Judith Korterink

Probiotics for childhood functional gastrointestinal disorders: a systematic review and meta-analysis.

A systematic review and meta‐analysis were performed to investigate the quantity and quality of the current evidence regarding the effect of different probiotic strains in the treatment of functional gastrointestinal disorders (FGID) in children and adolescents.

Childhood functional abdominal pain: mechanisms and management

Chronic abdominal pain is one of the most common clinical syndromes encountered in day to day clinical paediatric practice. Although common, its definition is confusing, predisposing factors are poorly understood and the pathophysiological mechanisms are not clear. The prevailing viewpoint in the pathogenesis involves the inter-relationship between changes in hypersensitivity and altered motility, to which several risk factors have been linked. Making a diagnosis of functional abdominal pain can be a challenge, as it is unclear which further diagnostic tests are necessary to exclude an organic cause. Moreover, large, well-performed, high-quality clinical trials for effective agents are lacking, which undermines evidence-based treatment. This Review summarizes current knowledge regarding the epidemiology, pathophysiology, risk factors and diagnostic work-up of functional abdominal pain. Finally, management options for children with functional abdominal pain are discussed including medications, dietary interventions, probiotics and psychological and complementary therapies, to improve understanding and to maximize the quality of care for children with this condition.

Dientamoeba fragilis and chronic abdominal pain in children: a case–control study

Background The association between Dientamoeba (D.) fragilis and the aetiology of functional gastrointestinal disorders (FGID) in children is unclear. Aim The aim of this retrospective case–control study is to clarify the clinical relevance of D. fragilis in children with chronic abdominal pain. Methods From April 2011 until April 2013, a total of 132 patients with chronic abdominal pain (AP), aged 8–18 years, referred to a non-academic hospital, and 77 control patients, aged 8–18 years without gastrointestinal symptoms referred to a psychiatric hospital, were included in the study. D. fragilis was diagnosed by real-time PCR in faecal samples. Symptomatic children without a D. fragilis infection fulfilled the ROME III criteria for AP-related FGID (AP-FGID). Clinical data were retrospectively analysed by examining patients’ hospital records from the Jeroen Bosch Hospital and Herlaarhof in The Netherlands. Results D. fragilis was detected in 57 patients with chronic AP (43.2%) and in 39 controls (50.6%) (p=0.255). No significant differences in symptomatology were found between D. fragilis-infected children and children fulfilling the criteria for AP-FGID. Parasitological eradication was achieved in 61.7% of patients after treatment with metronidazole or clioquinol, while clinical improvement occurred in only 40.4% of patients (p=0.435). Conclusions There were no differences in symptoms comparing children with and without D fragilis infection. Furthermore, no relation was found between clinical and microbiological response after treatment for D. fragilis. This retrospective study suggests that there is no association between chronic AP and D. fragilis infection.

Glucose hydrogen breath test for small intestinal bacterial overgrowth in children with abdominal pain-related functional gastrointestinal disorders.

Objectives: A potential link between small intestinal bacterial overgrowth (SIBO) and abdominal pain–related functional gastrointestinal disorders (AP-FGID) has been suggested by symptom similarities and by the reported prevalence of SIBO in children with irritable bowel syndrome (IBS) and functional AP. The aim of this study is to evaluate the prevalence of SIBO using the glucose hydrogen breath test (GHBT), in a cohort of Dutch children with AP-FGID fulfilling the Rome III criteria, and to identify potential predictors. Methods: Children ages 6 to 18 years with AP-FGID fulfilling the Rome III criteria were included. All of the children underwent a GHBT. SIBO was diagnosed if the fasting breath hydrogen concentration was ≥20 ppm or an increase in H2 levels of ≥12 ppm above the baseline value was measured after ingestion of glucose. Gastrointestinal symptoms were collected using a standardised AP questionnaire. Results: A total of 161 Dutch children with AP-FGID were enrolled. Twenty-three patients (14.3%) were diagnosed as having SIBO, as assessed by GHBT; 78% of the children diagnosed as having SIBO had fasting hydrogen levels ≥20 ppm. IBS was significantly more found in children with SIBO compared with children without SIBO (P = 0.001). An altered defecation pattern (ie, change in frequency or form of stool) (P = 0.013), loss of appetite (P = 0.007), and belching (P = 0.023) were significantly more found in children with SIBO compared with those without SIBO. Conclusions: SIBO is present in 14.3% of children presenting with AP-FGID. IBS, altered defecation pattern, loss of appetite, and belching were predictors for SIBO in children with AP-FGID.

Yoga Therapy for Abdominal Pain-Related Functional Gastrointestinal Disorders in Children: A Randomized Controlled Trial.

Objectives: The aim of the present study was to compare effects of 10 weeks of yoga therapy (YT) and standard medical care (SMC) on abdominal pain and quality of life (QoL) in children with abdominal pain–related functional gastrointestinal disorders (AP-FGIDs). Methods: Sixty-nine patients, ages 8 to 18 years, with AP-FGIDs, were randomized to SMC complemented with YT or SMC alone. YT is a mixture of yoga poses, meditation, and relaxation exercises and was given once a week in group sessions. SMC consisted of education, reassurance, dietary advice, and fibers/mebeverine, if necessary. Pain intensity (pain intensity score [PIS] 0–5) and frequency (pain frequency score [PFS] 0–4) were scored in a pain diary, and QoL was measured with KIDSCREEN-27. Follow-up was 12 months. Treatment response was defined as ≥50% reduction of weekly pain scores. Results: At 1-year follow-up, treatment response was accomplished in 58% of the YT group and in 29% of the control group (P = 0.01); no significant differences for other time points were found. YT, and not SMC, resulted in a significant reduction of PIS (P < 0.01) and PFS (P < 0.01) after 12 months. During the study, however, YT was not significantly superior compared with SMC. Subanalyses for time points demonstrated a significant greater reduction of PIS at 12 months in favor of YT. No differences were found for QoL. YT was more effective in the reduction of reported monthly school absence (P = 0.03). Conclusion: At 1-year follow-up, YT in addition to standard care was superior compared with SMC according to treatment success, PIS, and reduction of school absence. YT, however, was not significantly more effective in improving PFS or QoL, compared with SMC.

Pseudothrombocytopenia in a neonate due to mother

Ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia (PTCP) is the phenomenon of a false low platelet count reported by an automated haematology analyzer due to in vitro aggregation of platelets. This aggregation is due to the interaction between antibodies and EDTA-dependent crypt antigens on platelets. We observed a new born child whose mother was diagnosed with transient PTCP due to transplacental transmission of maternal immunoglobulin G antibodies during pregnancy. Conclusion: Although maternal–neonatal PTCP is rare, it is important to consider this phenomenon as a cause of trombocytopenia, as it can result in unnecessary diagnostic workup and treatment.

Reply to Doctor S. Özsoylu.

We thank Doctor Özsoylu for the constructive comment regarding our article [1]. We noted in the publication that in case of thrombocytopenia without any clinical sign, it is important to consider pseudothrombocytopenia (PTCP). PTCP could be confirmed by platelets counting performed in blood collected in Na citrate-containing tubes. Dr. Özsoylu suggested adding peripheral smear examination to strengthen the diagnosis. PTCP is characterized by in vitro aggregation of platelets after blood collection [2]. Therefore, we agree with this comment. In the case of thrombocytopenia, review of a peripheral blood film is essential to confirm platelet aggregation (Fig. 1). Also in the case we described in our publication, microscopic examination of the blood films confirmed the platelet aggregation. References