Gati Dhroove

A million-dollar work-up for abdominal pain: is it worth it?

Background and Aim: Pain-predominant-functional gastrointestinal disorders (PP-FGIDs) are common. The diagnosis is clinical and there are no biological markers to characterize these conditions. Despite limited evidence, investigations are commonly performed. The aim of the study was to investigate diagnostic practices, yield, and costs in children with PP-FGIDs. Patients and Methods: Charts of all of the children older than 4 years diagnosed as having abdominal pain were reviewed. Results and costs of diagnostic investigations were analyzed. Results: Of 243 children with abdominal pain, 122 (50.2%) had PP-FGIDs (79 girls, mean age 12.7 years). All of the children underwent diagnostic work-up. Complete blood cell count was done in 91.8% of patients. None had elevated white blood cells, platelets, and low albumin. Six had either elevated erythrocyte sedimentation rate or C-reactive protein, but none had elevation of both; 4 of these 6 cases underwent endoscopies with normal results in 3 cases; Helicobacter pylori was found in 1 case. One child had elevated tissue transglutaminase 1 only antibodies with normal endoscopy. Amylase, lipase, direct bilirubin, stool cultures, and ova or parasites were always normal. One child had intermittent elevation of aspartate aminotransferase and alanine transaminase. There were no significant abnormalities in urinalysis or electrolytes. Abdominal x-rays were done in 38.5%, showing only retained stools in 13% of these patients. Abdominal ultrasound and computed tomography scan were done in 23.7% and 9% of cases, respectively, but were of no clinical value; 33.6% patients had esophagogastroduodenoscopy (9.7% abnormal: Helicobacter pylori, chemical gastritis, esophagitis) and 17.2% had colonoscopy (9.5% abnormal: rare fork crypts, lymphoid hyperplasia). Total costs:

How Reliable Are the Rome III Criteria for the Assessment of Functional Gastrointestinal Disorders in Children

744,726. Average cost per patient:

Recurrent headaches in children: An epidemiological survey of two middle schools in inner city Chicago

6104.30. Conclusions: In children with PP-FGIDs, investigations are common, costs are substantial, and yield is minimal.

Prevalencia de trastornos gastrointestinales funcionales en escolares mexicanos

OBJECTIVES:Functional gastrointestinal disorders (FGIDs) are common in children. Diagnosis of these conditions is based on the pediatric Rome criteria. In the past, we have shown that there was low inter-rater reliability (IRR) among pediatric gastroenterologists using the Rome II criteria. Since then, a new version of the criteria has been issued. The reliability of the Rome III criteria has not been established.METHODS:A total of 10 pediatric gastroenterologist specialists and 10 pediatric gastroenterology fellows were provided with 20 clinical vignettes and a list of 17 possible diagnoses (all pediatric categories of the Rome criteria plus “none of the above” or “not enough information”) and instructed to select one or more diagnosis for each vignette.RESULTS:The average percentage of agreement among the raters was 50% for the pediatric gastroenterologists and 45% for the pediatric gastroenterology fellows. The inter-rater percentage of agreement per clinical case was >50% in only 7 out of 20 (35%) vignettes for the gastroenterologists and only 6 out of 20 (30%) cases for the fellows. The inter-rater percentage of agreement was <25% in 2 out of 20 (10%) vignettes for the gastroenterologists and 4 out of 20 (20%) vignettes for the fellows. The κ coefficient was 0.45 for the specialists (P<0.0001) and 0.39 for the fellows (P<0.0001). In a subanalysis of the groups of pain and constipation-related disorders, the inter-rater percentage of agreement per clinical case ranged between 27 and 100% (mean 57%, κ=0.37, P<0.0001) for the gastroenterologists and between 36 and 80% (mean 52%, κ=0.33, P<0.0001) for the fellows in the constipation subgroup. The inter-rater percentage of agreement per clinical case for the pain subgroup ranged between 22 and 80% (mean 48%, κ=0.36, P<0.0001) for the gastroenterologists and 22 and 62% (mean 39%, κ=0.29, P<0.0001) for the fellows in the pain subgroup. The κ coefficient for specialists with expertise in FGIDs was 0.37 (P<0.0001) and for those with expertise in other gastroenterology conditions was 0.53 (P<0.0001).CONCLUSIONS:The IRR among pediatric gastroenterologists and fellows was found to be fair to moderate for the Rome III criteria. Only slight to fair agreement between raters existed for important subcategories of pain and constipation. The results from our current study are almost similar to that of the IRR study done for the Rome II criteria. This indicates the need for further refinement of the Rome criteria to make them more encompassing and user friendly.

Sa1119 Will Split Dosing of Bowel Preparation Improve Quality of Colonoscopy and Increase Colorectal Neoplasm Detection

Objectives:  The aim of this study was to longitudinally evaluate the epidemiological characteristics of headaches in a school‐based, community setting and to determine the impact of headache symptoms on the health of children.

Functional Abdominal Pain in Children

INTRODUCTION AND AIMS Functional gastrointestinal disorders are among the most common chronic disorders in children worldwide. Studies in schoolchildren from various Latin American countries have shown a high prevalence of functional gastrointestinal disorders, but their prevalence in Mexican schoolchildren is unknown. Our aim was to assess the prevalence of functional gastrointestinal disorders in Mexican schoolchildren in accordance with the Rome III criteria. MATERIAL AND METHODS Children and adolescents from public and private schools in Monterrey and Cuernavaca privately completed the Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III) in class, using the same methods and questionnaires of previous studies conducted by our group in other Latin American countries. RESULTS A total of 362 schoolchildren (public school 82, private school 280), with a mean age of 11.6±2.1 years completed the QPGS-III. Ninety-nine schoolchildren (27.3%) met the criteria for a FGID, according to the Rome III criteria. Functional constipation was the most common FGID (12.6%). Irritable bowel syndrome (6.4%) was the most common FGID associated with abdominal pain. There was no significant difference in the prevalence of FGIDs between sexes (P=.8). CONCLUSIONS We found a high prevalence of FGIDs in Mexican school-aged children and adolescents.

Prevalence of functional gastrointestinal disorders in Mexican schoolchildren

BackgroundAdequate bowel preparation is an important element in screening colonoscopy. Bowel preparation with ingestion of polyethylene glycol(PEG)solution the evening before colonoscopy results in suboptimal cleansing and affects the diagnostic yield. The American College of Gastroenterology supports the concept of split dosing to enhance the efficacy of bowel preparation. AimsTo compare the efficacy of the bowel preparation with split dosing(SD)of polyethylene glycol(PEG)solution versus the conventional dosing(CD). MethodsCharts of 492 consecutive patients undergoing screening colonoscopy by a single endoscopist from January 2010 to October 2011 were reviewed. Of these, 243 patients had received SD bowel preparation(SD group)compared to 249 patients who had received CD bowel preparation(CD group).Data on patient demographics, quality of preparation,cecal intubation rate, polyp detection rate, adenoma detection rate and polyp histology were collected. Significant Colorectal Neoplasm(CRN)was defined as polyp > 1 cm in size,≥ 3 adenomas and those with villous histology. Right sided colon was defined as cecum, ascending colon, transverse colon. Left sided colon was defined as descending colon, sigmoid colon and the rectum. A weighted score was assigned to poor, sub-optimal and good quality of bowel preparation as determined by the endoscopist. Results: Table 1 lists the patient demographics in the two groups. Both groups were well-matched in terms of age, sex and ethnicity. Polyp detection rate was 40% in SD group vs.33% in CD group (p=0.09). There was no significant difference in adenoma detection rate (24% vs. 23%, p=0.87) and cecal intubation rate (98% vs. 97%, p=0.35) between two groups. Significant CRN detection rate on right side was 12% with SD group and 4% with CD group(p=0.028). On left side significant CRN detection rate was 7% with SD group and 6% with CD group. 2 colorectal cancers were detected in the SD group and none in CD group(Table 2). Bowel preparation score was 2.8 in SD group compared to 2.6 in CD group Conclusions: Both the groups had similar bowel preparation scores and cecal intubation rates. However, bowel preparation with split-dose PEG solution resulted in a trend towards a higher polyp detection rate though it did not meet statistical significance. The SD regimen was efficient in detecting more significant CRN on the right side compared to CD regimen. Table 1

781 Inter-Rater Reliability of the ROME III Criteria in Children

Approximately 50 years ago, Apley and Naish described children who presented with repeated episodes of abdominal pain for at least 3 months without any identifiable cause under the term recurrent abdominal pain (Apley and Naish 1958). Later studies showed that this term was a “waste basket” encompassing functional and organic conditions. More recent symptom-based criteria, known as Rome criteria, exclusively define those gastrointestinal conditions thought to be of functional origin and without clinical evidence of anatomical or structural abnormalities. The third edition of the Rome criteria (Rasquin 2006), classifies pain-predominant functional gastrointestinal disorders (FGIDs) in four different conditions.