Marina Russo

Stool consistency, but not frequency, correlates with total gastrointestinal transit time in children.

OBJECTIVES To evaluate the correlation between stool characteristics (consistency and frequency) and gut transit time in children and to determine whether the Bristol Stool Form Scale is a reliable method of assessing intestinal transit rate in children. STUDY DESIGN From March 2011 to March 2012, 44 children (25 boys and 19 girls, mean age 7.8 years) with a diagnosis of functional constipation and 36 healthy, nonconstipated children (17 boys and 19 girls, mean age 7.6 years) were enrolled. All participants maintained a 1-week stool diary, recording the time and date of every bowel movement and stool form, and then completed a validated questionnaire on functional constipation according to Rome III criteria. Whole gut transit time (WGTT) was then assessed using the radiopaque markers test. RESULTS There was a significant correlation between stool form and WGTT in both constipated and nonconstipated children (correlation coefficient -0.84, P<.001). By contrast, there was no correlation between either stool frequency and WGTT or stool frequency and stool form. Multivariate logistic regression analysis, using WGTT as a dependent variable, showed that the sole variable significantly associated with WGTT was stool form (regression coefficient 2.9, OR 18.4, 95% CI 5.4-62.5, P<.001). CONCLUSION In this prospective, observational, case-control study, we show that stool form, as measured by the Bristol Stool Form Scale, rather than stool frequency, correlates with WGTT in both constipated and nonconstipated children.

Early-life factors associated with pediatric functional constipation.

Objective: This multicenter prospective study aimed to establish possible risk factors for functional constipation (FC) in the first year of life. Methods: At the infants age of 3, 6, and 12 months, parents of all included infants completed 2 questionnaires: one about the presence of FC and the other screened the possible risk factors for FC. Parents of 465 infants completed the questionnaires at 3 and 6 months and of 402 infants at 12 months of life. Results: According to the Rome III criteria, FC was found in 11.6% of the infants at 3 months, in 13.7% at 6 months, and in 10.7% at 12 months after birth. Family history of atopy was present in 38.8% and 45.3% of infants with constipation at 3 and 6 months (P = 0.04 and P = 0.02, respectively), but no significant association was found at 12 months (P = 0.80). Breast-feeding was significantly related to a normal evacuation pattern at 3 months (P = 0.05), but not at 6 and 12 months (P = 0.12 and P = 0.9, respectively). Acetaminophen and female sex appeared to be risk factors for FC at 12 months. After the adjustment for all analyzed variables, FC in infants was significantly associated with the use of acetaminophen (odds ratio 6.98, 95% confidence interval 0.82–13.50). Conclusions: Our results confirmed that breast-feeding is a protective factor for FC in the first 3 months of life and that the female sex is at risk to have FC. We found that the use of acetaminophen was associated with a higher incidence of FC in the first year of life.

Do Distinct Functional Dyspepsia Subtypes Exist in Children

Background and Aim: Two different subtypes of functional dyspepsia (FD) are recognized in adults: epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). The aim of the study was to assess the presence of FD subtypes in childhood at diagnosis and to observe changes at follow-up. Methods: A total of 100 patients with a diagnosis of FD based on pediatric Rome III criteria were consecutively enrolled. FD subtypes were successively classified through adult Rome III classification. Children were revaluated after 6 months of follow-up (T1). Results: At T0, 17 (17%) of 100 patients were classified as EPS, whereas 47 (47%) of 100 patients fulfilled criteria for PDS. In 36 (36%) of 100 children an overlap between the 2 subtypes was identified. Nausea was significantly higher in PDS and overlap groups when compared with EPS (&khgr;2 = 21.7, P = 0.0001; &khgr;2 = 20.7, P = 0.0001). Headache was significantly increased in PDS and overlap groups compared with patients with EPS (&khgr;2 = 9.8, P = 0.001; &khgr;2 = 13.1, P = 0.0001, respectively). At T1 among children belonging to PDS group at enrolment, 9 of 47 (19.1%) changed to EPS group, and 9 of 47 (19.1%) changed to the overlap group. Five (29.4%) of 17 patients and 2 (11.8%) of 17 children diagnosed as having EPS at T0 switched to PDS and overlap group, respectively. Of the 36 patients with overlap at enrollment, 11 (30.6%) satisfied criteria for PDS, and 7 (19.4%) switched to EPS group. Conclusions: Two distinct FD subtypes are identifiable in pediatric population. A high percentage of overlap and a variation of subtype over time were found, suggesting a common pathophysiologic mechanism.

Early-Life Risk Factors for Functional Constipation: Preliminary Results of an Italian Multicentre Prospective Study

R. Turcoa, M. Russoa, R. Mastroianni a , L. Pensabeneb , L. Grecoa, A. Staianoa, A. Campanozzi c , O. Borrelli d , C. Romanoe, G. Guariso f aDepartment of Pediatrics, University of Naples “Federico II”; bDepartment of Pediatrics, University “Magna Graecia” of Catanzaro; cDepartment of Pediatrics, University of Foggia; dDepartment of Pediatrics, University of Rome “La Sapienza”; eDepartment of Pediatrics, University of Messina; fDepartment of Pediatrics, University of Padua

Do Stool Consistency and Frequency Correlate With Total Gastrointestinal Transit Time? Results From an Italian Study in Constipated and Healthy Children

Background: Bloating and objective abdominal distention are considered gas-related symptoms and while they are related, they may represent expressions of different underlying pathophysiological process and have different response to treatment.1-2 Therefore, the efficacy of 100 mg pinaverium bromide + 300 mg simethicone (PB+S) over these symptoms, was studied in a 12-week randomized placebo-controlled trial. Methods: We studied 285 IBS-Rome III patients. They all filled-out a 12-week questionnaire that included 10-cm visual analog scales (VAS) for evaluating the intensity abdominal pain and bloating, and registered their girth circumference (objective distension) early in the morning and before bedtime during weeks 1, 6 and 12 of treatment. Data was analyzed with ANOVA for repeated measurements, using as covariate the linear combination of the girth measurements during all the weeks (explained 78% to 80% of the total variance). Finally, the abdominal volume was calculated with a mathematical model: (circumference cm)3/[6π2]. Results: Patients were 37±9 years old, F: 83%, BMI: 27±5, and were classified as IBS-C: 44%, IBS-D: 23%, IBS: 31%, and IBS-U: 2%. They reported a significant decrease in abdominal pain and bloating favoring PB+S vs. placebo (Size effect: 23% and 21% respectively, p<0.05 for both). Abdominal girth increased at night vs. morning with a mean difference of 1.8±0.2 cm, and between basal and the other weeks: 0.9±0.3 cm (Both: p<0.05). However, there were no differences in PB+S vs. placebo. Themathematical model showed difference betweenmorning and night for women: 800 mL and men: 1000 mL. The calculated abdominal volume between the basal measurement and the combination of weeks 4th and 6th were 400 mL for women and 500 mL for men. Conclusions: PB+S is effective for improving abdominal pain and bloating with no differences on objective distention. These findings suggest that BP+S may improve the gas-related symptoms through an effect on visceral perception or that measuring waist circumference is not sensitive enough to detect subtle changes in the volume of intestinal gas. Future studies should explore if distension triggers abdominal pain. 1. Chang L, et al. Am J Gastroenterol. 2001;96:3341-7. 2. Azpiroz F, Malagelada JR. Gastroenterology. 2005;129:1060-78.

PA7 OBESITY IS A RISK FACTOR FOR GASTROESOPHAGEAL REFLUX IN CHILDREN

Background: Gastroesophageal reflux (GER) is a very common disorder in obese adults. An association between high values of body-mass index (BMI) and GER symptoms has not been demonstrated in children. The implications of obesity in the etiology, management and outcomes in children with GER disease have become increasingly important due to the recent outbreak of obesity, particularly in childhood. Aims: The aims of our study were to evaluate 1) the prevalence of GER symptoms in overweight and obese children in comparison to general normalweight population and 2) whether the GER symptoms are associated with the abdominal circumference (AC). Methods: The study population consisted of 106 consecutive children (M/F: 53/53; mean age: 8.19 years; range: 2-17.7 years) referred to our Department for a well-child visit from June 2009 to December 2009. A detailed history and physical examination, including determination of height, weight, BMI and AC, was obtained from each patient. A questionnaire on reflux symptoms was completed by caregivers. On the basis of this questionnaire, a reflux symptomatic score, considering duration and severity of each referred symptom, was calculated. Results: All of the 106 patients prospectively enrolled during the 6-month period were categorized according to BMI in normal-weight (BMI 95° pct) and according to AC in children with AC 90° pct. The reflux symptomatic score resulted significantly higher (p 90° pct compared to those with AC <75° pct (average score: 2.90 vs 0.66, respectively). A trend towards a higher rate of reflux symptomatic score was present in patients with overweight (1.02 vs 0.64, respectively; p=0.33) and this positive trend continued across all categories of both BMI and AC, including those less than 85° for BMI and 75° for AC. Conclusions: Our preliminary data demonstrate that, also in childhood, overweight and obesity are risk factors for the development of GER symptoms. The risk of GER symptoms seems to rise progressively with the increase of both BMI and AC, even in normal-weight children. Our findings have important implications for future studies, since even moderate weight gain may cause or exacerbate GER symptoms.