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Pop D, Man SC, Farcău D. Anxiety and Depression in Children with Irritable Bowel Syndrome-A Narrative Review. Diagnostics (Basel) 2025; 15:433. [PMID: 40002584 PMCID: PMC11853794 DOI: 10.3390/diagnostics15040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 02/03/2025] [Accepted: 02/06/2025] [Indexed: 02/27/2025] Open
Abstract
Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders diagnosed in children. It has a complex pathophysiology with several potential risk factors, including psychological disorders like anxiety and depression. This paper aimed to find genetic, pathophysiological, and clinical links between psychological factors (mainly anxiety and depression) and IBS in children. Impairment of the gut-brain communication and signalling of serotonin is responsible for both gastrointestinal and psychological disorders. Childhood psychological events seem to be linked to gastrointestinal symptoms not only in childhood but also in adulthood. Evidence of the efficacy of therapies targeting psychological disorders (antidepressant, hypnotherapy, and cognitive behavioural therapy) in children with IBS was evaluated. Further studies that use updated criteria for IBS and uniform questionnaires and outcome measures are needed to draw reliable conclusions regarding the connection between psychological factors and IBS.
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Affiliation(s)
- Daniela Pop
- Third Pediatric Discipline, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania
- Third Pediatric Department, Emergency Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Sorin Claudiu Man
- Third Pediatric Discipline, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania
- Third Pediatric Department, Emergency Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Dorin Farcău
- Third Pediatric Department, Emergency Hospital for Children, 400217 Cluj-Napoca, Romania
- Nursing Discipline, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania
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Vermeijden NK, de Silva L, Manathunga S, Spoolder D, Korterink J, Vlieger A, Rajindrajith S, Benninga M. Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis. Pediatrics 2025; 155:e2024067677. [PMID: 39761807 DOI: 10.1542/peds.2024-067677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 11/01/2024] [Indexed: 01/11/2025] Open
Abstract
CONTEXT Functional abdominal pain disorders (FAPDs) are debilitating disorders with unknown current prevalence. OBJECTIVE To estimate global prevalence rates of FAPDs, their entities, and variations by diagnostic criteria, geography, gender, and age. DATA SOURCES Medline, Embase, CINAHL, PsycInfo, and Cochrane Library were searched through October 14, 2024. STUDY SELECTION Epidemiological studies of birth cohorts, school based, and from general population samples reporting FAPD prevalence in children (aged 4-18 years) using the Rome criteria. DATA EXTRACTION Two researchers independently performed screening, data extraction, and quality assessment. RESULTS A total of 66 studies, encompassing 201 134 participants from 29 countries, were included. The estimated global pooled prevalence of FAPDs was 11.7% (95% CI, 10.5%-13.1%). The most prevalent type was irritable bowel syndrome (5.8%; 95% CI, 4.5-7.4%), while functional abdominal pain-not otherwise specified was least prevalent (1.2%; 95% CI, 0.7%-2.1%)). Prevalence was highest using Rome III (13.2%; 95% CI, 11.3%-15.3%) and lowest under Rome IV criteria (9.0%; 95% CI, 6.7%-12.0%; P = .05). Girls had higher prevalence (14.4%; 95% CI, 12.5%-16.6%) than boys (9.4%; 95% CI, 7.8%-11.4%; P < .01). FAPDs were nonsignificantly more prevalent in Asia (13.0%; 95% CI, 10.4%-16.3%) compared to Europe (8.3%; 95% CI, 6.4%-10.7%) and North America (7.7%; 95% CI, 4.3-13.6; P = .09). No differences by age (P = .14) were recorded. Contributing factors include anxiety, depression, stress, negative life events, and poor sleep. LIMITATIONS Language restrictions, significant interstudy heterogeneity, and underrepresentation from Africa. CONCLUSIONS AND RELEVANCE FAPDs affect over 1 in 9 children worldwide, with higher prevalence in girls and those with psychological stressors.
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Affiliation(s)
- Nicolaas Koen Vermeijden
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Center, Academic Medical Centre/Emma Children's Hospital, Amsterdam, the Netherlands
- Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Daphne Spoolder
- Knowledge and Information Centre, St Antonius Academy, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Judith Korterink
- Department of Pediatrics, Gelre Hospital, Zutphen, the Netherlands
| | - Arine Vlieger
- Department of Pediatrics, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Marc Benninga
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Di Nardo G, Barbara G, Borrelli O, Cremon C, Giorgio V, Greco L, La Pietra M, Marasco G, Pensabene L, Piccirillo M, Romano C, Salvatore S, Saviano M, Stanghellini V, Strisciuglio C, Tambucci R, Turco R, Zenzeri L, Staiano A. Italian guidelines for the management of irritable bowel syndrome in children and adolescents : Joint Consensus from the Italian Societies of: Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP), Pediatrics (SIP), Gastroenterology and Endoscopy (SIGE) and Neurogastroenterology and Motility (SINGEM). Ital J Pediatr 2024; 50:51. [PMID: 38486305 PMCID: PMC10938778 DOI: 10.1186/s13052-024-01607-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/11/2024] [Indexed: 03/18/2024] Open
Abstract
The irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID), whose prevalence has widely increased in pediatric population during the past two decades. The exact pathophysiological mechanism underlying IBS is still uncertain, thus resulting in challenging diagnosis and management. Experts from 4 Italian Societies participated in a Delphi consensus, searching medical literature and voting process on 22 statements on both diagnosis and management of IBS in children. Recommendations and levels of evidence were evaluated according to the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was reached for all statements. These guidelines suggest a positive diagnostic strategy within a symptom-based approach, comprehensive of psychological comorbidities assessment, alarm signs and symptoms' exclusion, testing for celiac disease and, under specific circumstances, fecal calprotectin and C-reactive protein. Consensus also suggests to rule out constipation in case of therapeutic failure. Conversely, routine stool testing for enteric pathogens, testing for food allergy/intolerance or small intestinal bacterial overgrowth are not recommended. Colonoscopy is recommended only in patients with alarm features. Regarding treatment, the consensus strongly suggests a dietary approach, psychologically directed therapies and, in specific conditions, gut-brain neuromodulators, under specialist supervision. Conditional recommendation was provided for both probiotics and specific fibers supplementation. Polyethylene glycol achieved consensus recommendation for specific subtypes of IBS. Secretagogues and 5-HT4 agonists are not recommended in children with IBS-C. Certain complementary alternative therapies, antispasmodics and, in specific IBS subtypes, loperamide and rifaximin could be considered.
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Affiliation(s)
- Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Barbara
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, 40126, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Osvaldo Borrelli
- Neurogastroenterology & Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK
| | - Cesare Cremon
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, 40126, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Valentina Giorgio
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Greco
- General Pediatrician, Heath Care Agency of Bergamo, Bergamo, Italy
| | | | - Giovanni Marasco
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, 40126, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, Magna Graecia University, Catanzaro, Italy
| | - Marisa Piccirillo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Silvia Salvatore
- Pediatric Department, "F. Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Michele Saviano
- General Pediatrician, Heath Care Agency of Naples, Naples, Italy
| | - Vincenzo Stanghellini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, 40126, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rossella Turco
- Department of Pediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Letizia Zenzeri
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University Federico II, Via S. Pansini 5, Naples, 80131, Italy.
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Wal A, Wal P, Verma N, Pandey SS, Krishnan K, Bhowmick M. Children and Adolescents with Irritable Bowel Syndrome: Treatment and Management. Curr Pediatr Rev 2024; 20:166-177. [PMID: 36443973 DOI: 10.2174/1573396319666221128094843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/13/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a disorder that causes stomach pain in children and adolescents. It may also impact one's quality of life. IBS is linked to gastrointestinal issues such as diarrhoea and constipation. Despite the identification of several potential pathophysiological pathways, the aetiology of IBS remained unknown. OBJECTIVE The aim of this paper is to discuss the diagnosis, pathogenesis, case studies and treatment of Irritable bowel syndrome in children and adolescents. METHODS This systematic review covered relevant papers from the previous ten years that were accessible in Science Direct, Elsevier, NCBI, and Web of Science related to the pathophysiology and function of pharmacological drugs such as antidepressants, antispasmodics, prokinetics, and antibiotics in children with irritable bowel syndrome. RESULTS Only a few prospective therapy techniques have been investigated in children, and even fewer of those have been demonstrated to be effective. This article presents case studies including 50-59 children, which demonstrate a favourable acceptable impact that is more effective than a placebo in terms of reducing symptoms and improving the overall quality of life in children who have irritable bowel syndrome. Furthermore, the majority of the pathophysiological explanations and treatment options discussed are based on adult studies. These major issues arose when treating paediatric IBS, and they must be addressed in order to properly treat children with IBS. Trials that focus on many combinations of pharmacological and non-pharmacological therapies seem to be more helpful. DISCUSSION In recent years, a number of systematic reviews have been conducted to evaluate the efficacy of medication treatments in children for IBS; however, the dependability of these systematic reviews needs to be further investigated owing to the various experimental designs and levels of evidence used. This article highlights paediatric therapy options, including pharmaceutical medications such as antidepressants, antispasmodics, prokinetics, and antibiotics. The goal is to alleviate IBS symptoms while also enhancing the quality of life for children with this illness.
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Affiliation(s)
- Ankita Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Nh2 Kanpur Agra Highway Bhaunti, Kanpur, UP, India
| | - Pranay Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology, Nh2 Kanpur Agra Highway Bhaunti, Kanpur, UP, India
| | - Neha Verma
- Department of Pharmacy, Pranveer Singh Institute of Technology, Nh2 Kanpur Agra Highway Bhaunti, Kanpur, UP, India
| | | | - Karthickeyan Krishnan
- Institute of Science Technology & Advanced Studies Pallavaram, Chennai, 600117, Tamil Nadu, 600117, India
| | - Mithun Bhowmick
- D101 Shikshak Niketan, Campus of Bengal College of Pharmaceutical Sciences and Research, Bidhananagar Durgapur, West Bengal, 713212, India
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Ferrier L, Eutamène H, Siegwald L, Marquard AM, Tondereau V, Chevalier J, Jacot GE, Favre L, Theodorou V, Vicario M, Rytz A, Bergonzelli G, Garcia-Rodenas CL. Human milk oligosaccharides alleviate stress-induced visceral hypersensitivity and associated microbiota dysbiosis. J Nutr Biochem 2021; 99:108865. [PMID: 34582967 DOI: 10.1016/j.jnutbio.2021.108865] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/11/2021] [Accepted: 09/01/2021] [Indexed: 02/08/2023]
Abstract
Pain-related functional gastrointestinal disorders (FGIDs) are characterized by visceral hypersensitivity (VHS) associated with alterations in the microbiota-gut-brain axis. Since human milk oligosaccharides (HMOs) modulate microbiota, gut and brain, we investigated whether HMOs impact VHS, and explored the role of gut microbiota. To induce VHS, C57BL/6JRj mice received hourly water avoidance stress (WAS) sessions for 10 d, or antibiotics (ATB) for 12 d. Challenged and unchallenged (Sham) animals were fed AIN93M diet (Cont) or AIN93M containing 1% of a 6-HMO mix (HMO6). VHS was assessed by monitoring the visceromotor response to colorectal distension. Fecal microbiome was analyzed by shotgun metagenomics. The effect of HMO6 sub-blends on VHS and nociceptive pathways was further tested using the WAS model. In mice fed Cont, WAS and ATB increased the visceromotor response to distension. HMO6 decreased WAS-mediated electromyographic rise at most distension volumes and overall Area Under Curve (AUC=6.12±0.50 in WAS/HMO6 vs. 9.46±0.50 in WAS/Cont; P<.0001). In contrast, VHS in ATB animals was not improved by HMO6. In WAS, HMO6 promoted most microbiota taxa and several functional pathways associated with low VHS and decreased those associated with high VHS. Among the sub-blends, 2'FL+DFL and LNT+6'SL reduced visceromotor response close to Sham/Cont values and modulated serotoninergic and CGRPα-related pathways. This research further substantiates the capacity of HMOs to modulate the microbiota-gut-brain communication and identifies mitigation of abdominal pain as a new HMO benefit. Ultimately, our findings suggest the value of specific HMO blends to alleviate pain associated FGIDs such as infantile colic or Irritable Bowel Syndrome.
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Affiliation(s)
- Laurent Ferrier
- Nestlé Institute of Health Sciences, Nestle Research, Lausanne, Switzerland
| | - Hélène Eutamène
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRA, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Léa Siegwald
- Nestlé Institute of Health Sciences, Nestle Research, Lausanne, Switzerland
| | | | - Valerie Tondereau
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRA, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Julien Chevalier
- Nestlé Institute of Health Sciences, Nestle Research, Lausanne, Switzerland
| | - Guillaume E Jacot
- Nestlé Institute of Health Sciences, Nestle Research, Lausanne, Switzerland
| | - Laurent Favre
- Project Management, Nestle Research, Lausanne, Switzerland
| | - Vassilia Theodorou
- Toxalim (Research Centre in Food Toxicology), Université de Toulouse, INRA, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Maria Vicario
- Nestlé Institute of Health Sciences, Nestle Research, Lausanne, Switzerland
| | - Andreas Rytz
- Clinical Research Unit, Nestle Research, Lausanne, Switzerland
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Chumpitazi BP, Palermo TM, Hollier JM, Self MM, Czyzewski D, Weidler EM, Heitkemper M, Shulman RJ. Multisite Pain Is Highly Prevalent in Children with Functional Abdominal Pain Disorders and Is Associated with Increased Morbidity. J Pediatr 2021; 236:131-136. [PMID: 33940018 PMCID: PMC8403143 DOI: 10.1016/j.jpeds.2021.04.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/06/2021] [Accepted: 04/27/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To characterize the types of multisite pain experienced by children with functional abdominal pain disorders (FAPDs) and to examine differences in psychosocial distress, functional disability, and health-related quality of life in children with multisite pain vs abdominal pain alone. STUDY DESIGN Cross-sectional study of children ages 7-17 years (n = 406) with pediatric Rome III FAPDs recruited from both primary and tertiary care between January 2009 and June 2018. Subjects completed 14-day pain and stool diaries, as well as validated questionnaires assessing abdominal and nonabdominal pain symptoms, anxiety, depression, functional disability, and health-related quality of life. RESULTS In total, 295 (73%) children endorsed at least 1 co-occurring nonabdominal pain, thus, were categorized as having multisite pain with the following symptoms: 172 (42%) headaches, 143 (35%) chest pain, 134 (33%) muscle soreness, 110 (27%) back pain, 94 (23%) joint pain, and 87 (21%) extremity (arms and legs) pain. In addition, 200 children (49%) endorsed 2 or more nonabdominal pain symptoms. Participants with (vs without) multisite pain had significantly higher abdominal pain frequency (P < .001) and severity (P = .03), anxiety (P < .001), and depression (P < .001). Similarly, children with multisite pain (vs without) had significantly worse functional disability (P < .001) and health-related quality of life scores (P < .001). Increasing number of multisite pain sites (P < .001) was associated with increased functional disability when controlling for demographic and other clinical factors. CONCLUSIONS In children with FAPDs, nonabdominal multisite pain is highly prevalent and is associated with increased psychosocial distress, abdominal pain frequency and severity, functional disability, and lower health-related quality of life.
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Affiliation(s)
- Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA,Children’s Nutrition Research Center, United States Department of Agriculture, Houston, TX USA
| | - Tonya M. Palermo
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA USA,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle WA
| | - John M. Hollier
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Mariella M. Self
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Danita Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA,Children’s Nutrition Research Center, United States Department of Agriculture, Houston, TX USA
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA USA
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA,Children’s Nutrition Research Center, United States Department of Agriculture, Houston, TX USA
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Kumari MV, Amarasiri L, Rajindrajith S, Devanarayana NM. Functional abdominal pain disorders and asthma: two disorders, but similar pathophysiology? Expert Rev Gastroenterol Hepatol 2021; 15:9-24. [PMID: 32909837 DOI: 10.1080/17474124.2020.1821652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Functional abdominal pain disorders (FAPDs) and asthma are common ailments affecting both children and adults worldwide. Multiple studies have demonstrated an association between these two disorders. However, the exact reason for this observed association is not apparent. AREAS COVERED The current review has explored available literature and outlined multiple underlying pathophysiological mechanisms, common to both asthma and FAPDs, as possible reasons for this association. EXPERT OPINION Smooth muscle dysfunction, hypersensitivity and hyper-responsiveness, mucosal inflammation, and barrier dysfunction involving gastrointestinal and respiratory tracts are the main underlying pathophysiological mechanisms described for the generation of symptoms in FAPDs and asthma. In addition, alterations in neuroendocrine regulatory functions, immunological dysfunction, and microbial dysbiosis have been described in both disorders. We believe that the pathophysiological processes that were explored in this article would be able to expand the mechanisms of the association. The in-depth knowledge is needed to be converted to therapeutic and preventive strategies to improve the quality of care of children suffering from FAPDs and asthma.
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Affiliation(s)
- Manori Vijaya Kumari
- Department of Physiology, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka , Anuradhapura, Sri Lanka
| | - Lakmali Amarasiri
- Department of Physiology, Faculty of Medicine, University of Colombo , Colombo, Sri Lanka
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Low EXS, Mandhari MNKA, Herndon CC, Loo EXL, Tham EH, Siah KTH. Parental, Perinatal, and Childhood Risk Factors for Development of Irritable Bowel Syndrome: A Systematic Review. J Neurogastroenterol Motil 2020; 26:437-446. [PMID: 32989183 PMCID: PMC7547188 DOI: 10.5056/jnm20109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/13/2020] [Accepted: 09/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Adverse early life experiences are associated with the development of stroke, cancer, diabetes, and chronic respiratory and ischemic heart diseases. These negative experiences may also play a role in the development of irritable bowel syndrome (IBS)--a functional gastrointestinal disease. This review discusses the research to date on the parental, perinatal, and childhood risk and protective factors associated with the development of IBS. Methods A literature search was completed for studies published between 1966 and 2018 that investigated premorbid factors occurring during the perinatal and childhood periods as well as parental factors that were associated with the development of IBS. Results Twenty-seven studies fulfilled the review criteria. Risk factors that appeared in more than one study included: (1) parental IBS, substance abuse, parental punishment, and rejection as parental risk factors; (2) low birth weight as a perinatal risk factor; and (3) crowded living conditions in low-income families, childhood anxiety, depression, or child abuse as childhood risk factors. Protective factors for IBS were emotional warmth from the parents and being born to an older mother. Conclusions More effort is needed to identify what fetal and maternal factors are associated with low birth weight and IBS. A well-executed prospective birth cohort with a collection of bio-samples and functional data will provide a better understanding of how adversity and the interplay between genetics, epigenetics, and numerous risk factors affect the development of IBS.
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Affiliation(s)
- En X S Low
- Department of Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Maimouna N K Al Mandhari
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Charles C Herndon
- G Oppenheimer Center for Neurobiology of Stress and Resilience (CNSR), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Evelyn X L Loo
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Departments of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elizabeth H Tham
- Departments of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System (NUHS), Singapore, Singapore
| | - Kewin T H Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- Departments of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Fodor I, Man SC, Dumitrascu DL. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet in children. World J Clin Cases 2019; 7:2666-2674. [PMID: 31616683 PMCID: PMC6789397 DOI: 10.12998/wjcc.v7.i18.2666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/26/2019] [Accepted: 08/27/2019] [Indexed: 02/05/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a lifelong condition with a high prevalence among children and adults. As the diet is a frequent factor that triggers the symptoms, it has been assumed that by avoiding the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP), the symptoms might be improved. Therefore, in the past decade, low FODMAP diet has been intensively investigated in the management of IBS. The capacity of FODMAPs to trigger the symptoms in patients with IBS was related to the stimulation of mechanoreceptors in the small and large intestine. This stimulation appears as a response to a combination of increased luminal water (the osmotic effect) and the release of gases (carbon dioxide and hydrogen) due to the fermentation of oligosaccharides and malabsorption of fructose, lactose and polyols. Numerous studies have been published regarding the efficacy of a low FODMAP diet compared to a traditional diet in releasing the IBS symptoms in adults, but there are only a few studies in the juvenile population. The aim of this review is to analyze the current data on both low FODMAP diet in children with IBS and the effects on their nutritional status and physiological development, given the fact that it is a restrictive diet.
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Affiliation(s)
- Ioana Fodor
- 3rd Pediatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Sorin Claudiu Man
- 3rd Pediatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
| | - Dan L Dumitrascu
- 2nd Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400006, Romania
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Newton E, Schosheim A, Patel S, Chitkara DK, van Tilburg MAL. The role of psychological factors in pediatric functional abdominal pain disorders. Neurogastroenterol Motil 2019; 31:e13538. [PMID: 30729663 DOI: 10.1111/nmo.13538] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pediatric functional abdominal pain disorders (FAPDs) are disorders of brain-gut dysregulation. Psychological factors are known to be related to etiology, maintenance, and exacerbation of pediatric FAPDs. With the evolving literature in the past two decades, a better understanding has emerged of precisely which psychological factors are associated with childhood FAPDs. PURPOSE This narrative literature review summarizes the literature of both child and parent psychological factors in pediatric FAPD. Where anxiety and depression were major targets in the older literature, present-day focus is increasingly on pain-specific cognitions and coping strategies including disease threat and catastrophizing. In addition, parental reaction to a child's pain is increasingly recognized as an important moderator of a child's outcomes and has become an area for clinical intervention. Screening for these factors and integrative treatment approaches are recommended in childhood FAPD.
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Affiliation(s)
- Emily Newton
- Department of Clinical Research, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, North Carolina
| | - Alex Schosheim
- Department of Pediatric Gastroenterology, Stony Brook University Hospital, Stony Brook, New York
| | - Samit Patel
- Department of Pediatric Gastroenterology, Arnold Palmer Hospital, Orlando, Florida
| | - Denesh K Chitkara
- Department of Pediatric Gastroenterology, Saint Peters University Hospital, New Brunswick, New Jersey
| | - Miranda A L van Tilburg
- Department of Clinical Research, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, North Carolina
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- School of Social work, University of Washington, Seattle, Washington
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Kesuma Y, Firmansyah A, Bardosono S, Sari IP, Kurniawan A. Blastocystis ST-1 is associated with Irritable Bowel Syndrome-diarrhoea (IBS-D) in Indonesian adolescences. Parasite Epidemiol Control 2019; 6:e00112. [PMID: 31528737 PMCID: PMC6742775 DOI: 10.1016/j.parepi.2019.e00112] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 12/14/2022] Open
Abstract
Objective IBS is a functional gastrointestinal disorder and commonly presents in children and adolescences, presented as diarrhoea, constipation or mixed type. Blastocystis is a common intestinal protozoa found worldwide, which pathogenicity is still controversial. This study aimed to identify the risk factors of IBS, the association between IBS types with Blastocystis subtypes and analyse Blastocystis pathogenicity. Design A comparative cross-sectional study was conducted among senior high school students. Rome III Criteria for IBS diagnosis, questionnaires on the risk factors of IBS and types of IBS were recorded. Students were further selected and classified into IBS and non-IBS groups to analyse the association between IBS, IBS types with Blastocystis infection and its subtypes. Direct microscopic stool examination to identify single Blastocystis infection was performed, followed by culture in Jones' medium, PCR, sequencing of 18S rRNA and phylogenetic analysis to determine Blastocystis subtype. Data was analysed using SPSS v22.0 and P value <0.05 was considered statistically significant (95% confidence intervals). Results IBS was found in 30.2% of 454 students, consisted of 33.3% IBS Diarrhoea, 27.7% IBS Mixed, 27.7% IBS Unclassified and 11.1% IBS Constipation. Major risk factors to IBS consisted of family history of recurrent abdominal pain, abuse, bullying and female gender in respective order (OR 3.6–2.1). Blastocystis ST-1 was significantly associated to IBS-D with 2.9 times risk factor. Conclusions Blastocystis infection is a risk factor to develop IBS-D type in adolescence; Blastocystis ST-1 can be regarded as a pathogenic subtype.
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Affiliation(s)
- Yudianita Kesuma
- Department of Pediatrics, Faculty of Medicine, Universitas Sriwijaya and Moh. Hoesin Hospital, Palembang, Indonesia
- Doctoral Study program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Agus Firmansyah
- Department of Pediatrics, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Saptawati Bardosono
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ika Puspa Sari
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Agnes Kurniawan
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Corresponding author at: Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
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12
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Hollier JM, van Tilburg MA, Liu Y, Czyzewski DI, Self MM, Weidler EM, Heitkemper M, Shulman RJ. Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome. Neurogastroenterol Motil 2019; 31:e13509. [PMID: 30549152 PMCID: PMC6651721 DOI: 10.1111/nmo.13509] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anxiety and depression are implicated as contributors to abdominal pain in pediatric irritable bowel syndrome (IBS) but is unclear if this pain is associated with other psychological factors. The study objective was to test if the impact of anxiety or depression on IBS symptom severity is mediated by somatization and/or pain catastrophizing. METHODS We utilized baseline data from local pediatric IBS clinical studies. Through mediation analysis, we assessed whether somatization or pain catastrophizing mediated (either independently or combined) the separate relationships of anxiety or depression with IBS abdominal pain severity. KEY RESULTS We analyzed 261 participants. All psychological factors were positively correlated with one another and IBS abdominal pain severity. The association of anxiety with IBS abdominal pain was mediated by both somatization and pain catastrophizing in individual analyses (each mediated standardized coefficient [β] 0.11, CI 0.05-0.18) and in multiple analysis (mediated standardized β 0.18, CI 0.09-0.27). The association of depression with IBS abdominal pain was also mediated by somatization (mediated standardized β 0.08, CI0.02-0.14) and pain catastrophizing (mediated standardized β 0.06, CI 0.01-0.11) in individual analyses and in multiple analysis (mediated standardized β 0.19, CI 0.04-0.19). CONCLUSIONS AND INFERENCES Somatization and pain catastrophizing mediate the relationships between anxiety/depression and IBS abdominal pain severity. These findings suggest that somatization and pain catastrophizing may be better treatment targets than anxiety and depression. Clinicians should assess these psychological factors in pediatric IBS patients and refer for intervention to improve outcomes.
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Affiliation(s)
- John M. Hollier
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,Texas Children’s Hospital, Houston, Texas, United States of America
| | - Miranda A.L. van Tilburg
- Department of Clinical Research, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina, United States of America,Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America,School of Social Work, University of Washington, Seattle, Washington, United States of America
| | - Yan Liu
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Danita I. Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,Texas Children’s Hospital, Houston, Texas, United States of America
| | - Mariella M. Self
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,Texas Children’s Hospital, Houston, Texas, United States of America
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,United States Department of Agriculture/Agricultural Research Service, Children’s Nutrition Research Center, Houston, Texas, United States of America
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America,Texas Children’s Hospital, Houston, Texas, United States of America,United States Department of Agriculture/Agricultural Research Service, Children’s Nutrition Research Center, Houston, Texas, United States of America
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Pensabene L, Salvatore S, D'Auria E, Parisi F, Concolino D, Borrelli O, Thapar N, Staiano A, Vandenplas Y, Saps M. Cow's Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children? Nutrients 2018; 10:1716. [PMID: 30423934 PMCID: PMC6265683 DOI: 10.3390/nu10111716] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/04/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022] Open
Abstract
The role and prevalence of cow's milk protein allergy (CMA) in functional gastrointestinal disorders remains unclear. The aim of this review is to update knowledge on the relationship between CMA and functional abdominal pain disorders (FAPDs) in children. Cochrane Database and Pubmed were searched from inception using general and specific terms for CMA and functional gastrointestinal disorders. CMA is reported as a predisposing or coexisting factor in a wide range of functional gastrointestinal disorders in infants and children. Pathogenesis of both conditions is complex and multiple mechanisms including dysmotility and hypersensitivity might contribute to the clinical manifestations. Data supporting the possible role of food allergies in the pathogenesis of FAPDs are limited. CMA may predispose to early life inflammation and visceral hypersensitivity, which in turn might manifest as FAPDs. The diagnosis of either CMA or FAPDs and distinction between them is challenging because of nonspecific and overlapping symptoms. Lack of accurate allergy tests in non-IgE (immunoglobulin E) mediated cases is also problematic. Oral food challenge, following an elimination diet, should be performed to diagnose a suspected non-IgE CMA allergy in children with FAPDs. In the management of FAPDs, an elimination diet should be considered for a limited period to verify if the symptoms improve or resolve.
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Affiliation(s)
- Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Silvia Salvatore
- Department of Medicine and Surgery, Section of Pediatrics, University of Insubria, 21100 Varese, Italy.
| | - Enza D'Auria
- Department of Pediatrics, Vittore Buzzi Children's Hospital-University of Milan, 20154 Milan, Italy.
| | - Francesca Parisi
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Daniela Concolino
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy.
| | - Osvaldo Borrelli
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
| | - Nikhil Thapar
- Neurogastroenterology and Motility Unit, Department of Gastroenterology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", 80131 Naples, Italy.
| | - Yvan Vandenplas
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Holtz Children's Hospital, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
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Devanarayana NM, Rajindrajith S. Irritable bowel syndrome in children: Current knowledge, challenges and opportunities. World J Gastroenterol 2018; 24:2211-2235. [PMID: 29881232 PMCID: PMC5989237 DOI: 10.3748/wjg.v24.i21.2211] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common and troublesome disorder in children with an increasing prevalence noted during the past two decades. It has a significant effect on the lives of affected children and their families and poses a significant burden on healthcare systems. Standard symptom-based criteria for diagnosis of pediatric IBS have changed several times during the past two decades and there are some differences in interpreting symptoms between different cultures. This has posed a problem when using them to diagnose IBS in clinical practice. A number of potential patho-physiological mechanisms have been described, but so far the exact underlying etiology of IBS is unclear. A few potential therapeutic modalities have been tested in children and only a small number of them have shown some benefit. In addition, most of the described patho-physiological mechanisms and treatment options are based on adult studies. These have surfaced as challenges when dealing with pediatric IBS and they need to be overcome for effective management of children with IBS. Recently suggested top-down and bottom-up models help integrating reported patho-physiological mechanisms and will provide an opportunity for better understanding of the diseases process. Treatment trials targeting single treatment modalities are unlikely to have clinically meaningful therapeutic effects on IBS with multiple integrating patho-physiologies. Trials focusing on multiple combined pharmacological and non-pharmacological therapies are likely to yield more benefit. In addition to treatment, in the future, attention should be paid for possible prevention strategies for IBS.
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Affiliation(s)
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
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Khayyatzadeh SS, Kazemi-Bajestani SMR, Mirmousavi SJ, Heshmati M, Khoshmohabbat S, Ferns GA, Ghayour-Mobarhan M. Dietary behaviors in relation to prevalence of irritable bowel syndrome in adolescent girls. J Gastroenterol Hepatol 2018; 33:404-410. [PMID: 28770579 DOI: 10.1111/jgh.13908] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/21/2017] [Accepted: 07/25/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUNDS AND AIMS There is limited evidence regarding the relationship between dietary behaviors and irritable bowel syndrome (IBS). This study aimed to explore the association between diet-related practices and prevalence of IBS. METHODS The study was conducted among 988 adolescent girls living in Iran. Dietary behaviors were pre-defined and assessed in nine domains using a pre-tested questionnaire. To investigate the association between diet-related practices and the presence of IBS, this study used logistic regression analysis in crude and adjusted models. RESULTS The prevalence of IBS was 16.9% in this population. Compared with individuals who did not consume fluid with their meal, those who always consumed fluid with meals had a greater chance of IBS (odds ratio [OR]: 2.91; P: 0.01). This study found a direct relationship between a greater intake of spicy food and IBS prevalence (OR: 5.28; P: 0.02). The individuals who ate fried foods every day also had a greater risk of IBS compared with those who did not consume fried foods (OR: 1.65; P: 0.01). The subjects who had lost ≥ 5 teeth had 2.23 times greater odds for IBS than the individual who had lost ≤ 1 tooth (OR: 2.23; P: 0.01) was a significant inverse relationship between the chewing sufficiency and the risk of IBS (OR: 4.04; P: 0.02). These associations remained significant after controlling for potential confounder. CONCLUSIONS Intra-meal fluid intake, chewing insufficiency, higher tooth loss, and the consumption of spicy and fried food were associated with increased risk of IBS. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Sayyed Saeid Khayyatzadeh
- Student Research Committee, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Mohammad Reza Kazemi-Bajestani
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Seyed Jamal Mirmousavi
- Community Medicine, Community Medicine Department, Medical School, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Masoud Heshmati
- Department of Immunology and Microbiology, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Somaieh Khoshmohabbat
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Tsai JD, Wang IC, Shen TC, Lin CL, Wei CC. A 8-year population-based cohort study of irritable bowel syndrome in childhood with history of atopic dermatitis. J Investig Med 2018; 66:755-761. [DOI: 10.1136/jim-2017-000631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 12/15/2022]
Abstract
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder affecting a large number of people worldwide. Based on the concept of central sensitization, we conducted a population-based cohort analysis to investigate the risk of IBS in children with atopic dermatitis (AD) as one of the first steps in the atopic march. From 2000 to 2007, 1 20 014 children with newly diagnosed AD and 1 20 014 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of IBS in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and CIs were measured. The incidence of IBS during the study period was 1.45-fold greater (95% CI: 1.32 to 1.59) in the AD cohort than in the non-AD cohort (18.8 vs 12.9 per 10 000 person-years). The AD to non-AD HR of IBS was greater for girls (1.60, 95% CI: 1.39 to 1.85) and children≥12 years (1.59, 95% CI: 1.23 to 2.05). The HR of IBS in AD children increased from 0.84 (95% CI: 0.75 to 0.94) for those with ≤3 AD related visits to 16.7 (95% CI: 14.7 to 18.9) for those with >5 visits (P<0.0001, by the trend test). AD children had a greater risk of developing IBS. Further research is needed to clarify the role of allergy in the pathogenesis of IBS.
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Caes L, Orchard A, Christie D. Connecting the Mind-Body Split: Understanding the Relationship between Symptoms and Emotional Well-Being in Chronic Pain and Functional Gastrointestinal Disorders. Healthcare (Basel) 2017; 5:E93. [PMID: 29206152 PMCID: PMC5746727 DOI: 10.3390/healthcare5040093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022] Open
Abstract
Paediatric chronic conditions, e.g., chronic pain and functional gastrointestinal disorders, are commonly diagnosed, with fatigue, pain and abdominal discomfort the most frequently reported symptoms across conditions. Regardless of whether symptoms are connected to an underlying medical diagnosis or not, they are often associated with an increased experience of psychological distress by both the ill child and their parents. While pain and embarrassing symptoms can induce increased distress, evidence is also accumulating in support of a reciprocal relationship between pain and distress. This reciprocal relationship is nicely illustrated in the fear avoidance model of pain, which has recently been found to be applicable to childhood pain experiences. The purpose of this article is to illustrate how mind (i.e., emotions) and body (i.e., physical symptoms) interact using chronic pain and gastrointestinal disorders as key examples. Despite the evidence for the connection between mind and body, the mind-body split is still a dominant position for families and health care systems, as evidenced by the artificial split between physical and mental health care. In a mission to overcome this gap, this article will conclude by providing tools on how the highlighted evidence can help to close this gap between mind and body.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - Alex Orchard
- UCLH NHS Foundation Trust, Child and Adolescent Psychological Services, London NW1 2PQ, UK.
| | - Deborah Christie
- UCLH NHS Foundation Trust, Child and Adolescent Psychological Services, London NW1 2PQ, UK.
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Adeniyi OF, Adenike Lesi O, Olatona FA, Esezobor CI, Ikobah JM. Irritable bowel syndrome in adolescents in Lagos. Pan Afr Med J 2017; 28:93. [PMID: 29255563 PMCID: PMC5724937 DOI: 10.11604/pamj.2017.28.93.11512] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/16/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION irritable bowel syndrome (IBS) is one of the functional gastrointestinal disorders (FGIDs) which has been well described in western populations especially as the commonest cause of recurrent abdominal pain The aim of this study was to document the prevalence of Irritable bowel syndrome (IBS) amongst children in western Nigeria and increase the aware ness of IBS amongst physicians who manage children with abdominal pain. METHODS This was a cross-sectional study conducted amongst children aged 10-18 years in 8 schools located in two local government areas of Lagos state. A multistage stratified random-sampling survey was conducted using the validated Rome III criteria to assess for IBS and associated risk factors. The subtypes of IBS and associated extra-intestinal symptoms were also documented. RESULTS The prevalence of IBS was 16.0% in the study participants and the prevalence decreased with increasing age (p=0.05). Sixty two (62.5%) of the students with recurrent abdominal pain had IBS. IBS was more prevalent in the females compared to the males (p=0.000). The significant risk factors for IBS identified were gender (p=0.000), socioeconomic status (p=0.001) and past history of gastroenteritis (p=0.011). The commonest subtype of IBS seen was the alternating subtype. CONCLUSION IBS is prevalent in African children. Physicians who attend to children need to have a high index of suspicion for IBS in children who present with abdominal pain when there are no alarm symptoms. The need for further longitudinal studies in African children cannot be overemphasized.
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Affiliation(s)
- Oluwafunmilayo Funke Adeniyi
- Department of Paediatrics, College of Medicine, University of Lagos,Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olufunmilayo Adenike Lesi
- Department of Medicine, College of Medicine, University of Lagos, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Foluke Adenike Olatona
- Department of Community Health, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Christoper Imokhuede Esezobor
- Department of Paediatrics, College of Medicine, University of Lagos,Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Joanah Moses Ikobah
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
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Lankarani KB, Akbari M, Tabrizi R. Association of Gastrointestinal Functional Disorders and Migraine Headache: a Population Base Study. Middle East J Dig Dis 2017; 9:139-145. [PMID: 28894515 PMCID: PMC5585926 DOI: 10.15171/mejdd.2017.64] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/10/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Migraine is one of the prevalent headaches. Many of patients with migraine, complain of gastrointestinal symptoms. There is limited studies on relation of gastrointestinal symptoms and migraine headache at population level. METHODS In this population-based study, 1038 subjects older than 15 year from a rural area in Fars province, south of Iran. were investigated for functional gastrointestinal disorders. By cluster random sampling, 160 of these persons invited to receive endoscopy along with histopathology samples of upper gastrointestinal tract. Data were analyzed using Pearson chi-square and Fisher exact. RESULTS Mean age of participations were 34.3 years with female to male of 3:1. The prevalence of migraine, irritable bowel syndrome (IBS), reflux, and dyspepsia were 24.6%, 17.7%, 17.4%, and 32.1%, respectively. There were significant relationship between migraine and functional gastrointestinal diseases (odds ratio of association for migraine with IBS, reflux, and dyspepsia were 3.43, 1.68, and 1.68 with p-value < 0.001 for all). In endoscopic findings, only presence of hiatal hernia was associated significantly with migraine (p = 0.011). No histopathologic findings in antral or duodenal biopsies were associated with migraine. CONCLUSION In this population based study we found significant association between migraines and gastrointestinal functional disorders including IBS, reflux and dyspepsia. This may have implication in better management of patients with migraine headache.
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Affiliation(s)
- Kamran B Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences. Islamic Republic of Iran
| | - Maryam Akbari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences. Islamic Republic of Iran
| | - Reza Tabrizi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences. Islamic Republic of Iran
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Boronat AC, Ferreira-Maia AP, Matijasevich A, Wang YP. Epidemiology of functional gastrointestinal disorders in children and adolescents: A systematic review. World J Gastroenterol 2017; 23:3915-3927. [PMID: 28638232 PMCID: PMC5467078 DOI: 10.3748/wjg.v23.i21.3915] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the prevalence of functional gastrointestinal disorders (FGIDs) in children and adolescents. METHODS PubMed, EMBASE, and Scopus databases were searched for original articles from inception to September 2016. The literature search was made in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For inclusion, each study had to report epidemiological data on FGIDs in children between 4 and 18 years old and contain standardized outcome based on Rome II, III or IV criteria. The overall quality of included epidemiological studies was evaluated in accordance with Loney's proposal for prevalence studies of health literature. Two reviewers assessed each study for data inclusion and extraction. Discrepancies were reconciled through discussion with seniors. RESULTS A total of 659 articles were identified from the databases and 16 through manual search. A total of 43 articles fulfilled the eligibility criteria for full-text reading, with 26 remaining to be included in the final analysis. All studies were written in English and published between 2005 and 2016. Eight (30.8%) articles were performed in North America, five (19.2%) in Latin America, five (19.2%) in Europe, seven (27%) in Asia, and one (3.8%) in Africa. Sample size varied between 114 and 99416 subjects, totaling 132600 individuals. Fourteen (53.9%) studies recruited their target samples from schools, 11 (42.3%) from healthcare settings and the remaining one (3.8%) from online panel community. The overall FGID prevalence rates for student samples ranged from 9.9% to 29% to as high as 87% in clinical samples. Cyclic vomiting, irritable bowel syndrome and functional constipation were the most researched conditions, with a prevalence ranging from 0.2% to 6.2%, 0% to 45.1% and 0.5% to 86.9%, respectively. The qualitative appraisal revealed that most of the studies showed average or below average generalizability. CONCLUSION The heterogeneity of the studies on FGIDs must be improved in order to allow comparison. Improvements should include appropriate sampling of representative population, comparable study setting, and consistent data collection.
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Preschoolers With Allergic Diseases Have an Increased Risk of Irritable Bowel Syndrome When Reaching School Age. J Pediatr Gastroenterol Nutr 2017; 64:26-30. [PMID: 27035379 DOI: 10.1097/mpg.0000000000001219] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of the study was to systemically investigate the risk of subsequent irritable bowel syndrome (IBS) in children with antecedent allergic diseases in a population-based case-control study in Taiwan. METHODS We evaluated 11,242 children (age range: 7-18 years) with IBS and 44,968 age- and sex-matched control subjects who had been examined between 2000 and 2008. IBS odds ratios were calculated for children with antecedent allergic diseases, including allergic conjunctivitis, allergic rhinitis, asthma, atopic dermatitis, urticaria, and food allergy. RESULTS Children with antecedent allergic diseases had a greater risk of IBS than did control subjects (P < 0.001). Among the 6 evaluated diseases, the highest adjusted odds ratio of 1.78 was observed with allergic rhinitis (95% confidence interval [CI], 1.69-1.87). With 2 or more allergic diseases, the adjusted odds ratios increased to 2.06 (95% CI, 1.93-2.19) for all subjects, 2.07 (95% CI, 1.88-2.28) for girls, and 2.18 (95% CI, 2.02-2.35) for children 12 years or older. CONCLUSIONS Preschoolers with a history of allergic disease had an increased risk of subsequent IBS development upon reaching school age. This risk increased in the presence of concurrent allergic disease and a higher clinical allergy burden.
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Childhood Irritable Bowel Syndrome Characteristics Are Related to Both Sex and Pubertal Development. J Pediatr 2017; 180:141-147.e1. [PMID: 27639531 PMCID: PMC5183501 DOI: 10.1016/j.jpeds.2016.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the relationship of both pubertal development and sex to childhood irritable bowel syndrome (IBS) clinical characteristics including gastrointestinal symptoms (eg, abdominal pain) and psychological factors. STUDY DESIGN Cross-sectional study with children ages 7-17 years (n = 143) with a pediatric Rome III IBS diagnosis recruited from both primary and tertiary clinics between January 2009 and January 2014. Subjects completed 14-day prospective pain and stool diaries, as well as validated questionnaires assessing several psychological factors (somatization, depression, anxiety) and Tanner stage. Stool form ratings were completed using the Bristol Stool Form Scale. RESULTS Girls with higher Tanner scores (more mature pubertal development) had both decreased pain severity and pain interference; in contrast, boys with higher Tanner scores had both increasing pain severity (β = 0.40, P = .02) and pain interference (β = 0.16, P = .02). Girls (vs boys), irrespective of pubertal status, had both increased somatic complaints (P = .005) and a higher percentage (P = .01) of hard (Bristol Stool Form Scale type 1 or 2) stools. Pubertal status and sex did not significantly relate to IBS subtype, pain frequency, stooling frequency, anxiety, or depression. CONCLUSIONS In children with IBS, both pubertal development and/or sex are associated with abdominal pain severity, stool form, and somatization. These differences provide insight into the role of pubertal maturation during the transition from childhood to adult IBS.
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Abstract
UNLABELLED There is little evidence for most of the medications currently used to treat functional abdominal pain disorders (FAPDs) in children. Not only are there very few clinical trials, but also most have significant variability in the methods used and outcomes measured. Thus, the decision on the most appropriate pharmacological treatment is frequently based on adult studies or empirical data. In children, peppermint oil, trimebutine, and drotaverine have shown significant benefit compared with placebo, each of them in a single randomized clinical trial. A small study found that cyproheptadine was beneficial in the treatment of FAPDs in children. There are conflicting data regarding amitriptyline. While one small study found a significant benefit in quality of life compared with placebo, a large multicenter study found no benefit compared with placebo. The antidepressant, citalopram, failed to meet the primary outcomes in intention-to-treat and per-protocol analysis. Rifaximin has been shown to be efficacious in the treatment of adults with IBS. Those findings differ from studies in children where no benefit was found compared to placebo. To date, there are no placebo-controlled trials published on the use of linaclotide or lubiprostone in children. Alpha 2 delta ligands such as gabapentin and pregabalin are sometimes used in the care of this group of children, but no clinical trials are available in children with FAPDs. Similarly, novel drugs that have been approved for the care of irritable bowel with diarrhea in adults such as eluxadoline have yet to be studied in children. CONCLUSIONS Little data support the use of most medications commonly used to treat FAPDs in children. More randomized, placebo-controlled studies are needed to assess the efficacy of pharmacological interventions in the treatment of FAPDs in children.
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Affiliation(s)
- Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Adrian Miranda
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Bonilla S, Flores A. A New Piece in the Puzzle of Pediatric Irritable Bowel Syndrome. J Pediatr 2017; 180:10-11. [PMID: 27788930 DOI: 10.1016/j.jpeds.2016.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/28/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Silvana Bonilla
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital,Boston, Massachusetts
| | - Alejandro Flores
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital,Boston, Massachusetts.
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Paul SP, Basude D. Non-pharmacological management of abdominal pain-related functional gastrointestinal disorders in children. World J Pediatr 2016; 12:389-398. [PMID: 27363985 DOI: 10.1007/s12519-016-0044-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 04/02/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Abdominal pain-related functional gastrointestinal disorder (AP-FGID) comprises of 4 main conditions: functional dyspepsia, irritable bowel syndrome, abdominal migraine and functional abdominal pain. AP-FGIDs are diagnosed clinically based on the Rome IV criteria for FGIDs of childhood. There is limited evidence for pharmacological therapies. DATA SOURCES This review article discusses nonpharmacological management of AP-FGID based on the current literature including systematic reviews, randomized controlled trials, cohort and case control studies. We aim to provide a comprehensive overview on the available evidence for the pediatricians and pediatric gastroenterologists involved in managing children with AP-FGID. RESULTS Managing AP-FGIDs can be challenging. This should follow a stepwise approach with focused history, identification of "red flag" signs and symptoms, physical examination and investigations done following initial consultation. Family needs explaining that there is nothing seriously wrong with the child's abdomen. This explanation and reassurance can achieve symptom control in large number of cases. Non-pharmacological interventions are delivered through lifestyle and dietary changes and bio-psychosocial therapies. Dietary interventions vary depending on the type of AP-FGID. Bio-psychosocial therapies such as hypnotherapy, cognitive behavioral therapy and yoga aim at stress reduction. CONCLUSION There is increasing evidence for use of non-pharmacological interventions in children with APFGID.
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Affiliation(s)
- Siba Prosad Paul
- Torbay Hospital, Vowden Hall, Lowes Bridge, Torquay, TQ2 7AA, UK.
| | - Dharamveer Basude
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK
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Increased incidence of bowel and psychological symptoms in Chinese female D-IBS patients with premenstrual syndrome. Gastroenterol Nurs 2016; 37:351-9. [PMID: 25271828 DOI: 10.1097/sga.0000000000000067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to investigate levels of stress, gynecological events, bowel, and psychological symptoms in Chinese women of reproductive age who experienced both diarrhea-predominant irritable bowel syndrome (D-IBS) and premenstrual syndrome. A cross-sectional study used the self-reported questionnaire based on previous studies done abroad with the Rome III criteria and Symptom Checklist-90 Scale. The research was performed on 233 reproductive age women in China. A descriptive, comparative approach was used to (a) describe general characteristics and the history of disease both of the overlapping group and the D-IBS group, (b) compare stress and gynecological experience of the 2 groups, (c) compare the characteristics of defecation and bowel habits by group, and (d) compare psychological symptoms between groups. Percentage distribution and chi-square tests were used to analyze data. The results revealed that compared to simple D-IBS patients, the patients in the overlapping syndromes group had increased stress and gynecological events and more severe bowel and psychological symptoms. Overlapping syndromes were associated with repeated episodes of longer duration and delayed recovery. Future studies with expanded sample size and blood collection may verify and explain the results of this study.
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Farrell MK. Enough Epidemiology! We Know They are Common, We Need Proven Better Ways to Care for Children with Functional Gastrointestinal Disorders. J Pediatr 2016; 177:16-17. [PMID: 27475629 DOI: 10.1016/j.jpeds.2016.06.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 06/15/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Michael K Farrell
- Department of Gastroenterology, Hepatology, and Nutrition Cincinnati Children's Hospital Medical Center Cincinnati, Ohio.
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Le Gal J, Michel JF, Rinaldi VE, Spiri D, Moretti R, Bettati D, Romanello S, Berlese P, Lualdi R, Boizeau P, Viala J, Bellaiche M, Zuccotti GV, Crichiutti G, Alberti C, Titomanlio L. Association between functional gastrointestinal disorders and migraine in children and adolescents: a case-control study. Lancet Gastroenterol Hepatol 2016; 1:114-121. [PMID: 28404068 DOI: 10.1016/s2468-1253(16)30038-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders and migraine are both common causes of medical attention. We have previously shown an association between migraine and infant colic. In this case-control study, we aimed to establish whether there is an association between migraine and other functional gastrointestinal disorders in children and adolescents. METHODS We included children and adolescents aged 6-17 years presenting to the emergency department of four tertiary hospitals in France and Italy. Patients diagnosed with either migraine or tension-type headache by the hospital's paediatric neurologist were enrolled as cases. Patients presenting to the emergency department with minor trauma and no history of recurrent headache were enrolled as controls. Investigators masked to a patient's group allocation diagnosed functional gastrointestinal disorders using the Rome III diagnostic criteria. Univariable and multivariable analyses were done to identify specific disorders and baseline factors associated with migraines and tension-type headache. FINDINGS Between Nov 1, 2014, and Jan 31, 2015, we enrolled 648 controls and 424 cases (257 patients with migraine and 167 with tension-type headache). 83 (32%) children and adolescents in the migraine group were diagnosed with functional gastrointestinal disorders compared with 118 (18%) in the control group (p<0·0001). Multivariable logistic regression showed a significant association between migraine and three gastrointestinal disorders: functional dyspepsia (odds ratio 10·76, 95% CI 3·52-32·85; p<0·0001), irritable bowel syndrome (3·47, 1·81-6·62; p=0·0002), and abdominal migraine (5·87, 1·95-17·69; p=0·002). By contrast, there was an inverse association between migraine and functional constipation (0·34, 0·14-0·84, p=0·02). 41 (25%) participants with tension-type headache had functional gastrointestinal disorders, which did not significantly differ from the prevalence of these disorders in the control group (p=0·07); no significant association was noted between any functional gastrointestinal disease and tension-type headaches. INTERPRETATION Three abdominal-pain-related functional gastrointestinal disorders were associated with migraine in children and adolescents. These findings are of value to the diagnosis and management of these common diseases. Future studies should investigate whether antimigraine drugs are of benefit in functional gastrointestinal disorders. FUNDING None.
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Affiliation(s)
- Julie Le Gal
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Jean-Francois Michel
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Victoria Elisa Rinaldi
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Daniele Spiri
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Raffaella Moretti
- Pediatric Migraine and Neurovascular Diseases Unit, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy; INSERM, U1141, DHU PROTECT, Paris, France
| | - Donatella Bettati
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Silvia Romanello
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Pediatric Migraine and Neurovascular Diseases Unit, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Paola Berlese
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Rosa Lualdi
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Priscilla Boizeau
- Unit of Clinical Epidemiology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM, CIC 1426, Paris, France
| | - Jerome Viala
- Department of Pediatric Gastroenterology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM UMR1149 Paris, France
| | - Marc Bellaiche
- Department of Pediatric Gastroenterology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Crichiutti
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Corinne Alberti
- Unit of Clinical Epidemiology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM, CIC 1426, Paris, France
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Pediatric Migraine and Neurovascular Diseases Unit, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM, U1141, DHU PROTECT, Paris, France.
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Bhatia V, Deswal S, Seth S, Kapoor A, Sibal A, Gopalan S. Prevalence of functional gastrointestinal disorders among adolescents in Delhi based on Rome III criteria: A school-based survey. Indian J Gastroenterol 2016; 35:294-8. [PMID: 27554498 DOI: 10.1007/s12664-016-0680-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functional gastrointestinal diseases (FGIDs) are emerging as an important cause of morbidity in adolescents globally. The prevalence of FGIDs among Indian children or adolescents is not clear. METHODS A cross-sectional school-based survey conducted in 1115 children aged 10-17 years attending four semi urban government schools of National capital territory (NCT) of Delhi. Rome III questionnaire was translated into Hindi and was filled by the students under supervision. Prevalence of FGIDs was calculated. RESULTS Ten percent (112) adolescents had FGIDs. Out of 112, 52 % (58) were boys, and 48 % (54) were girls. 2.7 % (30) had functional dyspepsia, 1.3 % (15) had irritable bowel syndrome, 1.4 % (16) had abdominal migraine, 1.5 % (17) had aerophagia, 0.4 % (5) had functional abdominal pain syndrome, and 0.3 % (4) had functional abdominal pain. Prevalence of functional constipation, adolescent rumination syndrome, cyclical vomiting syndrome, and non-retentive fecal incontinence were 0.5 % (6), 0.3 % (4), 0.3 % (3), 0.4 % (5), respectively. Functional abdominal pain-related FGID were present in 6.3 % (70) children (35 boys and 35 girls). Functional constipation (4 vs. 2) and functional abdominal pain syndrome (4 vs. 1, p < 0.05) were significantly more in females. CONCLUSIONS The prevalence of functional gastrointestinal disorders in our study was 10 %. The most frequent FGID noted was functional dyspepsia.
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Affiliation(s)
- Vidyut Bhatia
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
| | - Shivani Deswal
- Department of Pediatrics, PGIMER and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110 001, India.
| | - Swati Seth
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
| | - Akshay Kapoor
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
| | - Anupam Sibal
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
| | - Sarath Gopalan
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
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Abstract
Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits. The bothersome and chronic nature of IBS symptoms negatively affects patients' activity level and quality of life, imparting an economic burden on the patient, the family, and the health care system. Research is still trying to elicit a clear pathophysiologic mechanism for IBS, and its clinical presentation and manifestations vary from patient to patient. The importance of a comprehensive history and physical examination cannot be emphasized enough in the diagnosis of IBS, as to date there are no specific laboratory studies that will confirm the diagnosis. There is currently no cure for IBS, and treatments range from a broad range of medications, to cognitive-behavioral therapy, to hyponotherapy. This review highlights recent advances in research on the epidemiology, pathophysiology, clinical manifestations, evaluation, and management of IBS.
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Devanarayana NM, Rajindrajith S, Pathmeswaran A, Abegunasekara C, Gunawardena NK, Benninga MA. Epidemiology of irritable bowel syndrome in children and adolescents in Asia. J Pediatr Gastroenterol Nutr 2015; 60:792-798. [PMID: 26000888 DOI: 10.1097/mpg.0000000000000714] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Several cross-sectional surveys have been conducted to study the prevalence of irritable bowel syndrome (IBS) in children. The aim of the present study was to conduct a systematic review and a meta-analysis of published literature to estimate the prevalence of IBS among Asian children. METHOD A computer-assisted search of MEDLINE, EMBASE, PsycINFO, and regional databases of Asia was carried out. Selected articles were reviewed in depth and data were extracted. Pooled prevalence, sex differences, and 95% confidence intervals were calculated. Heterogeneity of the studies was assessed using the I(2) test. RESULTS A total of 16 cross-sectional studies that reported prevalence of IBS (in children and adolescents) and qualified to be included were taken into the final analysis containing 38,076 patients. Selected studies are from China, Korea, Japan, Iran, Sri Lanka, and Saudi Arabia. Studies showed a marked heterogeneity with I(2) of 98.59 (P < 0.0001). Prevalence of IBS ranges from 2.8% to 25.7%, with a pooled prevalence of 12.41% (95% confidence interval 9.87-14.95). Prevalence risk ratio of girl:boy is 1.39. Prevalence of subtypes is diverse and varies between studies. CONCLUSIONS The published data indicate that IBS is a significant problem among Asian children and adolescents. Female sex predisposes children and adolescents to develop IBS.
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Affiliation(s)
- Niranga M Devanarayana
- *Department of Physiology †Department of Pediatrics ‡Department of Public Health §Department of Library ||Department of Parasitology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, Sri Lanka ¶Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PLoS One 2015; 10:e0126982. [PMID: 25992621 PMCID: PMC4439136 DOI: 10.1371/journal.pone.0126982] [Citation(s) in RCA: 301] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023] Open
Abstract
Objective We aimed to review the literature regarding epidemiology of functional abdominal pain disorders in children and to assess its geographic, gender and age distribution including associated risk factors of developing functional abdominal pain. Methods The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsychInfo databases were systematically searched up to February 2014. Study selection criteria included: (1) studies of birth cohort, school based or general population samples (2) containing data concerning epidemiology, prevalence or incidence (3) of children aged 4-18 years (4) suffering from functional abdominal pain. Quality of studies was rated by a self-made assessment tool. A random-effect meta-analysis model was used to estimate the prevalence of functional abdominal pain in childhood. Results A total of 58 articles, including 196,472 children were included. Worldwide pooled prevalence for functional abdominal pain disorders was 13.5% (95% CI 11.8-15.3), of which irritable bowel syndrome was reported most frequently (8.8%, 95% CI 6.2-11.9). The prevalence across studies ranged widely from 1.6% to 41.2%. Higher pooled prevalence rates were reported in South America (16.8%) and Asia (16.5%) compared to Europe (10.5%). And a higher pooled prevalence was reported when using the Rome III criteria (16.4%, 95% CI 13.5-19.4). Functional abdominal pain disorders are shown to occur significantly more in girls (15.9% vs. 11.5%, pooled OR 1.5) and is associated with the presence of anxiety and depressive disorders, stress and traumatic life events. Conclusion Functional abdominal pain disorders are a common problem worldwide with irritable bowel syndrome as most encountered abdominal pain-related functional gastrointestinal disorder. Female gender, psychological disorders, stress and traumatic life events affect prevalence.
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Affiliation(s)
- Judith J Korterink
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Kay Diederen
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma's Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
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Zheng Z, Huang C, Guo Y, Niu K, Momma H, Kobayashi Y, Fukudo S, Nagatomi R. Staple foods consumption and irritable bowel syndrome in Japanese adults: a cross-sectional study. PLoS One 2015; 10:e0119097. [PMID: 25785440 PMCID: PMC4364629 DOI: 10.1371/journal.pone.0119097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/09/2015] [Indexed: 12/15/2022] Open
Abstract
Background Carbohydrates can cause gastrointestinal symptoms due to incomplete absorption in the small bowel. Thus, high-carbohydrate diets may induce symptoms of irritable bowel syndrome (IBS). Objective This observational and cross-sectional study assessed the association between consumption of several carbohydrate-enriched staple foods, such as rice, Japanese wheat noodles, Chinese noodles, bread, pasta, and buckwheat noodles, and the prevalence of IBS in Japanese adults. Subjects and Methods One thousand and eighty-two (837 men) Japanese adult employees aged 19-85 were included in this cross-sectional study conducted in 2011. IBS diagnosis was based on the Rome III criteria. Consumption of staple foods was assessed using a brief self-administered diet history questionnaire, and divided into three categories (low, middle, high) depending on their distribution. Results In the multivariate analysis, daily consumption of rice (odds ratios [ORs] and [95% confidence interval (CI)]: middle, 1.36 [0.93–1.99]; high, 1.67 [1.12–2.49]; P for trend = 0.01), bread (middle, 1.88 [1.28–2.75]; high, 1.63 [1.10–2.41]; P for trend = 0.01), pasta (middle, 1.47 [1.01–2.15]; high, 1.68 [1.12–2.52]; P for trend = 0.01), and buckwheat noodles (middle, 1.76 [1.18–2.61]; high, 1.98 [1.31–3.00]; P for trend = 0.001) were associated with higher prevalence of IBS after adjustment for socio-demographic, anthropometric, and lifestyle-related factors. Buckwheat noodles, but not other staple foods, retained an association with the prevalence of IBS even after adjustment for daily intake of carbohydrates or plant proteins. Conclusions This cross-sectional study demonstrated that the consumption of staple foods, such as rice, bread, pasta, and buckwheat noodles is associated with the prevalence of IBS. Of these, the consumption of buckwheat noodles, but not other staple foods, is associated with IBS independent of carbohydrate or plant protein contents.
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Affiliation(s)
- Zhaoqiu Zheng
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Cong Huang
- Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Yinting Guo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaijun Niu
- Department of Epidemiology, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Haruki Momma
- Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Yoritoshi Kobayashi
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoichi Nagatomi
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
- Division of Biomedical Engineering for Health and Welfare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
- * E-mail:
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Altamimi EM, Al-Safadi MH. Abdominal Pain-Predominant Functional Gastrointestinal Disorders in Jordanian School Children. Gastroenterology Res 2014; 7:137-142. [PMID: 27785284 PMCID: PMC5040537 DOI: 10.14740/gr627w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 12/12/2022] Open
Abstract
Background Recurrent abdominal pain (RAP) is a common complaint in children. Significant portion of them are of functional origin. This study aimed to assess the prevalence of abdominal pain-predominant functional gastrointestinal disorder (FGID) and its types in Jordanian school children. Methods This is a school-based survey at south Jordan. Information using the self-reporting form of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-RIII) - the official Arabic translation - was collected. Classes from academic years (grades) 6 - 8 were selected. SPSS Statistical Package Version 17 (IBM, Armonk, NY, USA) was used. Categorical data were analyzed using Fisher’s exact test, and continuous data were analyzed using t-test. P < 0.05 was considered significant. Results Five hundred questionnaires were distributed, and 454 returned answered (91%). Two hundred twenty-nine (50.8%) were males. The average age of participants was 12.7 years (11 - 15 years). One hundred sixteen (25.7%) had abdominal pain-predominant FGID. Seventy-nine (68%) of them were females. Forty-seven (10.6%) had irritable bowel syndrome (IBS). Thirty-six (8%), 17 (3.8%), 11 (2.4%) and five (1.1%) had abdominal migraine, functional abdominal pain, functional abdominal pain syndrome and functional dyspepsia, respectively. Conclusion Abdominal pain-predominant FGID has become a major health issue in Jordanian children. One of four children between the ages of 11 and 15 years exhibits at least one abdominal pain-predominant FGID. The most common form of abdominal pain-predominant FGID in our children was IBS. Females are affected more often than males. Intestinal and extra-intestinal symptoms are seen regularly with abdominal pain-predominant FGIDs.
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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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Ludidi S, Mujagic Z, Jonkers D, Keszthelyi D, Hesselink M, Kruimel J, Conchillo J, Masclee A. Markers for visceral hypersensitivity in patients with irritable bowel syndrome. Neurogastroenterol Motil 2014; 26:1104-11. [PMID: 24920528 DOI: 10.1111/nmo.12365] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/19/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a heterogenous disorder with visceral hypersensitivity as important hallmark. It is not known whether IBS patients with visceral hypersensitivity have different epidemiological and clinical characteristics compared with IBS patients without visceral hypersensitivity. Aim of our study was to compare in detail a large group of hyper- vs normosensitive IBS patients with respect to epidemiological and clinical characteristics. METHODS IBS patients (Rome III criteria) have been recruited for a large-scale cohort study. All patients from this cohort who underwent a rectal barostat procedure were included and allocated based on those with and without visceral hypersensitivity. Patient demographics, and symptoms were collected using questionnaires (GSRS, HADS, SF-36) and a 14-day symptom diary for IBS-related symptoms. A multivariate logistic regression model was used to identify risk markers for having visceral hypersensitivity. KEY RESULTS Ninety-five normosensitive and 93 hypersensitive IBS patients participated in this study. Hypersensitive patients had significantly higher scores for GSRS abdominal pain (p < 0.05), indigestion, reflux and constipation syndrome (all p < 0.01), and IBS symptom intensity, discomfort (both p < 0.05) and mean symptom composite score (p < 0.01). Age, female sex, and the use of SSRI medication were significantly different between the normo- and the hypersensitive IBS patients. However, after adjustment for other risk markers, only increasing age was found to be significantly associated with lower odds for having hypersensitivity (OR 0.97 [95% CI: 0.94; 0.99]). CONCLUSIONS & INFERENCES Apart from more severe symptomatology, hypersensitive IBS patients are characterized by significantly younger age compared with normosensitive IBS patients. The study has been registered in the US National Library of Medicine (http://www.clinicaltrials.gov, NCT00702026).
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Affiliation(s)
- S Ludidi
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism - Maastricht University Medical Center+, Maastricht, The Netherlands
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Srinath AI, Youk AO, Bielefeldt K. Biliary dyskinesia and symptomatic gallstone disease in children: two sides of the same coin? Dig Dis Sci 2014; 59:1307-15. [PMID: 24715545 PMCID: PMC4113830 DOI: 10.1007/s10620-014-3126-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/18/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite lack of consensus criteria, biliary dyskinesia (BD) is an increasingly accepted pediatric diagnosis. AIMS We compared patient characteristics, outcomes, and resource utilization (before and after surgery) between children with BD and symptomatic cholecystolithiasis (LITH). METHODS Data from the electronic medical record were abstracted for children diagnosed with BD or LITH between December 1, 2002, and November 30, 2012, at Children's Hospital of Pittsburgh. RESULTS Four hundred and ten patients were identified (BD: 213 patients, LITH: 197 patients). Patients with BD had significantly lower BMI, longer symptom duration, more dyspeptic symptoms, and were more likely to present with other symptoms. Forty-one patients (13.8%) with BD underwent cholecystectomy despite a normal gallbladder ejection fraction (GB-EF). In 32 of these, sincalide triggered pain compared to 75 of the 155 patients with low GB-EF. After surgery, patients with BD more commonly visited gastroenterology clinics and had more GI-related hospitalizations, while emergency room visits decreased in both groups. Only the nature of biliary disease independently predicted continuing pain after surgery, which in turn was the best predictor for higher resource utilization after cholecystectomy. CONCLUSIONS A large percentage of children with BD did not meet the adult diagnostic standards. Compared to those with LITH, children with BD have more widespread symptoms and continue to use more clinical resources after surgery. These findings suggest that despite its benign prognosis, BD is increasingly treated like other potentially acute gallbladder diseases, although it has the typical phenotype of FGIDs and should be treated using approaches used in such disorders.
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Affiliation(s)
- Arvind I. Srinath
- Division of Pediatric Gastroenterology, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), 4401 Penn Avenue, Pittsburgh, PA 15224, USA
| | - Ada O. Youk
- Department of Biostatistics, University of Pittsburgh, 4200 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Klaus Bielefeldt
- Division of Gastroenterology, University of Pittsburgh Medical Center (UPMC), 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Xing Z, Hou X, Zhou K, Qin D, Pan W. Impact of parental-rearing styles on irritable bowel syndrome in adolescents: a school-based study. J Gastroenterol Hepatol 2014; 29:463-468. [PMID: 24117871 DOI: 10.1111/jgh.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM A strong association between family function and irritable bowel syndrome (IBS) has been observed. Parental rearing styles, as a comprehensive mark for family function, may provide new clues to the etiology of IBS. This study aimed to explore which dimensions of parental rearing styles were risk factors or protective factors for IBS in adolescents. METHODS Two thousand three hundred twenty adolescents were recruited from one middle school and one high school randomly selected from Jiangan District (an urban district in Wuhan City). Data were collected using two Chinese versions of validated self-report questionnaires including the Rome III diagnostic criteria for pediatric IBS and the Egna Minnen Beträffande Uppfostran: One's Memories of Upbringing for perceived parental rearing styles. RESULTS Ninety-six subjects diagnosed as pediatric IBS were compared with 1618 controls. The IBS patients reported less both paternal and maternal emotional warmth (all P < 0.01) and more both paternal and maternal punishment, overinterference, rejection, and overprotection (only for father) (all P < 0.01) than the controls. Furthermore, the IBS patients had higher total scores of parental rearing styles (all P < 0.001) than the controls. With univariate logistic regression, standardized regression coefficients and odds ratios of parental rearing variables were calculated. Multivariate logistic regression revealed that paternal rejection (P = 0.001) and maternal overinterference (P = 0.002) were independent risk factors for IBS in adolescents. CONCLUSIONS Parental emotional warmth is a protective factor for IBS in adolescents and parental punishment, overinterference, rejection, and overprotection are risk factors for IBS in adolescents.
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Affiliation(s)
- Zhouxiong Xing
- Division of Gastroenterology, Union Hospital, Wuhan, China; Tongji Medical College, Wuhan, China; Huazhong University of Science and Technology, Wuhan, China
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Zhu X, Chen W, Zhu X, Shen Y. A cross-sectional study of risk factors for irritable bowel syndrome in children 8-13 years of age in suzhou, china. Gastroenterol Res Pract 2014; 2014:198461. [PMID: 24899889 PMCID: PMC4034766 DOI: 10.1155/2014/198461] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 02/07/2023] Open
Abstract
To determine the prevalence and risk factors of IBS in children 8-13 years of age in Suzhou city, a cross-sectional study was conducted on children in grades 1 through 6 in public elementary schools in three districts of Suzhou. A multistage stratified random-sampling survey was conducted in a primary investigation using standardized questionnaires. Rome II criteria were used to confirm IBS and their risk factors were analyzed. Of 8,000 questionnaires 7,472 responded satisfactorily for a response rate of 93.4%. IBS was diagnosed in 10.81%. A decrease in the prevalence of IBS was significantly associated with advancing age and grade in school (trend test, P < 0.05). The prevalence of IBS in females was higher but not significantly different than males. The significant risk factors for IBS included young age (OR = 0.94), food allergy (OR = 1.53), gastroenteritis during childhood (OR = 1.29), eating fried food (OR = 1.62), anxiety (OR = 1.49), psychological insults in early childhood (OR = 1.47), and parental history of constipation (OR = 1.81; all P < 0.05). IBS prevalence of 10.81% in study population warrants preventive measures such as encouraging dietary changes, preventing gastroenteritis and childhood psychological insults.
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Affiliation(s)
- Xueping Zhu
- Department of Neonatology, Soochow University Affiliated Children's Hospital, Suzhou 215003, China
| | - Weichang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- *Weichang Chen: and
| | - Xiaoli Zhu
- Department of Intervention, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- *Xiaoli Zhu:
| | - Yueping Shen
- Statistics Office, Soochow University, Suzhou 215000, China
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Devanarayana NM, Rajindrajith S, Bandara C, Shashiprabha G, Benninga MA. Ultrasonographic assessment of liquid gastric emptying and antral motility according to the subtypes of irritable bowel syndrome in children. J Pediatr Gastroenterol Nutr 2013; 56:443-448. [PMID: 23201712 DOI: 10.1097/mpg.0b013e31827f7a3d] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Gastric motor abnormalities have been reported in adults with irritable bowel syndrome (IBS), commonly in constipation-predominant IBS (IBS-C); however, such studies are uncommon in children. Furthermore, differences of gastric motility have not been studied in children with different IBS subtypes. METHODS Seventy-six children (33 [43%] boys, age 4-14 years, mean 7.9 years, SD 3.0 years) fulfilling Rome III criteria for IBS and 20 healthy controls (8 [40%] boys, age 4-14 years, mean 8.4 years, SD 3.0 years) were recruited (diarrhea-predominant IBS=21, IBS-C=31, mixed IBS=19, and unsubtyped IBS=5). Liquid gastric emptying rate (GER) and antral motility were assessed using an ultrasound method. RESULTS Average GER (43.8% vs 66.2% in controls), amplitude of antral contractions (56.4% vs 89%), and antral motility index (5.1 vs 8.3) were lower and fasting antral area (1.6 vs 0.6) was higher in patients with IBS (P<0.0001). Frequency of antral contractions F (8.9 vs 9.3) did not show a significant difference. Patients exposed to stressful events had a significantly lower GER, compared to those not exposed to such events (P=0.03). Gastric motility parameters had no correlation with severity of symptoms. GER (42.6%, 46.3%, 39.6%), fasting antral area (1.4 cm², 1.8 cm², 1.8 cm²), amplitude of antral contractions (53%, 58.9%, 51.8%), frequency of antral contractions (8.7, 8.9, 9.2), and antral motility index (4.7, 5.3, 4.8) were not different among diarrhea-predominant IBS, IBS-C, and mixed IBS (P>0.05). CONCLUSIONS GER and antral motility parameters were significantly impaired in children with IBS compared with controls. GER and antral motility parameters were not different between IBS subtypes.
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Affiliation(s)
- Niranga M Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, Sri Lanka.
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Rajindrajith S, Devanarayana NM. Functional gastrointestinal diseases in children: facing the rising tide. J Gastroenterol Hepatol 2013; 28:208-210. [PMID: 23339385 DOI: 10.1111/jgh.12051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2012] [Indexed: 12/09/2022]
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Canadian Digestive Health Foundation Public Impact Series 3: irritable bowel syndrome in Canada. Incidence, prevalence, and direct and indirect economic impact. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:252-6. [PMID: 22590697 DOI: 10.1155/2012/861478] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada in 2009. The current article presents the updated findings from the study concerning irritable bowel syndrome.
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Zhou HQ, Shi WB, Wang XF, Yao M, Cheng GY, Chen PY, Li DG. An epidemiological study of sleep quality in adolescents in South China: a school-based study. Child Care Health Dev 2012; 38:581-7. [PMID: 21831260 DOI: 10.1111/j.1365-2214.2011.01300.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study explored the prevalence of disturbed sleep and investigated its distribution characteristics and associated factors in adolescents in South China. METHODS Junior middle school and senior high school students (n = 1221) were recruited from schools in Shanghai, China. Students completed a questionnaire using the Pittsburgh Sleep Quality Index and factors associated with disturbed sleep. RESULTS The prevalence of a tendency towards poor sleep was 34.32% [95% confidence interval (CI): 31.66-36.98] with no significant difference between genders. This tendency increased with age, yielding a significant group effect (P < 0.01). In middle school and high school, the propensity towards poor sleep was 31.34% (95% CI: 28.29-34.39) and 42.22% (95% CI: 36.92-47.52) respectively. The factors associated with poor sleep were more television viewing during weekdays [odds ratio (OR): 1.56, CI: 1.36-1.71], more frequent computer/Internet use (OR: 1.25, CI: 1.08-1.39), earlier school starting time (OR: 1.12, CI: 1.07-1.28), and more time on homework during weekdays (OR: 1.78, CI: 1.51-1.98) and weekends (OR: 1.35, CI: 1.21-1.52) CONCLUSIONS A tendency towards poor sleep is common in adolescents in South China and its incidence increases with age. The factors associated with this phenomenon indicate that poor sleep in adolescents could be improved, at least partly, by reducing the use of visual technologies and by changing school timetables.
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Affiliation(s)
- H-Q Zhou
- Department of Gastroenterology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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Rajindrajith S, Devanarayana NM. Subtypes and Symptomatology of Irritable Bowel Syndrome in Children and Adolescents: A School-based Survey Using Rome III Criteria. J Neurogastroenterol Motil 2012; 18:298-304. [PMID: 22837878 PMCID: PMC3400818 DOI: 10.5056/jnm.2012.18.3.298] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/12/2012] [Accepted: 02/23/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS This study was conducted with objectives of assessing subtypes of irritable bowel syndrome (IBS) in children aged 10-16 years, their symptomatology and gender differences. METHODS For this survey, 107 children who fulfilled Rome III criteria for IBS and 1,610 healthy controls were recruited from 8 randomly selected schools, in 4 provinces in Sri Lanka. Data was collected using a previously validated, self administered questionnaire. RESULTS Constipation predominant, diarrhea predominant and mixed type IBS were almost equally distributed (27%-28%), while unsubtyped IBS had a lower prevalence (17.8%). IBS was more common in girls (59.8% vs 40.2% in boys, P = 0.001). Bloating, flatulence, burping, headache and limb pain were significantly higher in affected children (P < 0.05). CONCLUSIONS This study highlights the distribution of IBS subtypes among Sri Lankan children and adolescents and its female preponderance. This study also shows a higher prevalence of other intestinal-related and extraintestinal somatic symptoms among affected children.
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Quigley EMM, Abdel-Hamid H, Barbara G, Bhatia SJ, Boeckxstaens G, De Giorgio R, Delvaux M, Drossman DA, Foxx-Orenstein AE, Guarner F, Gwee KA, Harris LA, Hungin APS, Hunt RH, Kellow JE, Khalif IL, Kruis W, Lindberg G, Olano C, Moraes-Filho JP, Schiller LR, Schmulson M, Simrén M, Tzeuton C. A global perspective on irritable bowel syndrome: a consensus statement of the World Gastroenterology Organisation Summit Task Force on irritable bowel syndrome. J Clin Gastroenterol 2012; 46:356-66. [PMID: 22499071 DOI: 10.1097/mcg.0b013e318247157c] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Irritable bowel syndrome (IBS) is common in western Europe and North America, and many aspects of its epidemiology, risk factors, and natural history have been described in these regions. Recent data suggest, however, that IBS is also common in the rest of the world and there has been some evidence to suggest some differences in demographics and presenting features between IBS in the west and as it is experienced elsewhere. The World Gastroenterology Organization, therefore, established a Task Force comprising experts on the topic from all parts of the world to examine IBS from a global perspective. IBS does, indeed, seem to be common worldwide though with some significant variations in prevalence rates between regions and countries and there may well be some potentially interesting variations in presenting symptoms and sex distribution. The global map of IBS is far from complete; community-based prevalence data is not available from many areas. Furthermore, while some general trends are evident in terms of IBS impact and demographics, international comparisons are hampered by differences in diagnostic criteria, study location and methodology; several important unanswered questions have been identified that should form the basis for future collaborative research and have the potential to shed light on this challenging disorder.
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ZHOU HQ, YAO M, CHEN WB, SUN MF, CHENG GY, CHEN YP, LI DG. High prevalence of irritable bowel syndrome with poor sleep quality in children and adolescents in Shanghai. Sleep Biol Rhythms 2012. [DOI: 10.1111/j.1479-8425.2012.00535.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Surdea-Blaga T, Băban A, Dumitrascu DL. Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol 2012; 18:616-626. [PMID: 22363132 PMCID: PMC3281218 DOI: 10.3748/wjg.v18.i7.616] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 09/22/2011] [Accepted: 01/18/2012] [Indexed: 02/06/2023] Open
Abstract
From a pure motor disorder of the bowel, in the past few years, irritable bowel syndrome (IBS) has become a multifactorial disease that implies visceral hypersensitivity, alterations at the level of nervous and humoral communications between the enteric nervous system and the central nervous system, alteration of the gut microflora, an increased intestinal permeability and minimum intestinal inflammation. Psychological and social factors can interfere with the communication between the central and enteric nervous systems, and there is proof that they are involved in the onset of IBS and influence the response to treatment and outcome. There is evidence that abuse history and stressful life events are involved in the onset of functional gastrointestinal disorders. In order to explain clustering of IBS in families, genetic factors and social learning mechanisms have been proposed. The psychological features, such as anxiety, depression as well as the comorbid psychiatric disorders, health beliefs and coping of patients with IBS are discussed in relation to the symptoms and outcome.
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Zhou HQ, Yao M, Chen GY, Ding XD, Chen YP, Li DG. Functional gastrointestinal disorders among adolescents with poor sleep: a school-based study in Shanghai, China. Sleep Breath 2011; 16:1211-8. [PMID: 22203339 DOI: 10.1007/s11325-011-0635-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/29/2011] [Accepted: 12/09/2011] [Indexed: 12/18/2022]
Abstract
PURPOSE This study aimed to determine whether functional gastrointestinal disorders are more common among adolescents with self-reported poor sleep. METHODS Junior middle school and senior high school students (n = 1,362) were recruited from schools in Shanghai. Students completed two questionnaires: the questionnaire for irritable bowel syndrome (IBS) in adolescents and the Pittsburgh Sleep Quality Index. RESULTS The prevalence of poor sleep was 34.29% [95% confidence interval (CI) = 31.77-36.81] and there was no significant difference between genders (P = 0.991). The tendency towards poor sleep increased with age, with age group yielding a significant effect (P = 0.001). In junior middle school and senior high school students, the propensity towards poor sleep was 30.10% (95% CI = 27.08-33.12%) and 42.11% (95% CI = 37.67-46.55%), respectively. Among students with poor sleep, the prevalence of IBS was 19.70% (95% CI = 16.09-23.31). After adjusting for age, sex, night pain, and psychological factors, IBS was significantly more common in students with poor sleep (odds ratio = 1.92; 95% CI = 1.07-2.58). CONCLUSION We conclude that IBS is prevalent in students with poor sleep. Poor sleep was independently associated with IBS among adolescents in Shanghai China.
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Affiliation(s)
- Hui-Qing Zhou
- Department of Gastroenterology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
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Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S. Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress. J Pediatr Gastroenterol Nutr 2011; 53:659-665. [PMID: 21697745 DOI: 10.1097/mpg.0b013e3182296033] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Functional gastrointestinal disorders (FGD) are common among children, but little is known regarding their prevalence in developing countries. We assessed the prevalence of abdominal pain-predominant FGD, in addition to the predisposing factors and symptomatology, in Sri Lankan children. PATIENTS AND METHODS A cross-sectional survey was conducted among a randomly selected group of 10- to 16-year-olds in 8 randomly selected schools in 4 provinces in Sri Lanka. A validated, self-administered questionnaire was completed by children independently in an examination setting. FGD were diagnosed using Rome III criteria. RESULTS A total of 2180 questionnaires were distributed and 2163 (99.2%) were included in the analysis (1189 [55%] boys, mean age 13.4 years, standard deviation 1.8 years). Of them, 270 (12.5%) had at least 1 abdominal pain-predominant FGD. Irritable bowel syndrome (IBS) was seen in 107 (4.9%), functional dyspepsia in 54 (2.5%), functional abdominal pain in 96 (4.4%), and abdominal migraine (AM) in 21 (1.0%) (2 had AM and functional dyspepsia, 6 had AM and IBS). Extraintestinal symptoms were more common among affected children (P < 0.05). Abdominal pain-predominant FGD were higher in girls and those exposed to stressful events (P < 0.05). Prevalence negatively correlated with age (r = -0.05, P = 0.02). CONCLUSIONS Abdominal pain-predominant FGD affects 12.5% of children ages 10 to 16 years and constitutes a significant health problem in Sri Lanka. IBS is the most common FGD subtype present. Abdominal pain-predominant FGD are higher in girls and those exposed to emotional stress. Prevalence of FGD decreased with age. Extraintestinal symptoms are more frequent in affected children.
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