162), 3.052 (1.172-7.949), 3.706 (1.847-7.435), and 2.649 (1.477-4.750), respectively. CONCLUSION RAP is a common problem among children who first present with nonorganic acute abdominal pain. The identification of risk factors may provide proper management, especially follow-up plans for this group in the future.
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Affiliation(s)
- Varisa Piriyakitphaiboon
- Department of Pediatrics, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Salin Sirinam
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pongsak Noipayak
- Department of Pediatrics, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Suwanna Pornrattanarungsri
- Department of Pediatrics, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kriengsak Limkittikul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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38
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Chu A, Torres L, Kao G, Gilbert C, Monico EC, Chumpitazi BP. Multidisciplinary Care for Refractory Pediatric Functional Abdominal Pain Decreases Emergency and Inpatient Utilization. J Pediatr Gastroenterol Nutr 2022; 74:248-252. [PMID: 34560729 PMCID: PMC8799479 DOI: 10.1097/mpg.0000000000003305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Children with refractory functional abdominal pain (FAP) experience functional disability and may utilize emergency department (ED) and/or inpatient services. Whether multidisciplinary programs which help care for children with refractory FAP affect acute healthcare utilization is unknown. A retrospective chart review of children initially evaluated by the outpatient Multidisciplinary Abdominal Pain Program (MAPP) from October 2016 to May 2019 was completed. Patient characteristics and number of ED visits and hospitalizations for abdominal pain in the year prior to versus year after MAPP evaluation were captured. Thirty-eight children (ages 9-17 years [median 13 years]) were included. The median number of ED visits/patient/year decreased from 1 (range: 0-7) to 0 (range: 0-3) (P < 0.0001). Seven (18%) children had been hospitalized and, in these children, the median number of hospitalizations/patient/year decreased from 1 (range: 1-5) to 0 (range: 0-1) (P < 0.05). These data suggest multidisciplinary outpatient intervention for refractory FAP is associated with significant decreases in acute healthcare utilization.
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Affiliation(s)
- Andrew Chu
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine/Texas Children’s Hospital
| | - Laura Torres
- Department of Anesthesia, Baylor College of Medicine/Texas Children’s Hospital
| | - Grace Kao
- Department of Anesthesia, Baylor College of Medicine/Texas Children’s Hospital
| | - Caroyl Gilbert
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine/Texas Children’s Hospital
| | - Evelyn Caro Monico
- Stanford Medicine Department of Anesthesia, Perioperative and Pain Medicine, Palo Alto, California
| | - Bruno P. Chumpitazi
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine/Texas Children’s Hospital
- Children’s Nutrition Research Center, United States Department of Agriculture, Houston, TX
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39
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Kumari MV, Amarasiri L, Rajindrajith S, Devanarayana NM. Gastric motility and pulmonary function in children with functional abdominal pain disorders and asthma: A pathophysiological study. PLoS One 2022; 17:e0262086. [PMID: 34982797 PMCID: PMC8726504 DOI: 10.1371/journal.pone.0262086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An association has been shown between functional abdominal pain disorders (FAPDs) and asthma. However, the exact reason for this association is obscured. The main objective of this study is to identify the possible underlying pathophysiological mechanisms for the association between FAPDs and asthma using gastric motility and lung function tests. METHODS This was a cross-sectional comparative study that consisted of four study groups. Twenty-four children (age 7-12 years) each were recruited for four study groups; asthma only, FAPDs only, both asthma and FAPDs, and healthy controls. Asthma was diagnosed using the history and bronchodilator reversibility test. The diagnosis of FAPDs was made using Rome IV criteria. All subjects underwent ultrasound assessment of gastric motility and pulmonary function assessment by spirometry, using validated techniques. RESULTS All gastric motility parameters, gastric emptying rate, amplitude of antral contraction, and antral motility index, were significantly impaired in children with FAPDs only, children with asthma only, and children with both asthma & FAPDs, compared to controls (p<0.05). Pulmonary function parameters indicating airway obstruction (FEV1/FVC ratio, peak expiratory flow rate, FEF25-75%) were not impaired in children with FAPDs only compared to controls (p>0.05), but significantly impaired in children with asthma and children with both disorders. Antral motility index correlated with the FEV1/FVC ratio (r = 0.60, p = 0.002) and FEF25%-75% (r = 0.49, p = 0.01) in children with both asthma and FAPDs. CONCLUSIONS Gastric motor functions were significantly impaired in children with asthma, children with FAPDs, and children with both disorders. Motility index, measuring overall gastric motor activity, showed a significant positive correlation with lung function parameters that measure airflow limitation. Therefore, these diseases might arise as a result of primary disturbance of smooth muscle activity in the airways and gastrointestinal wall, which could be a possible pathophysiological mechanism for this association between asthma and FAPDs.
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Affiliation(s)
- Manori Vijaya Kumari
- Department of Physiology, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, North Central Province, Sri Lanka
| | - Lakmali Amarasiri
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Western Province, Sri Lanka
| | - Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, Western Province, Sri Lanka
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40
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Layer P, Andresen V, Allescher H, Bischoff SC, Claßen M, Elsenbruch S, Freitag M, Frieling T, Gebhard M, Goebel-Stengel M, Häuser W, Holtmann G, Keller J, Kreis ME, Kruis W, Langhorst J, Jansen PL, Madisch A, Mönnikes H, Müller-Lissner S, Niesler B, Pehl C, Pohl D, Raithel M, Röhrig-Herzog G, Schemann M, Schmiedel S, Schwille-Kiuntke J, Storr M, Preiß JC, Andus T, Buderus S, Ehlert U, Engel M, Enninger A, Fischbach W, Gillessen A, Gschossmann J, Gundling F, Haag S, Helwig U, Hollerbach S, Karaus M, Katschinski M, Krammer H, Kuhlbusch-Zicklam R, Matthes H, Menge D, Miehlke S, Posovszky MC, Schaefert R, Schmidt-Choudhury A, Schwandner O, Schweinlin A, Seidl H, Stengel A, Tesarz J, van der Voort I, Voderholzer W, von Boyen G, von Schönfeld J, Wedel T. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1323-1415. [PMID: 34891206 DOI: 10.1055/a-1591-4794] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P Layer
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - V Andresen
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - H Allescher
- Zentrum für Innere Medizin, Gastroent., Hepatologie u. Stoffwechsel, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - S C Bischoff
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart, Deutschland
| | - M Claßen
- Klinik für Kinder- und Jugendmedizin, Klinikum Links der Weser, Bremen, Deutschland
| | - S Elsenbruch
- Klinik für Neurologie, Translational Pain Research Unit, Universitätsklinikum Essen, Essen, Deutschland.,Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - M Freitag
- Abteilung Allgemeinmedizin Department für Versorgungsforschung, Universität Oldenburg, Oldenburg, Deutschland
| | - T Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - M Gebhard
- Gemeinschaftspraxis Pathologie-Hamburg, Hamburg, Deutschland
| | - M Goebel-Stengel
- Innere Medizin II, Helios Klinik Rottweil, Rottweil, und Innere Medizin VI, Psychosomat. Medizin u. Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - W Häuser
- Innere Medizin I mit Schwerpunkt Gastroenterologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
| | - G Holtmann
- Faculty of Medicine & Faculty of Health & Behavioural Sciences, Princess Alexandra Hospital, Brisbane, Australien
| | - J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - M E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - J Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Deutschland
| | - P Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - A Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover, Hannover, Deutschland
| | - H Mönnikes
- Klinik für Innere Medizin, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | | | - B Niesler
- Abteilung Molekulare Humangenetik Institut für Humangenetik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Pehl
- Medizinische Klinik, Krankenhaus Vilsbiburg, Vilsbiburg, Deutschland
| | - D Pohl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - M Raithel
- Medizinische Klinik II m.S. Gastroenterologie und Onkologie, Waldkrankenhaus St. Marien, Erlangen, Deutschland
| | | | - M Schemann
- Lehrstuhl für Humanbiologie, TU München, Deutschland
| | - S Schmiedel
- I. Medizinische Klinik und Poliklinik Gastroenterologie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - J Schwille-Kiuntke
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Tübingen, Deutschland.,Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Storr
- Zentrum für Endoskopie, Gesundheitszentrum Starnberger See, Starnberg, Deutschland
| | - J C Preiß
- Klinik für Innere Medizin - Gastroenterologie, Diabetologie und Hepatologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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Walker LS, Stone AL, Han GT, Garber J, Bruehl S, Smith CA, Anderson J, Palermo TM. Internet-delivered cognitive behavioral therapy for youth with functional abdominal pain: a randomized clinical trial testing differential efficacy by patient subgroup. Pain 2021; 162:2945-2955. [PMID: 34793406 PMCID: PMC8602868 DOI: 10.1097/j.pain.0000000000002288] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/22/2021] [Indexed: 12/19/2022]
Abstract
ABSTRACT Inconsistent results of psychological treatments for pediatric functional abdominal pain (FAP) may be due to heterogeneity of patients' pain-related psychological characteristics. This randomized controlled trial tested whether statistically derived patient subgroups (high pain dysfunctional [HPD], high pain adaptive [HPA], and low pain adaptive [LPA]) moderated response to cognitive behavior therapy (CBT) for adolescents with FAP and their parents (n = 278 dyads; patients were 66% female, mean [SD] age was 14.62 [1.88] years, and parents were 95% female). Randomization to Internet-delivered CBT vs Internet-delivered pain education (EDU) was stratified by patient subgroup. Follow-up assessments of gastrointestinal (GI) symptoms (primary outcome), abdominal pain, and pain interference were at midtreatment, posttreatment, 6 months, and 12 months. Data were analysed using linear mixed effects models. Significant treatment × subgroup × time interaction effects showed that patient subgroup significantly moderated the effect of treatment on GI symptoms (t[853 = -2.93, P = 0.003) and abdominal pain (t(844) = -2.14, P = 0.03) across the treatment period. Among HPD youth, those in CBT had significantly greater GI symptom reduction than those in EDU through posttreatment. By contrast, among HPA and LPA youth, symptom improvement did not differ by treatment condition. Furthermore, among all patients assigned to CBT, HPD youth demonstrated significantly greater reductions in GI symptoms compared with HPA and LPA youth and greater reductions in abdominal pain compared with LPA youth. All subgroups maintained symptom reductions throughout the follow-up period. Results suggest that subgrouping FAP patients may inform treatment allocation and optimize treatment response.
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Affiliation(s)
- Lynn S. Walker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Gloria T. Han
- Child Study Center, Yale University School of Medicine, New Haven, CT
- Department of Psychology, Vanderbilt University, Nashville, TN
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Craig A. Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Julia Anderson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington
- Seattle Children’s Research Institute, Seattle, WA
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Strisciuglio C, Martinelli M, Lu P, Bar Lev MR, Beinvogl B, Benninga MA, Di Lorenzo C, Fiori Nastro F, Nurko S, Pearlstein H, Rosen R, Shamir R, Staiano A. Overall Impact of Coronavirus Disease 2019 Outbreak in Children With Functional Abdominal Pain Disorders: Results From the First Pandemic Phase. J Pediatr Gastroenterol Nutr 2021; 73:689-694. [PMID: 34417400 DOI: 10.1097/mpg.0000000000003286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We aimed to assess how the first phase of coronavirus disease 2019 (COVID-19) pandemic influenced symptoms in children with functional abdominal pain disorders (FAPDs) and to characterize their quality of life (QoL), anxiety and global health. METHODS This was a multicenter, observational, international study conducted between April and July 2020 at six different referral centers. Children diagnosed with FAPDs between October 2019 and February 2020 were enrolled and prospectively interviewed at 4 months of follow-up during the first pandemic phase (Quarantine group). Patients were asked to complete PedsQL 4.0 Generic Core Scale and PROMIS Anxiety and Global Health questionnaires. A cohort of children diagnosed with FAPDs between October 2018 and February 2019 was used as a Control group. RESULTS Three-hundred-fifty-six children were enrolled of whom 180 (mean age at diagnosis: 14 ± 2.8 years) in the Quarantine group and 176 (mean age at diagnosis: 13 ± 2.8 years) in the Control group. At 4 months of follow-up, we observed a significant reduction of children reporting >5 episodes of abdominal pain per month when compared to baseline, in both groups (Quarantine group: 63.9% vs 42.2%, P < 0.001; Control group: 83.5% vs 50%, P < 0.001). The Quarantine group had median QoL values of 84.8 with 16.6% of children showing high anxiety values and 55% having decreased global health score. CONCLUSIONS We demonstrated symptoms' improvement at 4 months of follow-up in both cohorts. During the first months of the COVID-19 quarantine children with FAPDs showed satisfactory QoL and anxiety scores, suggesting positive effects of school closure and increased parental attention.
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Affiliation(s)
- Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Napoli
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Peter Lu
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Michal Rozenfeld Bar Lev
- Institute of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Beate Beinvogl
- Boston Children's Hospital, Harvard medical School, Boston, MA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Francesca Fiori Nastro
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Samuel Nurko
- Boston Children's Hospital, Harvard medical School, Boston, MA
| | - Haley Pearlstein
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Rachel Rosen
- Boston Children's Hospital, Harvard medical School, Boston, MA
| | - Raanan Shamir
- Institute of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
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Livitz M, Friesen AS, Glynn EF, Schurman JV, Colombo JM, Friesen CA. Healthcare System-to-System Cost Variability in the Care of Pediatric Abdominal Pain-Associated Functional Gastrointestinal Disorders. CHILDREN (BASEL, SWITZERLAND) 2021; 8:985. [PMID: 34828700 PMCID: PMC8622335 DOI: 10.3390/children8110985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to assess cost variability in the care of abdominal pain-associated functional gastrointestinal disorders (AP-FGIDS) in youth across health systems, races, and specific AP-FGID diagnoses. Patients, aged 8-17 years, with a priority 1 diagnosis corresponding to a Rome IV defined AP-FGID were identified within the Health Facts® database. Total costs were obtained across the continuum of care including outpatient clinics, emergency department, and inpatient or observation units. Cost variability was described comparing different health systems, races, and diagnoses. Thirteen thousand two hundred and fourteen patients were identified accounting for 17,287 encounters. Total costs were available for 38.7% of the encounters. There was considerable variability in costs within and, especially, across health systems. Costs also varied across race, urban vs. rural site of care, and AP-FGID diagnoses. In conclusion, there was considerable variability in the costs for care of AP-FGIDs which is sufficient to support multi-site studies to understand the value of specific tests and treatments. Significant differences in costs by race merit further investigation to understand key drivers.
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Affiliation(s)
- Michelle Livitz
- Kansas City University of Medicine and Biosciences, 1750 Independence Ave., Kansas City, MO 64106, USA;
| | - Alec S. Friesen
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, MO 66160, USA;
| | - Earl F. Glynn
- Children’s Mercy Research Institute, 2401 Gillham Rd., Kansas City, MO 64108, USA;
| | - Jennifer V. Schurman
- Division of Pediatric Gastroenterology, Children’s Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO 64108, USA; (J.V.S.); (J.M.C.)
- School of Medicine, University of Missouri Kansas-City, 2411 Holmes Rd., Kansas City, MO 64108, USA
| | - Jennifer M. Colombo
- Division of Pediatric Gastroenterology, Children’s Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO 64108, USA; (J.V.S.); (J.M.C.)
- School of Medicine, University of Missouri Kansas-City, 2411 Holmes Rd., Kansas City, MO 64108, USA
| | - Craig A. Friesen
- Division of Pediatric Gastroenterology, Children’s Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO 64108, USA; (J.V.S.); (J.M.C.)
- School of Medicine, University of Missouri Kansas-City, 2411 Holmes Rd., Kansas City, MO 64108, USA
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44
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Pesce M, Puoti MG, Rybak A, Andreozzi M, Bruzzese E, Sarnelli G, Borrelli O. Pharmacological interventions for pediatric irritable bowel syndrome. Expert Opin Pharmacother 2021; 23:91-103. [PMID: 34523358 DOI: 10.1080/14656566.2021.1976753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Irritable bowel syndrome is a common functional gastrointestinal disorder in children, characterized by recurrent abdominal pain associated with altered bowel habits in terms of both frequency and consistency. According to change in stool consistency it is categorized into 4 subtypes. From the etiological perspective, it is a combination of factors takes part in symptoms' generation, the overall treatment response rate is often unsatisfactory if a multidisciplinary is not pursued. AREAS COVERED The aim of this manuscript is to summarize the current pharmacotherapy in pediatric irritable bowel syndrome in order to aid clinicians in treating this challenging disorder. EXPERT OPINION Most evidence involving pediatric populations rely on open label or retrospective studies and/or are not specifically designed for irritable bowel syndrome but tend to generalize their results to mixed populations of children with functional gastrointestinal disorders. A high placebo response rate combined with poor patients' selection could account for the overall weak evidence supporting the use of pharmacological agents in pediatric irritable bowel syndrome. Given the multifaceted nature of the disorder, multidisciplinary approaches combining pharmacotherapy with alternative treatments is highly recommendable.
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Affiliation(s)
- Marcella Pesce
- Department of Clinical Medicine and Surgery, University "Federico Ii" of Naples, Naples, Italy
| | - Maria Giovanna Puoti
- Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for children, London, UK
| | - Anna Rybak
- Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for children, London, UK
| | - Marta Andreozzi
- Department of Clinical Medicine and Surgery, University "Federico Ii" of Naples, Naples, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Science, University "Federico Ii" of Naples, Naples, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University "Federico Ii" of Naples, Naples, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for children, London, UK
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Thomaz de Almeida CN, Tahan S, Areco KN, Morais MBD. Association between abuse and neglect with functional constipation and irritable bowel syndrome in adolescents. Scand J Gastroenterol 2021; 56:1146-1151. [PMID: 34469265 DOI: 10.1080/00365521.2021.1923059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the association between violence exposure, abuse, and neglect victimization with functional constipation and irritable bowel syndrome in adolescents. METHODS Observational cross-sectional case-control study conducted with adolescents from two public schools in the municipality of Osasco, metropolitan region of São Paulo, Brazil. A self-administered questionnaire validated for Brazilian Portuguese Child Abuse Screening Tools - Children's version (ICAST-C) was used to screen the different types of violence. The definition of functional constipation and irritable bowel syndrome was performed using the Rome IV criteria for adolescents. Parents or legal guardians completed the questionnaire for socioeconomic assessment and signed the informed consent form. RESULTS 265 students aged 11-17 years, 157 females, were evaluated. Functional constipation and irritable bowel syndrome were found in 74 (27.9%) of the 265 adolescents. Violence exposure was found in 82.6% of the 265 screened adolescents, physical abuse in 91.3%, psychological abuse in 93.2%, sexual abuse in 12.1%, and neglect in 53.6%. The multiple logistic regression analysis showed an association (p < .05) between functional constipation and irritable bowel syndrome with violence exposure (OR = 2.77), physical abuse (OR = 2.17), psychological abuse (OR = 2.95), and neglect (OR= 2.31). There was no association with sexual abuse. CONCLUSIONS Functional constipation and irritable bowel syndrome were associated with violence exposure, physical abuse, psychological abuse, and neglect in adolescent students from public schools. No association was found with sexual abuse. Further studies are necessary to investigate the causal relationship between violence and functional gastrointestinal disorders.
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Affiliation(s)
- Camila Nunes Thomaz de Almeida
- Division of Pediatric Gastroenterology, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Soraia Tahan
- Division of Pediatric Gastroenterology, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kelsy Nema Areco
- Division of Health Informatics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauro Batista de Morais
- Division of Pediatric Gastroenterology, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Högström S, Philipson A, Ekstav L, Eriksson M, Fagerberg UL, Falk E, Möller M, Sandberg E, Särnblad S, Duberg A. Dance and yoga reduced functional abdominal pain in young girls: A randomized controlled trial. Eur J Pain 2021; 26:336-348. [PMID: 34529293 DOI: 10.1002/ejp.1862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Functional abdominal pain disorders (FAPDs) affect children, especially girls, all over the world. The evidence for existing treatments is mixed, and effective accessible treatments are needed. Dance, a rhythmic cardio-respiratory activity, combined with yoga, which enhances relaxation and focus, may provide physiological and psychological benefits that could help to ease pain. OBJECTIVES The aim of this study was to evaluate the effect of a dance and yoga intervention on maximum abdominal pain in 9- to 13-year- old girls with FAPDs. METHODS This study was a prospective randomized controlled trial with 121 participants recruited from outpatient clinics as well as the general public. The intervention group participated in dance and yoga twice weekly for 8 months; controls received standard care. Abdominal pain, as scored on the Faces Pain Scale-Revised, was recorded in a pain diary. A linear mixed model was used to estimate the outcomes and effect sizes. RESULTS Dance and yoga were superior to standard health care alone, with a medium to high between-group effect size and significantly greater pain reduction (b = -1.29, p = 0.002) at the end of the intervention. CONCLUSIONS An intervention using dance and yoga is likely a feasible and beneficial complementary treatment to standard health care for 9- to 13-year-old girls with FAPDs. SIGNIFICANCE FAPDs affect children, especially girls, all over the world. The negative consequences such as absence from school, high consumption of medical care and depression pose a considerable burden on children and their families and effective treatments are needed. This is the first study examining a combined dance/yoga intervention for young girls with FAPDs and the result showed a reduction of abdominal pain. These findings contribute with new evidence in the field of managing FAPDs in a vulnerable target group.
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Affiliation(s)
- Sofie Högström
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anna Philipson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lars Ekstav
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ulrika L Fagerberg
- Department of Pediatrics, Center for Clinical Research, Västmanland Hospital, Västerås, Uppsala University Uppsala, Västerås, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Elin Falk
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Child and Adolescent Psychiatry, Uppsala University hospital, Uppsala, Sweden
| | - Margareta Möller
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Elin Sandberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Clinical Sciences, Center for primary Health Care Research, Lund University, Malmö, Sweden
| | - Stefan Särnblad
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anna Duberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Jiménez Candel MI, Salvador Pinto T, García Peris M, Crehuá Gaudiza E, Jovaní Casano C, Moreno Ruiz MA, Hernández Bertó T, Largo Blanco E, Martínez Costa C. Rendimiento de las pruebas complementarias en el estudio de pacientes con dolor abdominal crónico. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpedi.2020.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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48
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Jiménez Candel MI, Salvador Pinto T, García Peris M, Crehuá Gaudiza E, Jovaní Casano C, Moreno Ruiz MA, Hernández Bertó T, Largo Blanco E, Martínez Costa C. Usefulness of complementary test in the study of patients with chronic abdominal pain. An Pediatr (Barc) 2021; 95:26-32. [PMID: 34092539 DOI: 10.1016/j.anpede.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/11/2020] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Chronic abdominal pain (CAP) in children is a symptom that frequently leads to a visit to the paediatrician, which affects family life and occasionally requires the need to perform diagnostic studies (DS). The objective was to carry out a qualitative, quantitative, and economic analysis on the tests requested. MATERIAL AND METHODS An observational, prospective and multicentre study was conducted that included children between 4-15 years old affected by CAP. The difference between organic and functional disorders was taken into account. The following variables were collected: history, warning signs and symptoms, DS, and the cost of these. RESULTS The study included 235 children with CAP (Age; mean 9.7 ± 2.7 SD). The large majority (79%) were functional disorders and 21% organic disorders. Almost half of the patients had some warning sign or symptom, but urinary symptoms were only associated with organic disorders. The abdominal ultrasound, faecal parasites, breath test, and endoscopy were the most associated with organic disorders. There was a difference between the costs of the DS according to each centre. The total economic cost was 52,490.80 euros, with 195 euros per patient for functional disorders and 306 euros for organic disorders. CONCLUSION Signs and symptoms of alarm in CAP were very frequent, but had low discriminative capacity. The abdominal ultrasound and faecal parasites are innocuous DS, and could be useful as a first level study. The endoscopy and the breath test were the most discriminative of organic disease. The economic cost of DS arising from the diagnosis of exclusion in CAP was high.
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Affiliation(s)
| | - Tatiana Salvador Pinto
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital de la Marina Baja, Villajoyosa, Spain
| | - Mónica García Peris
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Lluís Alcanyís, Xátiva, Valencia, Spain
| | - Elena Crehuá Gaudiza
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Carmen Jovaní Casano
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital General Universitario de Castellón, Castellón, Spain
| | | | - Tomás Hernández Bertó
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital General Universitario de Albacete, Albacete, Spain
| | - Esther Largo Blanco
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital General Universitario de Valencia, Valencia, Spain
| | - Cecilia Martínez Costa
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Valencia, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
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49
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Madani S, Madani R, Parikh S, Manivannan A, Orellana WR, Thomas R, Di Lorenzo C. Symptomatic Treatment of Pain-Related Pediatric Functional Gastrointestinal Disorders in a Biopsychosocial Construct, and a Validity Study of Rome III Criteria. Clin Pediatr (Phila) 2021; 60:304-313. [PMID: 33973488 DOI: 10.1177/00099228211007964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study aims to assess improvement with symptomatic treatment of pain-related functional gastrointestinal disorders (FGIDs) in a biopsychosocial construct and evaluate validity of Rome III criteria. Children with chronic abdominal pain diagnosed with an FGID or organic disease were followed for 1 year: 256/334 were diagnosed with an FGID and 78/334 were diagnosed with a possible organic disease due to alarm signs or not meeting Rome III criteria. After 1 year, 251 had true FGID and 46 had organic diseases. Ninety percent of FGID patients improved with symptomatic treatment over an average of 5.4 months. With a 95% confidence interval, Rome criteria predicted FGIDs with sensitivity 0.89, specificity 0.90, positive predictive value 0.98, and negative predictive value 0.59. We conclude that symptomatic treatment of pain-related FGIDs results in clinical improvement and could reduce invasive/expensive testing. Rome III criteria's high specificity and positive predictive value suggest they can rule in a diagnosis of FGID.
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Affiliation(s)
| | - Rohit Madani
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Suchi Parikh
- Cook Children's Physician Network, Fort Worth, TX, USA
| | | | - Wilma R Orellana
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Ron Thomas
- Children's Hospital of Michigan, Troy, MI, USA
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50
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Rexwinkel R, de Bruijn CMA, Gordon M, Benninga MA, Tabbers MM. Pharmacologic Treatment in Functional Abdominal Pain Disorders in Children: A Systematic Review. Pediatrics 2021; 147:peds.2020-042101. [PMID: 34045320 DOI: 10.1542/peds.2020-042101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Functional abdominal pain disorders (FAPDs) are common in childhood, impacting quality of life and school attendance. There are several compounds available for the treatment of pediatric FAPDs, but their efficacy and safety are unclear because of a lack of head-to-head randomized controlled trials (RCTs). OBJECTIVE To systematically review the efficacy and safety of the pharmacologic treatments available for pediatric FAPDs. DATA SOURCES Electronic databases were searched from inception to February 2021. STUDY SELECTION RCTs or systematic reviews were included if the researchers investigated a study population of children (4-18 years) in whom FAPDs were treated with pharmacologic interventions and compared with placebo, no treatment, or any other agent. DATA EXTRACTION Two reviewers independently performed data extraction and assessed their quality. Any interresearcher disagreements in the assessments were resolved by a third investigator. RESULTS Seventeen articles representing 1197 children with an FAPD were included. Trials investigating antispasmodics, antidepressants, antibiotics, antihistaminic, antiemetic, histamine-2-receptor antagonist, 5-HT4-receptor agonist, melatonin, and buspirone were included. No studies were found on treatment with laxatives, antidiarrheals, analgesics, antimigraines, and serotonergics. LIMITATIONS The overall quality of evidence on the basis of the Grading of Recommendations, Assessment, Development and Evaluations system was very low to low. CONCLUSIONS On the basis of current evidence, it is not possible to recommend any specific pharmacologic agent for the treatment of pediatric FAPDs. However, agents such as antispasmodics or antidepressants can be discussed in daily practice because of their favorable treatment outcomes and the lack of important side effects. High-quality RCTs are necessary to provide adequate pharmacologic treatment. For future intervention trials, we recommend using homogenous outcome measures and instruments, a large sample size, and long-term follow-up.
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Affiliation(s)
- Robyn Rexwinkel
- Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; .,Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Academic Medical Center and Emma Children's Hospital, Amsterdam, The Netherlands.,Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and.,Contributed equally as co-first authors
| | - Clara M A de Bruijn
- Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Academic Medical Center and Emma Children's Hospital, Amsterdam, The Netherlands.,Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and.,Contributed equally as co-first authors
| | - Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Marc A Benninga
- Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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