Nausea in Children With Functional Abdominal Pain Predicts Poor Health Outcomes in Young Adulthood

Abstract

Background & Aims Nausea is common among children with functional abdominal pain (FAP). We evaluated the relation of nausea to short- and long-term morbidity in pediatric patients with FAP. Methods We performed a prospective study of 871 children with FAP (8–17 years old) seen in a pediatric gastroenterology practice; follow-up data were collected from 396 of the patients 8.7±3.3 years later. Participants were defined as having significant nausea if they reported nausea “a lot” or “a whole lot” within the past 2 weeks. Validated questionnaires assessed abdominal pain, gastrointestinal and somatic symptoms, and depression. Baseline measures, anxiety, and the Rome III criteria were assessed in the follow-up evaluation. Results At baseline, 44.8% of the patients reported significant nausea. Those with nausea reported worse abdominal pain, gastrointestinal symptoms, somatic symptoms, and depression than those without nausea (P< .001 for all). When the children had reached young adulthood, those with nausea in childhood continued to have more severe gastrointestinal (P< .001) and somatic symptoms (P= .003) than patients without nausea in childhood, as well as higher levels of anxiety (P = .02) and depression (P = .02). In the follow-up evaluation, somatic symptoms, depression, and anxiety remained significant after controlling for baseline abdominal pain severity. Conclusions Pediatric patients with FAP and nausea have more severe short- and long-term gastrointestinal and somatic symptoms than patients with FAP without nausea, as well as reductions mental health and daily function. Pediatric patients with FAP and nausea therefore need intensive treatment and follow up.

The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice

“…Studies have shown that nausea is a common symptom in children with functional abdominal pain disorders [18] and that some children have nausea or vomiting that presents in a non-stereotypical and cyclical fashion [19]. Moreover, studies have shown that nausea is a highly invalidating symptom and that children with severe and prolonged nausea have a poor quality of life [20]. As a result, the Rome IV criteria established two new diagnoses: functional nausea and functional vomiting.…”

Nausea exacerbates symptom burden, quality of life, and functioning in adolescents with functional abdominal pain disorders

“…Nausea is a common and debilitating symptom that is increasingly recognized among children with FAPDs, but yet poorly described . A community survey identified nausea in as many as 15.9% of school‐aged children .…”

“…Importantly, the presence of nausea in that study correlated with poor school and social functioning and uniquely predicted social disability. Further, a long‐term study in children with FAPDs demonstrated that those with co‐existent nausea compared to those without nausea suffered from more somatic, GI, and psychiatric symptoms that continued into young adulthood …”

The role of psychological factors in pediatric functional abdominal pain disorders

“…Although that interpretation is no longer widely held, the idea that somatization has psychological underpinnings has persisted and suggestions have been made that somatization may be due to increased psychological distress or a learned behavior to attend to physical symptoms . Some studies show that comorbidities such as nausea, incontinence, and fibromyalgia increase the risk of anxiety and depression for children with FAPD . In addition, evidence that attention to pain stimuli can be a learned behavior has come from studies showing that FAPD patients have an (subconscious) attentional bias toward pain .…”

“…Some studies show that comorbidities such as nausea, incontinence, and fibromyalgia increase the risk of anxiety and depression for children with FAPD. 15,36,45 In addition, evidence that attention to pain stimuli can be a learned behavior has come from studies showing that FAPD patients have an (subconscious) attentional bias toward pain. 46,47 However, it has also been suggested that somatization may be due to autonomic nervous system dysregulation, decreased sensation thresholds for bodily symptoms, increased subclinical inflammation, or deficits in cellular metabolism.…”