Paediatric functional abdominal pain disorders

Thapar, Nikhil; Benninga, Marc A.; Crowell, Michael D.; Lorenzo, Carlo Di; Mack, Isabelle; Nurko, Samuel; Saps, Miguel; Shulman, Robert J.; Szajewska, Hania; Tilburg, Miranda A. L. van; Enck, Paul

doi:10.1038/s41572-020-00222-5

Cited by 118 publications

(141 citation statements)

References 246 publications

(277 reference statements)

Supporting

Mentioning

132

Contrasting

Unclassified

Order By: Relevance

“…These results need to be interpreted in the light of some limitations. The diagnostic criteria for RAP have been subject to some debate (Thapar et al, 2020). Apley's original definition of childhood RAP (Apley & Naish, 1958), which corresponds best to the ALSPAC data collected in 1991, requires children to suffer from less frequent pain than the Rome IV criteria, and it does not include a detailed assessment of their functional impairment.…”

Section: Discussionmentioning

confidence: 99%

“…The most widely accepted definition of recurrent abdominal pain, introduced by Apley, is when a child has had, “At least three bouts of pain, severe enough to affect his/her activities, over a period of at least 3 months, with attacks continuing in the year preceding examination” (Apley & Naish, 1958). However, the concept of childhood RAP has more recently (2016) been replaced by the term pediatric Functional Abdominal Pain Disorders (FAPDs) (Thapar et al, 2020). According to the Rome IV Criteria, FAPDs can be defined as when abdominal pain occurs 4 or more times a month, for at least 2 months, in either an episodic or continuous fashion, and cannot be ascribed to an inflammatory, anatomic, metabolic, or neoplastic process (Hyams et al, 1996).…”

Section: Introductionmentioning

confidence: 99%

“…Pediatric FAPDs can be subclassified, utilizing the Rome IV criteria, to comprise irritable bowel syndrome, functional dyspepsia, abdominal migraine, and functional abdominal pain not otherwise specified (Hyams et al, 2016). FAPDs are thought to share the same etiology and they more recently tend to be described as disorders of GI–brain interaction (Thapar et al, 2020). Whilst the Apley definition requires children to suffer from less frequent pain than those applied for childhood FAPDs, it includes pain severity and functional impairment, so it remains useful and relates to the operational definitions used in the Rome criteria, which became available in 2005 (Rasquin‐Weber et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

“…FAPDs are thought to share the same etiology and they more recently tend to be described as disorders of GI-brain interaction (Thapar et al, 2020). Whilst the Apley definition requires children to suffer from less frequent pain than those applied for childhood FAPDs, it includes pain severity and functional impairment, so it remains useful and relates to the operational definitions used in the Rome criteria, which became available in 2005 (Rasquin-Weber et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population‐based cohort

Stein

Warne

Heron

et al. 2021

Intl J Eating Disorders

View full text Add to dashboard Cite

Objective Gastrointestinal (GI) problems are common in eating disorders, but it is unclear whether these problems predate the onset of disordered eating. Recurrent abdominal pain (RAP) is the most prevalent GI problem of childhood, and this study aimed to explore longitudinal associations between persistent RAP (at ages 7 and 9) and fasting for weight control at 16. Method The Avon Longitudinal Study of Parents and Children (ALSPAC) is a UK population cohort of children. Childhood RAP was reported by mothers and defined as RAP 5+ (5 pain episodes in the past year) in our primary analysis, and RAP 3+ (3 pain episodes) in our sensitivity analysis. Fasting for weight control was reported by adolescents at 16. We used logistic regression models to examine associations, with adjustments for potential confounders. Results After adjustments, we found no association between childhood RAP 5+ and adolescent fasting for weight control at 16 (OR 1.30 (95% Confidence Intervals [CI] 0.87, 1.94) p = .197). However, we did find an association between RAP 3+ and later fasting, in the fully adjusted model (OR 1.50 [95% CI 1.16, 1.94] p = .002), and after excluding those with pre‐existing anxiety (OR 1.52 [95% CI 1.17, 1.97] p = .002). Discussion Our findings suggest a possible independent contribution of RAP to later risk of fasting for weight control, and RAP should be enquired about in the assessment of eating disorders. However, frequency of childhood abdominal pain (as captured by ALSPAC) may be less important to long‐term outcomes than functional impairment.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population‐based cohort

Stein

Warne

Heron

et al. 2021

Intl J Eating Disorders

View full text Add to dashboard Cite

show abstract

“…Chronic idiopathic constipation (CIC) is a common pediatric gastrointestinal disorder worldwide (1,2). Patients with CIC always suffer from abdominal pain, painful bowel movements, large stools, and fecal incontinence (2,3). At present, the standard medical care of functional constipation contains dietary adjustment, toilet training, reassurance, education, and the use of laxatives (2,4,5).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Non-pharmacologic Auxiliary Treatments in Improving Defecation Function in Children With Chronic Idiopathic Constipation: A Systematic Review and Network Meta-analysis

Tang

2021

Front. Pediatr.

View full text Add to dashboard Cite

Background: Non-pharmacologic auxiliary treatments have been considered crucial therapies for treating chronic idiopathic constipation (CIC) during the past decades worldwide. Several treatment patterns are available, but their relative efficacy is obscure because there are no head-to-head randomized controlled trials, especially in children. We conducted this network meta-analysis to evalute the effectiveness of these therapies in improving defecation function based on their direct comparisons with standard medical care.Methods: Medline, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) published in English from inception to October 2020, assessing the efficacy of auxiliary therapies (behavior therapy, physiotherapy, biofeedback, or anorectal manometry) in children with CIC. We extracted data for endpoints, risk of bias, and evidence quality. Eligible studies in the meta-analysis reported the data of a dichotomous assessment of overall response to treatment (response or not) or defecation frequency per week after treatment. The hierarchical Bayesian network meta-analysis was used in the study. We chose a conservative methodology, random effects model, to pool data which could handle the heterogeneity well. The relative risk (RR) with 95% confidence intervals (CIs) was calculated for dichotomous outcomes. For continuous results, weighted mean difference (WMD) with related CIs was calculated. The included treatments were ranked to define the probability of being the best treatment.Results: Seven RCTs (838 patients) met inclusion and endpoint criteria. Based on an endpoint of the absence of constipation (Rome criteria) with laxatives allowed, physiotherapy plus standard medical care (SMC) had the highest probability (84%) to bethe most effective therapy. When the treatment response was defined as an absence of constipation with not laxatives allowed, biofeedback plus SMC ranked first (probability 52%). Physiotherapy plus SMC ranked first when the endpoint was based on defecation frequency per week with laxatives allowed (probability 86%).Conclusion: Almost all auxiliary therapies are effective complementary therapies for treating CIC, but they needed to be used simultaneously with SMC. Nevertheless, because of the small number of eligible studies and their small sample sizes, the differences in treatment duration and the endpoints, large sample RCTs with long-term follow-up are required for further investigation.

show abstract

Effect of Open-label Placebo on Children and Adolescents With Functional Abdominal Pain or Irritable Bowel Syndrome

et al. 2022

Self Cite

View full text Add to dashboard Cite

IMPORTANCEAlthough it is widely believed that concealment or deception is required to elicit a placebo response, recent studies with adults suggest that open-label placebo (OLP) (ie, honestly prescribed placebos) can yield significant benefits. No studies of OLP have been performed with children.OBJECTIVE To evaluate the efficacy of OLP for the treatment of children and adolescents with functional abdominal pain or irritable bowel syndrome.DESIGN, SETTING, AND PARTICIPANTS This multicenter crossover randomized clinical trial was conducted from July 1, 2015, to June 15, 2018, at 3 US centers among children and adolescents aged 8 to 18 years with functional abdominal pain or irritable bowel syndrome defined per Rome III criteria. Statistical analysis was performed from March 1, 2019, to September 30, 2020, on an intention-to-treat basis.INTERVENTIONS Patients completed 1 week of observation prior to randomization to 1 of 2 counterbalanced groups: OLP for 3 weeks followed by a 3-week control period or control period for 3 weeks followed by OLP for 3 weeks. During the OLP period, participants took 1.5 mL of an inert liquid placebo twice a day. A standardized method for explaining the OLP was used, and the interaction with clinicians had the same duration and style for both time periods. Hyoscyamine was allowed as a rescue medication. MAIN OUTCOMES AND MEASURESThe primary outcome was the mean daily pain score during each of the interventions, measured on a 0-to 100-mm visual analog scale, where higher scores indicated greater pain. The number of rescue medications taken during each intervention served as an objective secondary measure.RESULTS Thirty patients (mean [SD] age, 14.1 [3.4] years; 24 female participants [80.0%]; 16 [53.3%] with functional abdominal pain and 14 [46.7%] with irritable bowel syndrome) completed the study. The mean (SD) pain scores were significantly lower during OLP treatment compared with the control period (39.9 [18.9] vs 45.0 [14.7]; difference, 5.2; 95% CI, 0.2-10.1; P = .03). Patients took nearly twice as many hyoscyamine pills during the control period compared with during the OLP period (mean [SD] number, 3.8 [5.1] pills vs 2.0 [3.0] pills; difference, 1.8 pills; 95% CI, 0.5-3.1 pills). CONCLUSIONS AND RELEVANCEDuring OLP, patients with functional abdominal pain or irritable bowel syndrome reported significantly less pain and took significantly fewer pain medications. Open-label placebo may be an effective treatment for children and adolescents with functional abdominal pain or irritable bowel syndrome.

show abstract

Paediatric functional abdominal pain disorders

Cited by 118 publications

References 246 publications

Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population‐based cohort

Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population‐based cohort

Efficacy of Non-pharmacologic Auxiliary Treatments in Improving Defecation Function in Children With Chronic Idiopathic Constipation: A Systematic Review and Network Meta-analysis

Effect of Open-label Placebo on Children and Adolescents With Functional Abdominal Pain or Irritable Bowel Syndrome

Contact Info

Product

Resources

About