Functional dyspepsia in children: A study of pathophysiological factors

Abstract

Background and Aim Functional dyspepsia (FD) is common in children, and treatment targeted towards the altered pathophysiology can improve outcome. We evaluated FD children for abnormality of gastric accommodation and emptying, psychological stressors (PS), Helicobacter pylori (HP) infection, and post‐infectious FD. Methods Diagnosis of FD was based on ROME III criteria. Clinical evaluation including dyspeptic symptom scoring and assessment for PS was performed. Satiety drink test for gastric accommodation, gastroscopy with biopsy for HP infection, and solid meal gastric emptying were performed. Sixty‐seven healthy children were enrolled for assessing PS and satiety drink test. Results Fifty‐five FD children (33 boys, age 12 [6–18] years) with symptoms for 4 (2–48) months and dyspeptic score of 5 (1–13) were enrolled. PS were more common in FD than in controls (46/55 vs 9/67; P < 0.001). Median satiety drink volume was 360 mL (180–1320 mL); no patients had satiety drink volume of < 5th centile of healthy children. The frequency (98% vs 85%; P = 0.01) and severity (65 [10–175] vs 50 [5–130]; P < 0.001) of postprandial symptoms were higher in FD than in controls. Of the postprandial symptoms, pain (20.3% vs 0%; P = 0.000) was present only in FD. Delayed gastric emptying was present in 6.5%, HP infection in 11%, and post‐infectious FD in 13% cases. Etiological factor was identified in 87% children, with 20% having multiple factors. Conclusions Abnormality of gastric sensorimotor function is seen in one‐fourth of FD cases. HP infection and post‐infectious FD are present in 11% and 13% cases, respectively.

Efficacy and Safety of Shenqu Xiaoshi Oral Liquid Compared With Domperidone Syrup in Children With Functional Dyspepsia

“…Although the exact pathogenesis of FD remains unclear, several pathophysiological mechanisms have been proposed to influence the etiology of FD, such as gastroduodenal motor dysfunction, visceral hypersensitivity, low-grade gastroduodenal inflammation, Helicobacter pylori infection, mental stress, and/or abnormal central nervous system processing through the gut-brain axis (Koppen et al, 2017;Walker et al, 2019;Shava et al, 2021). Most pediatricians commonly personalize the patient's medical treatment, including dietary modifications, prokinetics, antacids, antispasmodics, antidepressants, and analgesics according to their predominant symptoms and associated comorbidities (Hyams et al, 2016;Browne et al, 2018;Masuy et al, 2019).…”

Pediatric functional dyspepsia: A comprehensive review

“…Thus, the decision to eradicate H. pylori should be individualized and preferred in patients with risk factors (i.e., peptic ulcer disease, gastric cancer, and Asian origin). A recent study in pediatrics found H. pylori to be present in 11% of the subjects with FD (n = 55) 36 .…”

“…Common stress examples in children include failing an exam, separating from a best friend, loss of a parent's job, and/or moving to a new place 17 . A recent study found that psychological stressors were the most common etiology for FD in children 36 . Abuse also predisposes to functional abdominal pain disorders, with one study showing that abdominal pain-predominant FGIDs were significantly higher in children who were abused sexually (34%), emotionally (25%), and physically (20%) when compared to those who were not abused 37 .…”

Testing the Arabic-Saudi Arabia version of the Rome IV Diagnostic Questionnaire for functional gastrointestinal disorders for Children living in Saudi Arabia

“…These findings support a previous study result, where the incidence of FD in children was between 3% and 27% ( 26 , 27 ). Altered visceral sensation, Helicobacter pylori infection, and gastrointestinal motor abnormalities have all been identified as major pathophysiological mechanisms for the development of FD ( 28 , 29 ).…”