Objectives The updated Rome III criteria for pediatric functional gastrointestinal disorders (FGIDs) include new FGID categories and changes to the Rome II criteria for various FGIDs. To our knowledge, the implications of these revisions for patient classification have not been identified. The purpose of this study was to compare classification results using Rome II versus Rome III criteria for FGIDs associated with chronic abdominal pain. Patients and Methods Participants were 368 pediatric patients whose subspecialty evaluations for chronic abdominal pain yielded no evidence of organic disease. The children’s gastrointestinal symptoms were assessed with the parent-report version of the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS). Results More patients met the criteria for a pediatric pain-related FGID according to the Rome III criteria (86.6%) than the Rome II criteria (68.0%). In comparison with the results from the Rome II criteria, the Rome III criteria classified a greater percentage of children as meeting criteria for Abdominal Migraine (23.1% vs 5.7%) and Functional Abdominal Pain (11.4% vs 2.7%). Irritable Bowel Syndrome was the most common diagnosis according to both Rome II (44.0%) and Rome III (45.1%). Conclusions Changes to the Rome criteria make the Rome III criteria more inclusive, allowing classification of 86.6% of pediatric patients with medically unexplained chronic abdominal pain.

Background & Aims Pediatric functional abdominal pain has been linked to functional gastrointestinal disorders (FGID) in adulthood, but little is known about patient characteristics in childhood that increase risk for FGID in young adulthood. We investigated the contribution of GI symptoms, extra-intestinal somatic symptoms, and depressive symptoms in pediatric patients with functional abdominal pain and whether these predicted FGIDs later in life. Methods In a longitudinal study, consecutive new pediatric patients, diagnosed with functional abdominal pain in a subspecialty clinic, completed a comprehensive baseline evaluation of the severity of their physical and emotional symptoms. They were contacted 5–15 years later and evaluated, based on Rome III symptom criteria, for abdominal pain-related FGIDs, including irritable bowel syndrome (IBS), functional dyspepsia, functional abdominal pain syndrome, and abdominal migraine. Controlling for age, sex, baseline severity of abdominal pain, and time to follow-up evaluation, multivariable logistic regression was used to evaluate the association of baseline GI, extra-intestinal somatic, and depressive symptoms in childhood with FGID in adolescence and young adulthood. Results Of 392 patients interviewed an average of 9.2 years after initial evaluation, 41% (n=162) met symptom criteria for FGID; most met the criteria for IBS. Extra-intestinal somatic and depressive symptoms at the initial pediatric evaluation were significant predictors of FGID later in life, after controlling for initial levels of GI symptoms. Age, sex, and abdominal pain severity at initial presentation were not significant predictors of FGID later in life. Conclusions In pediatric patients with functional abdominal pain, assessment of extra-intestinal and depressive symptoms may be useful in identifying those at risk for FGID in adolescence and young adulthood.

Objective The association between clinical symptoms and laboratory visceral sensitivity remains poorly defined and controversial. It has even been suggested that laboratory observations of visceral sensitivity are irrelevant to the clinical presentation of chronic visceral pain. To better understand this association, gastrointestinal and psychological features of pediatric patients’ clinical presentation were examined in relation to a laboratory-based measure of visceral sensitivity. Patients and Methods At the time of their medical evaluation, 101 patients with medically unexplained abdominal pain (ages 8–15 years) completed validated questionnaires assessing recent depressive symptoms, functional disability, pain efficacy beliefs, gastrointestinal (GI), and non-GI symptoms. These clinical features were examined in relation to visceral sensitivity assessed 2 months later in the laboratory. The measure of visceral sensitivity was based on increases in GI complaints in response to the water load symptom provocation task. Results More severe GI symptoms and functional disability in the weeks before patients’ clinical evaluation were associated with significantly greater increases in GI symptoms in the laboratory in response to the water load symptom provocation task (all P < 0.04). Patients believing that they had the ability to alleviate their pain (high problem-focused pain efficacy) had significantly lower laboratory visceral sensitivity (P < 0.01). Clinical depressive symptoms and non-GI symptoms were not associated with laboratory visceral sensitivity. Conclusions Clinical presentations of more severe GI symptoms and disability as well as low perceived pain efficacy are significant predictors of laboratory visceral sensitivity in children with functional abdominal pain. Depression does not account for the association between clinical presentation of GI symptoms and a laboratory measure of visceral sensitivity.

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.