Epidemiology of functional gastrointestinal disorders in children and adolescents: A systematic review

Table 1 Classification of functional gastrointestinal disorders in children and adolescents

	Rome IV nomenclature1	Frequency	Duration	Synonym, subtypes or approximate terms
H1: Functional nausea and vomiting disorders
H1a.	Cyclic vomiting syndrome	≥ 2 periods of intense, unremitting nausea and paroxysmal vomiting	h-d/6 mo	Periodic vomiting
H1b1.	Functional nausea	≥ 2 nausea episodes/wk	≥ 2 mo	Bothersome nausea
H1b2.	Functional vomiting	≥ 1 vomiting episode/wk	≥ 2 mo	-
H1c.	Rumination syndrome	Repetitive regurgitation and rechewing or expulsion of food	≥ 2 mo	Adolescent rumination syndrome2; regurgitation, reswallowing, spitting
H1d.	Aerophagia	Repetitive belching and/or increased flatus	≥ 2 mo	-
H2: Functional abdominal pain disorders
H2a.	Functional dyspepsia	≥ 1 symptom for ≥ 4 d/mo	≥ 2 mo	Postprandial distress syndrome;
				Epigastric pain syndrome
H2b.	Irritable bowel syndrome	Abdominal pain for ≥ 4 d/mo	≥ 2 mo	Abdominal discomfort2;
				Manning criteria
H2c.	Abdominal migraine	≥ 2 intense abdominal pain episodes	≥ 1 h/6 mo	Periumbilical pain2
H2d.	Functional abdominal pain - not otherwise specified	≥ 4 episodic or continuous abdominal pain/mo	≥ 2 mo	Functional abdominal pain2;
				Functional abdominal pain syndrome2
H3: Functional defecations disorders
H3a.	Functional constipation	≤ 2 defecations/wk	≥ 1 mo	-
		≥ 1 fecal incontinence/wk
H3b.	Nonretentive fecal incontinence	Episodes of fecal loss	≥ 1 mo	-

¹After appropriate evaluation, the symptoms cannot be fully explained by another medical condition;

²Rome III nomenclature.

Table 2 Prevalence or frequency of functional gastrointestinal disorders: Nausea and vomiting problems in children and adolescents

Author, year, country	Study design, setting	Sample size (participation %)	Age bracket yr	Case definition	Case ascertainment	Score1	FGID subtype prevalence % (CI 95%)
							Cyclic vomiting	Aerophagia	Rumination
Bhatia et al[6], 2016, India	Cross-sectional, school-based	1200 (93.3)	10-17	Rome III	Self-reported QPGS-RIII	5	0.2	1.5	0.3
					Medical records
					Physical examination
Caplan et al[18], 2005, Canada	Cross-sectional, tertiary care	315 (NR)	4-18	Rome II	Self-reported QPGS	3	p 4-9 yr = 6.2	p 4-9 yr = 1.1
					Parental QPGS		p 10-18 yr = 2.2	p 10-18 yr = 2.2
					Clinical evaluation		a 10-18 yr = 4.3	a 10-18 yr = 1.4
Devanarayana et al[36], 2010, Sri Lanka	Cross-sectional, school-based	464 (92)	12-16	Rome II	Self-reported QPGS	4	0.2	6.1
				Rome III			0.5	6.3	4.0
Helgeland et al[35], 2009, Norway	Cross-sectional, secondary care	192 (79.1)	4-15	Rome III	Parental QPGS-III	3	6.0	15.0	2.0
					Clinical evaluation
					Medical records
					Physical examination
					Laboratory exams
Játiva et al[30], 2016, Ecuador	Cross-sectional, school-based	420 (99.3)	8-15	Rome III	Self-reported QPGS-RIII	3	1.0	2.6	0.7
					Parental standard questionnaire
Lewis et al[25], 2016, United States	Cross-sectional, online panel community	1447 (NR)	4-18	Rome III	Parental QPGS-RIII	2	1.1	4.3	0.0
					PedsQL4.0
Lu et al[28], 2016, Panama	Cross-sectional, school-based	436 (82.8)	8-14	Rome III	Self-reported QPGS-RIII	4	0.3 (0.0-0.9)	0.3 (0.0-0.9)	0.0
					Parental standard questionnaire
Sagawa et al[16], 2012, Japan	Cross-sectional, school-based	3976 (NR)	10-17	Rome III	Self-reported QPGS-RIII	6	0.2	2.0	0.1
					Self-reported PedsQL4.0
					Clinical evaluation
Saps et al[26], 2014, Colombia	Cross-sectional, school-based	488 (83.2)	10.0 (mean age)	Rome III	Self-reported QPGS-RIII	4	0.3 (0.0-1.7)
					Parental standard questionnaire
Uc et al[22], 2006, United States	Cross-sectional, primary care	243 (100)	4-17	Rome II	Parental QPGS	4	0.8	2.5
					Clinical evaluation
van Tilburg et al[24], 2013, United States	Cross-sectional, tertiary care	135 (NR)	4-18	Rome III	Self-reported QPGS-III	3	p = 0.8	p = 0.8	p = 0.8
					Parental QPGS-III		c/a = 5.3	c/a = 3.5	c/a = 5.3
					Clinical evaluation		ph = 0	ph = 0	ph = 0
					Medical records
Zablah et al[27], 2015, El Salvador	Cross-sectional, school-based	434 (NR)	8-15	Rome III	Self-reported QPGS-RIII	3		0.5	0.2
					Parental standard questionnaire

¹Score: Methodological strength of study (maximum 8) by Loney’s criteria. NR: Not reported; w: With; p: Parents; c: Children; a: Adolescents; ph: Physician; QPGS-RIII: Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III; QPGS: Questionnaire on Pediatric Gastrointestinal Symptoms - Rome II; PedsQL4.0 Pediatric Quality of Life version Inventory 4.0.

Table 3 Prevalence or frequency of functional gastrointestinal disorders: Abdominal pain problems in children and adolescents

Author, year, country	Study design, setting	Sample size (participation %)	Age bracket yr	Case definition	Case ascertainment	Score1	FGID subtype prevalence %( 95%CI)
							Dyspepsia	Irritable bowel	Abdominal migraine	Abdominal pain - NOS
Baber et al[8], 2008, United States	Cross-sectional, tertiary care	548 (80.1)	8-17	Rome II	Parental QPGS	5	19.6	44.0	5.7	2.7
				Rome III	Clinical evaluation		15.2	45.1	23.1	17.4
					Medical records
					Laboratory exams
Bhatia et al[6], 2016, India	Cross-sectional, school-based	1200 (93.3)	10-17	Rome III	Self-reported QPGS-RIII	5	2.7	1.3	1.4	0.8
					Medical records
					Physical examination
Caplan et al[18], 2005, Canada	Cross-sectional, tertiary care	315 (NR)	4-18	Rome II	Self-reported QPGS	3	p 4-9 yr = 13.5	p 4-9 yr = 22.0	p 4-9 yr = 0	p 4-9 yr = 0
					Parental QPGS		p 10-18 yr = 14.4	p 10-18 yr = 23.9	p 10-18 yr = 0.7	p 10-18 yr = 2.9
					Clinical evaluation		a 10-18 yr = 10.2	a 10-18 yr = 35.5	a 10-18 yr = 2.2	a 10-18 yr = 2.9
Cristofori et al[33], 2014, Italy	Cross-sectional, tertiary care	992 (NR)	4-16	Rome III	Clinical evaluation	4	25.7	34.5	0.0	39.8
					Medical records
					Laboratory exams
Devanarayana et al[36], 2010, Sri Lanka	Cross-sectional, school-based	464 (92)	12-16	Rome II	Self-reported QPGS	4	1.2	2.8	0.2	1.4
				Rome III			3.5	7.0	0.2	3.0
Dong et al[37], 2005, China	Cross-sectional, school-based	5403 (NR)	6-18	Rome II	Self-reported standard questionnaire	6		13.2
					Parental standard questionnaire
					Medical records
Gijsbers et al[32], 2014, the Netherlands	Cross-sectional, secondary care	220 (NR)	4-16	Rome III	Clinical evaluation	3	3.6	5.0	0.0	15.0
					Medical records
					Laboratory exams
Gulewitsch et al[34], 2013, Germany	Cross-sectional, school-based	3658 (43.1)	5-12	Rome III	Parental QPGS-RIII	2	0.2	4.9	1.0	3.6
					Parental CSI
					Parental SDQ
Helgeland et al[35], 2009, Norway	Cross-sectional, secondary care	192 (NR)	4-15	Rome III	Parental QPGS-III	3	10.0	43.0	23.0	15.0
					Clinical evaluation
					Medical records
					Physical examination
					Laboratory exams
Játiva et al[30], 2016, Ecuador	Cross-sectional, school-based	420 (99.3)	8-15	Rome III	Self-reported QPGS-RIII	3	0.5	4.8	2.4	3.1
					Parental standard questionnaire
Lewis et al[25], 2016, United States	Cross-sectional, online painel community	1447 (NR)	4-18	Rome III	Parental QPGS-RIII	2	0.2	2.8	9.2	11.6
					PedsQL4.0
Lu et al[29], 2016, Colombia	Cross-sectional, school-based	4751 (89.8)	8-18	Rome III	Self-reported QPGS-RIII	3		4.8
					Parental standard questionnaire
Lu et al[28], 2016, Panama	Cross-sectional, school-based	436 (82.8)	8-14	Rome III	Self-reported QPGS-RIII	4	0.9 (0.0-2.0)	5.6 (3.1-8.1)	1.7 (0.2-2.9)	3.7 (1.7-5.8)
					Parental standard questionnaire					0.3 (0.0-0.9)
Sagawa et al[16], 2012, Japan	Cross-sectional, school-based	3976 (NR)	10-17	Rome III	Self-reported QPGS-RIII	6	0.9	5.9	1.8	4.2
					Self-reported PedsQL4.0
					Clinical evaluation
Saps et al[23], 2012, United States	Cross-sectional, Community	984 (25)	4-18	Rome III	Parental QPGS-III	2				8.1
Saps et al[26], 2014, Colombia	Cross-sectional, school-based	488 (83.2)	10.0 (mean age)	Rome III	Self-reported QPGS-RIII	4	1.7 (0.8-3.9)	5.4 (3.9-8.8)	1.0 (0.3-2.8)	2.7 (1.6-5.2)
					Parental standard questionnaire					0.3 (0.0-1.7)
Schurman et al[21], 2005, United States	Cross-sectional, tertiary care	205 (75)	8-18	Rome II	Self-reported QPGS	3	p = 47	p = 20;	p < 10	p < 10
					Parental QPGS		c/a = 35	c/a = 30;	c/a < 10;	c/a < 10
					Clinical evaluation		ph = 57	ph = 12	ph < 10	ph < 10
Uc et al[22], 2006, United States	Cross-sectional, primary care	243 (100)	4-17	Rome II	Parental QPGS	4	0.8	0.0	0.4	0.4
					Clinical evaluation
Udoh et al[41], 2016, Nigeria	Cross-sectional, school-based	856 (NR)	10-18	Rome III	Self-reported QPGS-RIII	4	0.4	5.6	1.8	2.6
					Standard questionnaires
Walker et al[20], 2004, United States	Cross-sectional, tertiary care	114 (NR)	4-17	Rome II	Parental QPGS	3	15.9	44.9	4.7	7.5
					Clinical evaluation
					Parental standard interview
					Medical records
					Physical examination
					Laboratory exams
Yamamoto et al[40], 2015, Japan	Cross-sectional, school-based	99416 (92.2)	12-18	Rome III	Self-reported standard questionnaire	6		18.6 (17.9-19.2)
Zablah et al[27], 2015, El Salvador	Cross-sectional, school-based	434 (NR)	8-15	Rome III	Self-reported QPGS-RIII	3	1.7	3.7	0.7	3.0
					Parental standard questionnaire
Zhou et al[38], 2011, China	Cross-sectional, school-based	3671 (NR)	12-18	Rome III	Self-reported standard questionnaire	5		19.8 (18.6-21.1)

¹Score: Methodological strength of study (maximum 8) by Loney’s criteria; NR: Not reported; w: With; p: Parents; c: Children; a: Adolescents; ph: Physician; QPGS-RIII: Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III; QPGS: Questionnaire on Pediatric Gastrointestinal Symptoms - Rome II; PedsQL4.0 Pediatric Quality of Life version Inventory 4.0CSI: Children’s Somatization Inventory; SDQ: Strengths and Difficulties Questionnaire.

Table 4 Prevalence or frequency of functional gastrointestinal disorders: Defecations problems in children and adolescents

Author, year, country	Study design, setting	Sample size (participation %)	Age bracket yr	Case definition	Case ascertainment	Score1	FGID subtype prevalence % (95%CI)
							Constipation	Nonretentive fecal incontinence
Bhatia et al[6], 2016, India	Cross-sectional, school-based	1200 (93.3)	10-17	Rome III	Self-reported QPGS-RIII	5	0.5	0.4
					Medical records
					Physical examination
Burgers et al[31], 2012, Netherlands	Cross-sectional (retrospective), tertiary care	176 (NR)	6-18	Rome II	Clinical evaluation	3	5.7
				Rome III	Medical records		86.9
					Physical examination
Caplan et al[18], 2005, Canada	Cross-sectional, tertiary care	315 (NR)	4-18	Rome II	Self-reported QPGS	3	p 4-9 yr = 19.2	p 4-9 yr = 0.6
					Parental QPGS		p 10-18 yr = 13.8	p 10-18 yr = 0.7
					Clinical evaluation		c/a 10-18 yr = 15.2	c/a 10-18 yr = 0.7
Devanarayana et al[36], 2010, Sri Lanka	Cross-sectional, school-based	464 (92)	12-16	Rome II	Self-reported QPGS	4	1.4	0.2
				Rome III			4.2	0.2
Helgeland et al[35], 2009, Norway	Cross-sectional, tertiary care	192 (NR)	4-15	Rome III	Parental QPGS-III	3	6.0
					Clinical evaluation
					Medical records
					Physical examination
					Laboratory exams
Játiva et al[30], 2016, Ecuador	Cross-sectional, school-based	420 (99.3)	8-15	Rome III	Self-reported QPGS-RIII	3	11.8	0.2
					Parental standard questionnaire
Lewis et al[25], 2016, United States	Cross-sectional, online painel community	1447 (NR)	4-18	Rome III	Parental QPGS-RIII	2	12.9	1.8
					PedsQL4.0
Lu et al[29], 2016, Colombia	Cross-sectional, school-based	4751 (89.8)	8-18	Rome III	Self-reported QPGS-RIII	3	12.7
					Parental standard questionnaire
Lu et al[28], 2016, Panama	Cross-sectional, school-based	436 (82.8)	8-14	Rome III	Rome III	4	15.9 (11.9-19.9)	0 (0.0-0.0)
					Self-reported QPGS-RIII
					Parental standard questionnaire
Rajindrajith et al[39], 2013, Sri Lanka	Cross-sectional, school-based	1855 (96.7)	13-18	Rome III	Self-reported QPGS-RIII	5	7.7
					Self-reported PedsQL4.0
Sagawa et al[16], 2012, Japan	Cross-sectional, school-based	3976 (NR)	10-17	Rome III	Rome III	6	0.3	0.2
					Self-reported QPGS-RIII
					Self-reported PedsQL4.0
					Clinical evaluation
Saps et al[26], 2014, Colombia	Cross-sectional, school-based	488 (83.2)	10.0 (mean age)	Rome III	Self-reported QPGS-RIII	4	14.0 (12.0-19.3)	1.5 (0.7-3.6)
					Parental standard questionnaire
Uc et al[22], 2006, United States	Cross-sectional, primary care	243 (100)	4-17	Rome II	Parental QPGS	4	16.1	0.4
					Clinical evaluation
Zablah et al[27], 2015, El Salvador	Cross-sectional, school-based	434 (NR)	8-15	Rome III	Self-reported QPGS-RIII	3	10.0	0.0
					Parental standard questionnaire
Zhou et al[38], 2011, China	Cross-sectional, school-based	3671 (NR)	12-18	Rome III	Self-reported standard questionnaire	5	24.9 (23.5-26.3)

¹Score: Methodological strength of study (maximum 8) by Loney’s criteria. NR: Not reported; w: With; p: Parents; c: Children; a: Adolescents; ph: Physician; QPGS-RIII: Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III; QPGS: Questionnaire on Pediatric Gastrointestinal Symptoms - Rome II; PedsQL4.0 Pediatric Quality of Life version Inventory 4.0.