Long-Term Study of Children With ROME III Functional Gastrointestinal Disorders Managed Symptomatically in a Biopsychosocial Model

Abstract

BackgroundOur study evaluated progression of and identified potential factors contributing to outcomes of ROME III defined-functional gastrointestinal disorders (FGIDs) in children treated symptomatically in a biopsychosocial model of care with a long-term follow-up.MethodsWe performed a retrospective review of pediatric patients who were diagnosed with ROME III defined-FGIDs including functional abdominal pain, functional dyspepsia, irritable bowel syndrome and abdominal migraine. Patients were managed symptomatically in a biopsychosocial model of care from the time of initial diagnosis. Demographics, management, progression and response to treatment assessed as complete, partial, and no improvement were reviewed.ResultsTwo hundred fifty-eight patients were included with mean age of 10.6 years, female 55.4%, mean number of encounters 3.3 visits, and mean follow-up was 18.7 months (range 2 - 59, SD 15.8). Diagnoses were functional abdominal pain 45%, irritable bowel syndrome 20.9%, multiple 13.2%, functional dyspepsia 12.8%, and abdominal migraine 8.1%. Investigations were performed in most patients: laboratory studies in 93.4% (non-contributory abnormal 23.6%), imaging studies in 45.3% (non-contributory abnormal 5%) and endoscopies in 43.0% (non-contributory abnormal 1.2%). Treatment included medication in 93.7%, and surgery in 1.9% (normal pathology). There were new functional gastrointestinal diagnosis in 11.6%, evolution of FGIDs, from one to another in 12.0%, and recurrence found in 35.7% of patients. There were 60.1% patients in the complete improvement group (CIG) and 39.1% in the partial/no improvement group (PIG/NIG). No statistical difference was found between CIG and PIG/NIG regarding demographics or evaluation. PIG/NIG had more encounters (mean 3.63 vs. 3.11; P = 0.03), had non-contributory lab abnormalities (34.4% vs. 20.0%; P = 0.01), needed more endoscopies (52.4% vs. 36.8%; P = 0.02), required more treatment changes (mean 1.41 vs. 0.81; P < 0.01) and developed new functional gastrointestinal diagnoses (19.4% vs. 6.5%; P < 0.01) with long-term follow-up.ConclusionsPatients with ROME III defined-FGIDs who experience partial or no improvement with treatment develop new FGID diagnosis, need more number of follow-up visits, require more number of endoscopies, need more treatment changes, and have more non-contributory laboratory abnormalities, compared to those who experience complete improvement. Symptomatic treatment offered in a biopsychosocial model of care is possibly beneficial in managing children with FGIDs.

Quantitative Analysis of Distribution of the Gastrointestinal Tract Eosinophils in Childhood Functional Abdominal Pain Disorders

“…A prospective study has demonstrated that approximately 41.0% of children with functional abdominal pain (FAP) continued to report clinically significant abdominal pain after a mean duration of a 9-year follow-up into adolescence and young adulthood. 2,3 The pathomechanism to explain FAPDs remains unclear and multifactorial hypotheses have been suggested. 4,5 Recently many studies have suggested that low-grade intestinal inflammation is essentially involved in the underlying pathogenesis of functional gastrointestinal disorders (FGIDs).…”

Burden of functional gastrointestinal disorders in a surgical clinic in Sri Lanka

“…Long term studies on FGID reveal that the persistent symptoms may either change or fluctuate in severity and the patients rarely become symptom-free [18,24]. A study among children found complete improvement in 60.1%, no improvement in 10.1% and recurrence in 35.7% of the patients whereas 11.6 5% of patients reported new symptoms [25]. In our study, 3.7% of the patients reported deferent symptoms during the follow up.…”

Economic Impact and Prognostic Factors of Functional Dyspepsia in Children

“…Acid suppressive medications are recommended for epigastric pain-like symptoms and prokinetic agents for postprandial symptoms (2,23). Cyproheptadine, tricyclic antidepressants, and alternative agents such as melatonin, ginger root extract, aloe vera, pepper mint oil, and even fecal transplantation have also been found to be effective (2,24,(34)(35)(36). We used cyproheptadine as initial treatment because of its reported efficacy in FAPDs, many patients having already failed on acid reducers, limitation in using metoclopramide due to black box warning and nonavailability of domperidone in the United States (34,36,37).…”

“…Cyproheptadine, tricyclic antidepressants, and alternative agents such as melatonin, ginger root extract, aloe vera, pepper mint oil, and even fecal transplantation have also been found to be effective (2,24,(34)(35)(36). We used cyproheptadine as initial treatment because of its reported efficacy in FAPDs, many patients having already failed on acid reducers, limitation in using metoclopramide due to black box warning and nonavailability of domperidone in the United States (34,36,37). Our finding that majority of patients do not improve despite being on 2 or more medications further emphasizes that FD is a recalcitrant condition, and although various treatments have been described none of them are singularly effective as was noted in our PIG/NIG of patients.…”