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1
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Sanchez RE, Reichard E, Bobbey A, Puri NB, Lu PL, Yacob D, Lorenzo CD, Williams K, Vaz KKH. Delayed Gastric Emptying Correlates With Decreased Post-prandial Motility in Children: A Single-center Retrospective Review. J Neurogastroenterol Motil 2025; 31:102-109. [PMID: 39779208 PMCID: PMC11735193 DOI: 10.5056/jnm24057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/02/2024] [Accepted: 07/18/2024] [Indexed: 01/11/2025] Open
Abstract
Background/Aims Pediatric patients with suspected gastroparesis often undergo antroduodenal manometry (ADM) and gastric emptying scintigraphy (GES) for diagnostic purposes. However, it is unknown if delayed gastric emptying (DGE) correlates with manometric findings. This study evaluates whether ADM parameters differ between normal and abnormal GES in pediatric patients. Methods Data from pediatric patients undergoing ADM and GES at Nationwide Children's Hospital from 2011-2020 were retrospectively reviewed. Manometry parameters including motility index (Ln [sum of amplitudes × number of contractions + 1]), number of antral contractions, and direction of the phase III migrating motor complex (MMC) were compared to GES results from age-matched patients with DGE (n = 32) and normal gastric emptying (NGE) (n = 32) of similar sex, body mass index, and weight. Results Children with DGE had a lower post-prandial antral motility index and antral contraction number than those with NGE (9.4 vs 11.2, P = 0.005; 21.8 vs 49.6, P < 0.001). The gastric emptying percentage at 4 hours was lower in patients with retrograde phase III (59.2% vs 83.9%, P = 0.022) and in those without an antral component in the fasting phase III of the migrating motor complex (70.3% vs 86.5%, P = 0.003). Post-prandial antral hypomotility occurred more frequently in the DGE group than in the NGE group (41% vs 9%, P = 0.008). Conclusions ADM findings differ between children with DGE and NGE. Children with DGE are more likely to have abnormal fasting phase III patterns and decreased post-prandial antral activity during ADM testing.
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Affiliation(s)
- Raul E Sanchez
- Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Adam Bobbey
- Pediatric Radiology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Neetu Bali Puri
- Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Peter L Lu
- Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Desale Yacob
- Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Carlo Di Lorenzo
- Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Kent Williams
- Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Karla K H Vaz
- Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, OH, USA
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Abstract
Neuromodulation, also known as bioelectric neuromodulation or neurostimulation, is the therapeutic use of electrical stimulation of nerves or brain centers. Neuromodulation has been trialed in an increasing range of human diseases as well as gastrointestinal disorders. The application of neuromodulation to treat pediatric motility and functional disorders is an exciting recent development. This review aims to briefly discuss the use of neuromodulation for the treatment of pediatric gastroparesis, constipation, and visceral hyperalgesia.
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Affiliation(s)
- Khalil I. El-Chammas
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA,Address for correspondence: Dr. Khalil I. El-Chammas, 3333 Burnet Ave, Cincinnati, Ohio - 45229, USA. E-mail:
| | - Neha R. Santucci
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Sherief Mansi
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Ajay Kaul
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
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3
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Bräutigam M, Dellenmark‐Blom M, Gatzinsky V, Bergström J, Abrahamsson K. Linguistic and content validity of the Swedish version of the PedsQL™ gastrointestinal symptoms scales and symptoms module for paediatric patients. Acta Paediatr 2021; 110:3124-3130. [PMID: 34390033 DOI: 10.1111/apa.16066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/16/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022]
Abstract
AIM To describe the process of linguistic and content validity of the Swedish version of the PedsQL™ Gastrointestinal Symptoms Scales and Symptoms Module, measuring health-related quality of life (HRQOL) in children with gastrointestinal (GI) disorders. METHODS The establishment of linguistic and content validity was carried out in compliance with international standards on patient-reported outcome measurements. The process included forward translation, expert review and reconciliation, backward translation, backward translation review and interviews with 15 children aged 5-18 years with GI tract symptoms and 20 parents of children with GI tract symptoms aged 2-18 years. RESULTS The Swedish version of the PedsQL™ Gastrointestinal Symptoms Scales and Symptoms Module (child report 5-18 years, parent report for children 2-18 years) was achieved without major difficulties. Eight issues needed discussion after forward translation, and there was one change after backward translation and three revisions following patient and parent testing. CONCLUSION A conceptually equivalent Swedish language version of PedsQL™ Gastrointestinal Symptoms Scale and Symptoms Module for children aged 2-18 years old was developed. This enables improved HRQOL evaluations in children with GI disorders in Sweden. Future research using a larger sample is recommended to evaluate validity and reliability of the Swedish language version of the module.
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Affiliation(s)
- Matilda Bräutigam
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy Gothenburg University Gothenburg Sweden
- Department of Pediatric Surgery Queen Silvia Children's Hospital Gothenburg Sweden
| | - Michaela Dellenmark‐Blom
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy Gothenburg University Gothenburg Sweden
- Department of Pediatric Surgery Queen Silvia Children's Hospital Gothenburg Sweden
| | - Vladimir Gatzinsky
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy Gothenburg University Gothenburg Sweden
- Department of Pediatric Surgery Queen Silvia Children's Hospital Gothenburg Sweden
| | - Jenny Bergström
- Department of Pediatric Surgery Queen Silvia Children's Hospital Gothenburg Sweden
| | - Kate Abrahamsson
- Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy Gothenburg University Gothenburg Sweden
- Department of Pediatric Surgery Queen Silvia Children's Hospital Gothenburg Sweden
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4
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Orsagh-Yentis DK, Ryan K, Hurwitz N, Diefenbach KA, Teich S, Mousa H, Bali N, Vaz K, Yacob D, Di Lorenzo C, Lu PL. Gastric electrical stimulation improves symptoms and need for supplemental nutrition in children with severe nausea and vomiting: A ten-year experience. Neurogastroenterol Motil 2021; 33:e14199. [PMID: 34132458 DOI: 10.1111/nmo.14199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gastric electrical stimulation (GES) is a promising therapy for children with severe nausea and vomiting, but information on long-term outcomes is limited. We sought to evaluate the long-term efficacy and safety of GES and to describe patient benefit and satisfaction. METHODS Using a prospective registry, we identified patients aged <21 years treated with GES at our institution between 2009 and 2019. Encounters were selected at baseline prior to GES and at follow-up at 1 month, 12 months, and the most recent visit. We compared symptoms, route of nutrition, and medication usage at baseline to follow-up timepoints. Factors associated with improvement were evaluated. We recorded complications and need for battery replacement. We contacted families to administer the Glasgow Children's Benefit Inventory (GCBI) and a parent satisfaction questionnaire. KEY RESULTS Eighty-five patients (68.2% female, median age 15.8 years) completed a trial of temporary GES due to severe nausea and vomiting. Seventy-seven (90.6%) had a positive response and underwent permanent stimulator placement. Use of tube feeding or parenteral nutrition (PN) decreased from 72.7% at baseline to 29.9% at the most recent follow-up (p < 0.001). Higher baseline vomiting severity was associated with the ability to stop supplemental nutrition by 1 month (p < 0.05). Fourteen patients (18.2%) had complications, primarily due to stimulator-associated discomfort, and 29 (37.7%) required battery replacement. Median GCBI was +52.1, indicating health-related benefit. CONCLUSIONS AND INFERENCES Children with severe nausea and vomiting treated with GES experienced significant and durable improvement in symptom severity and their ability to tolerate oral nutrition.
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Affiliation(s)
- Danielle K Orsagh-Yentis
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kelsey Ryan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Nicole Hurwitz
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Karen A Diefenbach
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Steven Teich
- Department of Pediatric Surgery, Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Hayat Mousa
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Neetu Bali
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karla Vaz
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Desale Yacob
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter L Lu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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5
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Cheng LK, Nagahawatte ND, Avci R, Du P, Liu Z, Paskaranandavadivel N. Strategies to Refine Gastric Stimulation and Pacing Protocols: Experimental and Modeling Approaches. Front Neurosci 2021; 15:645472. [PMID: 33967679 PMCID: PMC8100207 DOI: 10.3389/fnins.2021.645472] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Gastric pacing and stimulation strategies were first proposed in the 1960s to treat motility disorders. However, there has been relatively limited clinical translation of these techniques. Experimental investigations have been critical in advancing our understanding of the control mechanisms that innervate gut function. In this review, we will discuss the use of pacing to modulate the rhythmic slow wave conduction patterns generated by interstitial cells of Cajal in the gastric musculature. In addition, the use of gastric high-frequency stimulation methods that target nerves in the stomach to either inhibit or enhance stomach function will be discussed. Pacing and stimulation protocols to modulate gastric activity, effective parameters and limitations in the existing studies are summarized. Mathematical models are useful to understand complex and dynamic systems. A review of existing mathematical models and techniques that aim to help refine pacing and stimulation protocols are provided. Finally, some future directions and challenges that should be investigated are discussed.
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Affiliation(s)
- Leo K Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.,Riddet Institute, Palmerston North, New Zealand
| | - Nipuni D Nagahawatte
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Recep Avci
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Zhongming Liu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, United States
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6
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Abstract
Although the definition of gastroparesis in children is the same as in adults, there are key differences between gastroparesis in these two populations in presentation, diagnosis, treatment and outcomes. Infants and younger children with gastroparesis tend to be male, present with vomiting as their primary symptom and are more likely to experience the resolution of their symptoms over time. Adolescents with gastroparesis tend to be female, present with abdominal pain as their primary symptom and have a less favorable short- and medium-term outcome, sharing some similarities with adults with gastroparesis. Despite the fact that validated diagnostic criteria for gastroparesis are lacking in infants and younger children, these age groups make up nearly half of children with gastroparesis in some studies. The diagnosis and treatment of children with gastroparesis has thus far relied heavily on research studies performed in adults, but it is becoming increasingly clear that gastroparesis in children is a distinct entity and there are limitations to the applicability of data obtained from adults to the care of children.
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7
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Baaleman DF, Di Lorenzo C, Benninga MA, Saps M. The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice. Curr Gastroenterol Rep 2020; 22:21. [PMID: 32193635 DOI: 10.1007/s11894-020-00760-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW To evaluate the impact of the implementation of the Rome IV criteria on pediatric gastrointestinal practice. RECENT FINDINGS In 2016, the Rome IV criteria were published, providing an update of symptom-based criteria to diagnose children with functional gastrointestinal disorders (FGIDs). For neonates and toddlers, Wessel's criteria for diagnosing infant colic were abandoned, and a differentiation was made between toilet-trained and non-toilet-trained children in the diagnosis of functional constipation. For children and adolescents, two new disorders (functional nausea and functional vomiting) are described, and in the diagnosis of functional dyspepsia, pain does not have to be the chief complaint anymore. This change has made functional dyspepsia the most common functional abdominal pain disorder, exceeding the prevalence of irritable bowel syndrome (IBS). Lastly, the diagnosis of abdominal migraine was narrowed, causing an appropriate drop in its prevalence.
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Affiliation(s)
- Desiree F Baaleman
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Holtz Children's Hospital, Miller School of Medicine, University of Miami, Miami, FL, USA
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8
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Di Lorenzo C. Gastroparesis in children: Paralysis for the child or the provider? Neurogastroenterol Motil 2020; 32:e13792. [PMID: 32103613 DOI: 10.1111/nmo.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
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9
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Setya A, Nair P, Cheng SX. Gastric electrical stimulation: An emerging therapy for children with intractable gastroparesis. World J Gastroenterol 2019; 25:6880-6889. [PMID: 31908392 PMCID: PMC6938723 DOI: 10.3748/wjg.v25.i48.6880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
Management of gastroparesis remains challenging, particularly in pediatric patients. Supportive care and pharmacological therapies for symptoms remain the mainstay treatment. Although they are effective for mild and some moderately severe cases, often time they do not work for severe gastroparesis. There are a few prokinetics available, yet the use of these drugs is limited by a lack of persistent efficacy and/or safety concerns. Currently, the only modality for adult patients with severe intractable gastroparesis is surgery, e.g., pyloroplasty and partial gastrectomy, however, this option is generally considered too radical for a growing child. Novel therapeutic approaches, particularly those which are less invasive, are needed. This article explores gastric electrical stimulation (GES), a new therapy for gastroparesis. Unlike others, it neither needs medications nor gastrectomy; rather, it treats through the use of microelectrodes to deliver high-frequency low energy electric stimulation to the pacemaker area of the stomach. Thus, it is tolerated and safe in children. Like in adult patients, GES appears to work in releasing symptoms, improving nutrition, and enhancing the quality of life; it also helps wean off medications and eliminate many needs for hospitalization. Considering the transient nature of gastroparesis in children in many occasions, GES is considered a “bridging” therapy after failed medical interventions and before surgery.
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Affiliation(s)
- Aniruddh Setya
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32610, United States
| | - Priyanka Nair
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32610, United States
| | - Sam Xianjun Cheng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32610, United States
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10
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Santucci NR, Saps M, van Tilburg MA. New advances in the treatment of paediatric functional abdominal pain disorders. Lancet Gastroenterol Hepatol 2019; 5:316-328. [PMID: 31859185 DOI: 10.1016/s2468-1253(19)30256-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/19/2022]
Abstract
This Review summarises recent pharmacological and upcoming alternative interventions for children with functional abdominal pain disorders (FAPDs). Pharmacological targets include prokinetics and drugs affecting gastric accommodation to treat postprandial distress and nausea. Similarly, anti-inflammatory agents, junctional protein regulators, analgesics, secretagogues, and serotonin antagonists have a therapeutic role for irritable bowel syndrome. Non-pharmacological treatments include peripheral electrical nerve field stimulation to the external ear, gastric electrical stimulation, dietary interventions such as low fructose and fibre based diets, and nutraceuticals, which include probiotics, prebiotics, and synbiotics. Newer psychological advances such as exposure-based cognitive behavioural therapy, acceptance and commitment therapy, and mindfulness meditation are being investigated for paediatric functional pain. Lastly, alternative therapies such as acupuncture, moxibustion, yoga, and spinal manipulation are also gaining popularity in the treatment of FAPDs.
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Affiliation(s)
- Neha R Santucci
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Milner School of Medicine, University of Miami, Miami, FL, USA
| | - Miranda A van Tilburg
- Department of Clinical Research, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA; Department of Medicine, University of North Carolina, Chapel Hill, NC, USA; School of Social Work, University of Washington, Seattle, WA, USA
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11
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Lu PL, Saps M. Advances in the Evaluation and Management of Childhood Functional Abdominal Pain. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Lu PL, Mousa HM. Neuromodulation for Gastrointestinal Dysmotility in Pediatric Patients. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Carmona-Sánchez R, Gómez-Escudero O, Zavala-Solares M, Bielsa-Fernández M, Coss-Adame E, Hernández-Guerrero A, Huerta-Iga F, Icaza-Chávez M, Lira-Pedrín M, Lizárraga-López J, López-Colombo A, Noble-Lugo A, Pérez-Manauta J, Raña-Garibay R, Remes-Troche J, Tamayo J, Uscanga L, Zamarripa-Dorsey F, Valdovinos Díaz M, Velarde-Ruiz Velasco J. Mexican consensus on dyspepsia. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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14
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Carmona-Sánchez R, Gómez-Escudero O, Zavala-Solares M, Bielsa-Fernández MV, Coss-Adame E, Hernández-Guerrero AI, Huerta-Iga F, Icaza-Chávez ME, Lira-Pedrín MA, Lizárraga-López JA, López-Colombo A, Noble-Lugo A, Pérez-Manauta J, Raña-Garibay RH, Remes-Troche JM, Tamayo JL, Uscanga LF, Zamarripa-Dorsey F, Valdovinos Díaz MA, Velarde-Ruiz Velasco JA. Mexican consensus on dyspepsia. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:309-327. [PMID: 28413079 DOI: 10.1016/j.rgmx.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/19/2017] [Accepted: 01/31/2017] [Indexed: 02/07/2023]
Abstract
Since the publication of the 2007 dyspepsia guidelines of the Asociación Mexicana de Gastroenterología, there have been significant advances in the knowledge of this disease. A systematic search of the literature in PubMed (01/2007 to 06/2016) was carried out to review and update the 2007 guidelines and to provide new evidence-based recommendations. All high-quality articles in Spanish and English were included. Statements were formulated and voted upon using the Delphi method. The level of evidence and strength of recommendation of each statement were established according to the GRADE system. Thirty-one statements were formulated, voted upon, and graded. New definition, classification, epidemiology, and pathophysiology data were provided and include the following information: Endoscopy should be carried out in cases of uninvestigated dyspepsia when there are alarm symptoms or no response to treatment. Gastric and duodenal biopsies can confirm Helicobacter pylori infection and rule out celiac disease, respectively. Establishing a strong doctor-patient relationship, as well as dietary and lifestyle changes, are useful initial measures. H2-blockers, proton-pump inhibitors, prokinetics, and antidepressants are effective pharmacologic therapies. H.pylori eradication may be effective in a subgroup of patients. There is no evidence that complementary and alternative therapies are beneficial, with the exception of Iberogast and rikkunshito, nor is there evidence on the usefulness of prebiotics, probiotics, or psychologic therapies. The new consensus statements on dyspepsia provide guidelines based on up-to-date evidence. A discussion, level of evidence, and strength of recommendation are presented for each statement.
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Affiliation(s)
| | - O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopia Digestiva y Motilidad Gastrointestinal, Hospital Ángeles Puebla, Puebla, Puebla, México
| | - M Zavala-Solares
- Unidad de Motilidad Gastrointestinal, Hospital General de México, Ciudad de México, México
| | - M V Bielsa-Fernández
- Unidad de Pacientes en Estudio, Universidad Autónoma de Guadalajara, Zapopán, Jalisco, México
| | - E Coss-Adame
- Departamento de Gastroenterología y Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - A I Hernández-Guerrero
- Departamento de Endoscopia, Instituto Nacional de Cancerología, Ciudad de México, México
| | - F Huerta-Iga
- Servicio de Endoscopia y Fisiología Digestiva, Hospital Ángeles Torreón, Torreón, Coahuila, México
| | | | - M A Lira-Pedrín
- Hospital Ángeles Tijuana, Tijuana, Baja California Norte, México
| | - J A Lizárraga-López
- Servicio de Endoscopia, Unidad Médica de Atención Ambulatoria 265, Instituto Mexicano del Seguro Social, Culiacán, Sinaloa, México
| | - A López-Colombo
- Dirección de Educación e Investigación en Salud, UMAE Hospital de Especialidades del Centro Médico Nacional Manuel Ávila Camacho, IMSS, Puebla, Puebla, México
| | - A Noble-Lugo
- Servicio de Gastroenterología, Hospital Español de México, Ciudad de México, México
| | - J Pérez-Manauta
- Departamento de Enseñanza e Investigación, Hospital Español de México, Ciudad de México, México
| | - R H Raña-Garibay
- Servicio de Gastroenterología, Hospital Español de México, Ciudad de México, México
| | - J M Remes-Troche
- Departamento de Gastroenterología, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Veracruz, México
| | - J L Tamayo
- Servicio de Gastroenterología y Endoscopia Gastrointestinal, Hospital Civil de Culiacán, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México
| | - L F Uscanga
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - F Zamarripa-Dorsey
- Departamento de Gastroenterología, Hospital Juárez, Ciudad de México, México
| | - M A Valdovinos Díaz
- Departamento de Gastroenterología y Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J A Velarde-Ruiz Velasco
- Departamento de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
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Liu F, Han SP, Yu ZB, Zhang J, Chen XH, Wu WM, Chu X, Liu BB. [Effect of breastfeeding quality improvement on breastfeeding rate in very low birth weight and extremely low birth weight infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:937-942. [PMID: 27751207 PMCID: PMC7389552 DOI: 10.7499/j.issn.1008-8830.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the effect of breastfeeding quality improvement on the breastfeeding rate in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in the neonatal intensive care unit (NICU). METHODS A retrospective analysis was performed for the clinical data of VLBW and ELBW infants who were admitted from July 2014 to July 2015 (pre-improvement group) and those who were admitted from August 2015 to June 2016 after the implementation of breastfeeding quality improvement measures (post-improvement group). The parameters including condition of breastfeeding (breastfeeding rate, breastfeeding amount, and breastfeeding time), duration of parenteral nutrition, time to enteral feeding, and incidence of feeding intolerance were compared between the two groups. RESULTS The implementation of breastfeeding quality improvement measures significantly increased breastfeeding rate and amount, significantly shortened time to addition of human milk fortifier, duration of parenteral nutrition, and time to enteral feeding, and significantly decreased the incidence of feeding intolerance. CONCLUSIONS Breastfeeding quality improvement measures can increase breastfeeding rate in the NICU and decrease gastrointestinal complications in preterm infants.
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Affiliation(s)
- Feng Liu
- Department of Pediatrics, Nanjing Maternity Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China.
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Abstract
PURPOSE OF REVIEW The use of neurostimulation for treatment of gastrointestinal disorders has been growing over the past two to three decades. Our objective is to review current applications of neurostimulation in the treatment of gastrointestinal disorders with an emphasis on the use of these treatment modalities in children. RECENT FINDINGS Gastric electrical stimulation can lead to symptomatic improvement in children with chronic nausea and vomiting refractory to conventional treatment, and a recent report of long-term outcomes is encouraging. Sacral nerve stimulation can be effective in the treatment of children with constipation and fecal incontinence refractory to conventional treatment, and patient satisfaction with treatment remains high despite the risk of complications requiring further surgery. Abdominal transcutaneous electrical stimulation and posterior tibial nerve stimulation are noninvasive neurostimulation techniques that may be effective in the treatment of children with constipation and fecal incontinence. SUMMARY Although neurostimulation-based treatments appear promising and offer advantages compared to more invasive surgical treatment options, evidence for their benefit in children remains limited. High-quality studies demonstrating safety and efficacy and a better understanding of the mechanism of each modality are needed before there is more widespread acceptance of neurostimulation in the treatment of children with gastrointestinal disorders.
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Wo JM, Nowak TV, Waseem S, Ward MP. Gastric Electrical Stimulation for Gastroparesis and Chronic Unexplained Nausea and Vomiting. ACTA ACUST UNITED AC 2016; 14:386-400. [PMID: 27678506 DOI: 10.1007/s11938-016-0103-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OPINION STATEMENT Gastroparesis is a heterogeneous clinical syndrome. Some patients have debilitating vomiting, weight loss, and dehydration, while others have effortless regurgitation of undigested foods or postprandial distress suggestive of functional dyspepsia. Gastric electrical stimulation (GES) has been proposed as an effective treatment option for patients with gastroparesis refractory to medical therapy. Evidence suggests that the clinically available device, a low-energy high-frequency GES, activates the vagal afferent pathways to influence the central control mechanisms for nausea and vomiting. Myoelectrical effects of the stomach are also involved. The results of randomized controlled trials (RCTs) for adults with diabetic and idiopathic gastroparesis are conflicting. There are no RCTs in adults with chronic unexplained nausea and vomiting (CUNV) with normal gastric emptying or in children with gastroparesis. However, there is increasing evidence from large unblinded studies showing the long-term efficacy in selected adults with gastroparesis. Selection criteria should be based on three categories: (a) underlying etiology, (b) clinical presentation and predominant symptoms, and (c) potential risk for complication. Significant abdominal pain, daily opiate use, and idiopathic gastroparesis are identified as negative predictors of success. Temporary GES has been utilized to identify patients who may benefit from surgical GES, but this strategy has yet to be proven in controlled studies. Objectives for this review are to highlight the mechanisms of action for GES, to look at the evidence for clinical efficacy, and to select patients who are likely to benefit.
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Affiliation(s)
- John M Wo
- Division of Gastroenterology and Hepatology, Department of Medicine, GI Motility and Neurogastroenterology Unit, Indiana University Hospital, Room 1634, 550 University Blvd., Indianapolis, IN, 46202, USA.
| | - Thomas V Nowak
- Division of Gastroenterology and Hepatology, Department of Medicine, GI Motility and Neurogastroenterology Unit, Indiana University Hospital, Room 1634, 550 University Blvd., Indianapolis, IN, 46202, USA
| | - Shamaila Waseem
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Riley Children Hospital, Indianapolis, IN, USA
| | - Matthew P Ward
- Center of Implantable Devices, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
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Horn C, Zirpel L, Sciullo M, Rosenberg D. Impact of electrical stimulation of the stomach on gastric distension-induced emesis in the musk shrew. Neurogastroenterol Motil 2016; 28:1217-32. [PMID: 27072787 PMCID: PMC4956516 DOI: 10.1111/nmo.12821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/19/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Gastric electrical stimulation (GES) is implicated as a potential therapy for difficult-to-treat nausea and vomiting; however, there is a lack of insight into the mechanisms responsible for these effects. This study tested the relationship between acute GES and emesis in musk shrews, an established emetic model system. METHODS Urethane-anesthetized shrews were used to record emetic responses (monitoring intra-tracheal pressure and esophageal contractions), respiration rate, heart rate variability, blood pressure, and gastrointestinal electromyograms. We investigated the effects of acute GES pulse duration (0.3, 1, 5, and 10 ms), current amplitude (0.5, 1, and 2 mA), pulse frequency (8, 15, 30, and 60 Hz), and electrode placement (antrum, body, and fundus) on emesis induced by gastric stretch, using a balloon. KEY RESULTS There were four outcomes: (i) GES did not modify the effects of gastric stretch-induced emesis; (ii) GES produced emesis, depending on the stimulation parameters, but was less effective than gastric stretch; (iii) other physiological changes were closely associated with emesis and could be related to a sub-threshold activation of the emetic system, including suppression of breathing and rise in blood pressure; and (iv) a control experiment showed that 8-OH-DPAT, a reported 5-HT1A receptor agonist that acts centrally as an antiemetic, blocked gastric stretch-induced emesis. CONCLUSIONS AND INFERENCES These results do not support an antiemetic effect of acute GES on gastric distension-induced emesis within the range of conditions tested, but further evaluation should focus on a broader range of emetic stimuli and GES stimulation parameters.
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Affiliation(s)
- C.C. Horn
- Biobehavioral Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA,Department of Medicine: Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA,Corresponding Author: Charles C. Horn, PhD, Hillman Cancer Center – Research Pavilion, G.17b, 5117 Centre Avenue, Pittsburgh, PA 15213, Phone: (+00) 1-412-623-1417, Fax: 412-623-1119,
| | - L. Zirpel
- Neuromodulation Global Research, Medtronic
| | - M. Sciullo
- Biobehavioral Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - D. Rosenberg
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
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Russell AC, Stone AL, Walker LS. Functional Nausea in Children: A Review of the Literature and Need for Diagnostic Criteria. CHILDREN-BASEL 2016; 3:children3010005. [PMID: 27417243 PMCID: PMC4934479 DOI: 10.3390/children3010005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/03/2016] [Accepted: 03/08/2016] [Indexed: 12/12/2022]
Abstract
Nausea is common amongst children with functional gastrointestinal disorders and is associated with a high burden of somatic and psychosocial comorbidities in both the short and long-term. Current treatments including medications, phytotherapy, stress-reduction techniques, and gastric electrical stimulation for recalcitrant cases, are reviewed. Functional nausea merits its own diagnostic criteria as a pediatric functional gastrointestinal disorder.
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Affiliation(s)
- Alexandra C Russell
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | - Amanda L Stone
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN 37203, USA.
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional Disorders: Children and Adolescents. Gastroenterology 2016; 150:S0016-5085(16)00181-5. [PMID: 27144632 DOI: 10.1053/j.gastro.2016.02.015] [Citation(s) in RCA: 789] [Impact Index Per Article: 87.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 02/07/2023]
Abstract
Characterization of childhood and adolescent functional gastrointestinal disorders (FGIDs) has evolved during the two decade long Rome process now culminating in Rome IV. The era of diagnosing a FGID only when organic disease has been excluded is waning,as we now have evidence to support symptom-based diagnosis. In child/adolescent Rome IV we extend this concept by removing the dictum that there was "no evidence for organic disease" in all definitions and replacing it with "after appropriate medical evaluation the symptoms cannot be attributed to another medical condition". This change allows the clinician to perform selective or no testing to support a positive diagnosis of a FGID. We also point out that FGIDs can coexist with other medical conditions that themselves result in gastrointestinal symptoms (e.g., inflammatory bowel disease). In Rome IV functional nausea and functional vomiting are now described. Rome III "abdominal pain related functional gastrointestinal disorders" (AP-FGID) has been changed to functional abdominal pain disorders (FAPD) and we have derived a new term, "functional abdominal pain -not otherwise specified", to describe children who do not fit a specific disorder such as irritable bowel, functional dyspepsia, or abdominal migraine. Rome IV FGID definitions should enhance clarity for both clinicians and researchers.
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Affiliation(s)
- Jeffrey S Hyams
- Head, Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06101
| | - Carlo Di Lorenzo
- Head, Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Miguel Saps
- Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Robert J Shulman
- Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, 1100 Bates Street, Houston, TX 77030
| | - Annamaria Staiano
- Department of Translational Science, Section of Pediatrics, University of Naples, Federico II, Via S. Pansini, 5 80131 Naples, Italy
| | - Miranda van Tilburg
- University of North Carolina at Chapel Hill Department of Gastroenterology and Hepatology 130 Mason Farm rd, #4106 CB 7080 Chapel Hill NC
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Abstract
The sensation of nausea is a common occurrence with diverse causes and a significant disease burden. Nausea is considered to function as a protective mechanism, warning the organism to avoid potential toxic ingestion. Less adaptive circumstances are also associated with nausea, including post-operative nausea, chemotherapy-induced nausea, and motion sickness. A common definition of nausea identifies the symptom as a precursor to the act of vomiting. The interaction, though present, does not appear to be a simple relationship. Nausea is unfortunately the 'neglected symptom', with current accepted therapy generally directed at improving gastrointestinal motility or acting to relieve emesis. Improved understanding of the pathophysiological basis of nausea has important implications for exploiting novel mechanisms or developing novel therapies for nausea relief.
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Affiliation(s)
- Prashant Singh
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sonia S. Yoon
- Division of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
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Islam S, McLaughlin J, Pierson J, Jolley C, Kedar A, Abell T. Long-term outcomes of gastric electrical stimulation in children with gastroparesis. J Pediatr Surg 2016; 51:67-71. [PMID: 26526207 DOI: 10.1016/j.jpedsurg.2015.10.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 10/06/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastric electrical stimulation (GES) has been used in adults with gastroparesis. However its use has been limited in children. We describe the largest experience with GES in children with long-term outcomes. METHODS Data were collected on children who underwent GES over a 10-year period. Data regarding demographics, medical history, hospital course, and outcomes were collected and analyzed. Symptom scores (validated Likert scores) were compared using a paired Student's t test. RESULTS Overall, 97 patients underwent GES, and a majority were teenage Caucasian girls. Ninety-six had temporary GES (tGES), and 66 had improvement in their symptoms. A total of 67 underwent permanent implantation (pGES), and there was significant reduction in all individual symptoms (p<0.001) as well as the total symptom score (TSS) (p<0.0001) at 1, 6, 12, and >12 months. Recurrence of symptoms leading to device removal occurred in 7 cases. Forty-one patients had continued improvement in symptoms for over 12 months, with a mean follow-up of 3.5 years (range 1-9 years). CONCLUSIONS This study represents the largest experience of systematic application of GES in children. GES is a safe and effective therapy for selected children with intractable GP with continued symptomatic improvement at 1 year and beyond.
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Affiliation(s)
- Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States.
| | - Jillian McLaughlin
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Justine Pierson
- Division of Plastic Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Christopher Jolley
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Archana Kedar
- Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Thomas Abell
- Division of Gastroenterology, Department of Medicine, University of Louisville, Louisville, KY, United States
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Abstract
PURPOSE OF REVIEW Gastroparesis is a disorder with delayed gastric emptying in the absence of mechanical obstruction. It is one of the more common dysmotilities that occur in the gastrointestinal tract, and is thought to primarily affect adults. Pediatric cases of gastroparesis were considered rare; however, recent evidence suggests growing recognition in children and adolescents. Therefore, it is important for the pediatric caregiver to understand the condition and the treatment options available. RECENT FINDINGS The majority of patients are women, and presentation is usually with symptoms of persistent nausea, emesis, postprandial pain and bloating, and early satiety. Weight loss may occur in some cases, though this is not universal. The majority of cases are idiopathic, with diabetes mellitus the second most common cause. SUMMARY Treatment consists of symptomatic relief with medication to counteract the nausea, emesis, pain, bloating, gastroesophageal reflux, early satiety, and improve gastric emptying. Dietary modification is also used with small meals and avoidance of high fiber and fat-containing foods. Recalcitrant cases of gastroparesis require the use of additional approaches such as jejunal feeds, intrapyloric botulinum toxin, gastric emptying procedures such as pyloroplasty, and gastric electrical stimulation. We will review these options in this article.
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Abstract
OBJECTIVE The objective of this study was to report on the measurement properties of the Pediatric Quality of Life Inventory (PedsQL) Gastrointestinal Symptoms Module for patients with functional gastrointestinal (GI) disorders (FGIDs) and organic GI diseases, hereafter referred to as "GI disorders," for patient self-report ages between 5 and 18 and parent proxy-report for ages between 2 and 18 years. METHODS The 74-item PedsQL GI Module and 23-item PedsQL Generic Core Scales were completed in a 9-site study by 584 patients and 682 parents. Patients had physician-diagnosed GI disorders (such as chronic constipation, functional abdominal pain, irritable bowel syndrome, functional dyspepsia, Crohn disease, ulcerative colitis, gastroesophageal reflux disease). RESULTS Fourteen unidimensional scales were derived measuring stomach pain, stomach discomfort when eating, food and drink limits, trouble swallowing, heartburn and reflux, nausea and vomiting, gas and bloating, constipation, blood, diarrhea, worry, medicines, and communication. The PedsQL GI Module Scales evidenced excellent feasibility, excellent reliability for the Total Scale Scores (patient self-report α = 0.97, parent proxy-report α = 0.97), and good-to-excellent reliability for the 14 individual scales (patient self-report α = 0.67-0.94, parent proxy-report α = 0.77-0.95). Intercorrelations with the Generic Core Scales supported construct validity. Individual Symptoms Scales known-groups validity across 7 GI disorders was generally supported. Factor analysis supported the unidimensionality of the individual scales. CONCLUSIONS The PedsQL GI Module Scales demonstrated acceptable-to-excellent measurement properties and may be used as common metrics to compare GI-specific symptoms in clinical research and practice both within and across patient groups for FGIDs and organic GI diseases.
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PedsQL™ Gastrointestinal Symptoms Scales and Gastrointestinal Worry Scales in pediatric patients with functional and organic gastrointestinal diseases in comparison to healthy controls. Qual Life Res 2014; 24:363-78. [PMID: 25148757 DOI: 10.1007/s11136-014-0781-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The primary objective was to compare the gastrointestinal (GI) symptoms and worry of pediatric patients with functional GI disorders (FGIDs) and organic GI diseases to healthy controls utilizing the Pediatric Quality of Life Inventory™ (PedsQL™) Gastrointestinal Symptoms and Worry Scales for patient self-reports ages 5-18 years and parent proxy-reports for ages 2-18 years. The secondary objective was to compare FGIDs and organic GI diseases to each other. METHODS The PedsQL™ Gastrointestinal Symptoms and Worry Scales were completed in a 9-site study by 587 pediatric patients with GI disorders and 685 parents of patients. Patients had physician-diagnosed GI disorders (chronic constipation, functional abdominal pain, irritable bowel syndrome, functional dyspepsia, Crohn's disease, ulcerative colitis, and gastroesophageal reflux disease). Ten Gastrointestinal Symptoms Scales measuring Stomach Pain, Stomach Discomfort When Eating, Food and Drink Limits, Trouble Swallowing, Heartburn and Reflux, Nausea and Vomiting, Gas and Bloating, Constipation, Blood, and Diarrhea were administered along with two Gastrointestinal Worry Scales. Five hundred and thirteen healthy children and 337 parents of healthy children completed the PedsQL™ Gastrointestinal Scales in an Internet panel survey. RESULTS The PedsQL™ Gastrointestinal Symptoms and Worry Scales distinguished between pediatric patients with FGIDs and organic GI diseases in comparison with healthy controls, supporting known-groups validity. Patients with FGIDs reported more GI symptoms and worry than patients with organic GI diseases. CONCLUSIONS The PedsQL™ Gastrointestinal Symptoms and Worry Scales may be utilized as common metrics across pediatric patient groups with FGIDs and organic GI diseases and healthy samples to measure GI-specific symptoms in clinical research and practice.
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Rosen JM, Cocjin JT, Schurman JV, Colombo JM, Friesen CA. Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia. World J Gastrointest Pharmacol Ther 2014; 5:122-138. [PMID: 25133041 PMCID: PMC4133438 DOI: 10.4292/wjgpt.v5.i3.122] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/20/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
Functional gastrointestinal disorders (FGID) are common clinical syndromes diagnosed in the absence of biochemical, structural, or metabolic abnormalities. They account for significant morbidity and health care expenditures and are identifiable across variable age, geography, and culture. Etiology of abdominal pain associated FGIDs, including functional dyspepsia (FD), remains incompletely understood, but growing evidence implicates the importance of visceral hypersensitivity and electromechanical dysfunction. This manuscript explores data supporting the role of visceral hypersensitivity and electromechanical dysfunction in FD, with focus on pediatric data when available, and provides a summary of potential therapeutic targets.
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Kim JB, Shin JW, Kang JY, Son CG, Kang W, Lee HW, Lee DS, Park YC, Cho JH. A traditional herbal formula, Hyangsa-Pyeongwi san (HPS), improves quality of life (QoL) of the patient with functional dyspepsia (FD): randomized double-blinded controlled trial. JOURNAL OF ETHNOPHARMACOLOGY 2013; 151:279-286. [PMID: 24239600 DOI: 10.1016/j.jep.2013.10.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 09/24/2013] [Accepted: 10/17/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Hyangaa-Pyeongwi san is the most well known description in Traditional Chinese Medicine for treating functional gastrointestinal disorders. Functional dyspepsia (FD) is a main concern of intimidating quality of life (QoL) in recent days. Although many medicines have been developed to improve FD symptoms as well as QoL, there are no potential drugs and treatments for FD. The aim of this study is to investigate the effects of Hyangaa-Pyeongwi san (HPS) on QoL of patients with FD. METHODS This study was designed as a randomized, double blinded, placebo controlled, and parallel group trial. Participants received either placebo or HPS (9.68g of HPS at once, three times daily) for 4-weeks, and the efficacy evaluations were performed by assessing the Nepean Dyspepsia Index (NDI) and functional dyspepsia-quality of life (FD-QoL) at 0-, 4- and 8-weeks. RESULTS Total of 170 patients participated and were randomly allocated into placebo or HPS groups. Total symptom score of NDI decreased after 4-weeks trial in both groups (p>0.05). HPS significantly improved QoL scores, especially in the area of 'interference and eat/drink' in NDI (p=0.0031) as well as 'liveliness status', 'role-functioning status', and total score in FD-QoL (p=0.026 for liveliness status and p=0.035 for role-functioning status). This significant improvement of FD-QoL had lasted for 4-weeks. CONCLUSION HPS treatment is markedly effective in improving QoL in patients with FD. Moreover, we observed that this improvement had lasted for 4 weeks after finishing the trial through the follow-up study.
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Affiliation(s)
- Jeung-Bae Kim
- Internal Medicine of Immunology, Daejeon Oriental Hospital of Daejeon University, 22-5 Daehung-dong, Jung-gu, Daejeon 301-724, South Korea
| | - Jang-Woo Shin
- Internal Medicine of Immunology, Daejeon Oriental Hospital of Daejeon University, 22-5 Daehung-dong, Jung-gu, Daejeon 301-724, South Korea
| | - Ji-Young Kang
- Internal Medicine of Immunology, Daejeon Oriental Hospital of Daejeon University, 22-5 Daehung-dong, Jung-gu, Daejeon 301-724, South Korea
| | - Chang-Gue Son
- Internal Medicine of Immunology, Daejeon Oriental Hospital of Daejeon University, 22-5 Daehung-dong, Jung-gu, Daejeon 301-724, South Korea
| | - Weechang Kang
- Department of Business Information Statistics, College of Business Administration, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon 300-716, South Korea
| | - Hye-Won Lee
- TKM-Based Herbal Drug Research Group, Korea Institute of Oriental Medicine, 461-24, Jeonmin-dong, Yuseong-gu, Daejeon, South Korea
| | - Dong-Soo Lee
- Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Daehung-dong, Jung-gu, Daejeon, South Korea
| | - Yang-Chun Park
- Internal Medicine of Immunology and Lung, Daejeon Oriental Hospital of Daejeon University, 22-5 Daehung-dong, Jung-gu, Daejeon 301-724, South Korea
| | - Jung-Hyo Cho
- Internal Medicine of Immunology, Daejeon Oriental Hospital of Daejeon University, 22-5 Daehung-dong, Jung-gu, Daejeon 301-724, South Korea.
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