Papa Adams

Parental report of abdominal pain and abdominal pain-related functional gastrointestinal disorders from a community survey.

Background and Aims: Functional gastrointestinal disorders (FGIDs) are common in children. Abdominal pain (AP) is the most common gastrointestinal (GI) symptom in children. The severity of AP drives medical consultations and quality of life in adult patients with irritable bowel syndrome (IBS). Thirty-eight percent of 8- to 15-year-old schoolchildren report AP weekly with 24% of those children reporting persistence of AP >8 weeks. Despite the high prevalence of AP, only 2% of school children seek medical attention for AP. Lack of parental knowledge on their childs symptoms may constitute one of the factors affecting the low ratio of consultation in children reporting AP. The aim was to assess parental reports of AP symptoms in a population of healthy community children. Methods: Data of 5 studies with identical methodology to assess GI symptoms in children with celiac disease (CD), cows milk allergy (CMA), pyloric stenosis (PS), Henoch-Schönlein purpura (HSP), and stem cell transplant (SC) and their healthy siblings were reviewed: a phone questionnaire on GI symptoms and Pediatric Gastrointestinal Symptoms Rome III version questionnaire (QPGS-RIII). Inclusion criteria were healthy children 4 to 18 years of age with a sibling previously diagnosed with CD, CMA, PS, HSP, or SC. Results: Data on 246 healthy children, mean age (9.8 years, range 3–24, 112 girls) were obtained. Parents reported presence of AP in the last 8 weeks before the telephone contact in 20 (8.1%) children (age range 4–18 years, 11 girls). There was no significant difference in AP prevalence between boys and girls (P = 0.64). Six children (2.4%) met QPGS-RIII diagnostic criteria for FGIDs: 3 functional abdominal pain (FAP) and 3 IBS. Conclusions: AP was common in community children. FAP was the most common FGID among healthy community children. The prevalence of AP by parental report is lower than the previously published prevalence of AP reported by children. Lack of awareness of childrens symptoms may play a role in the low ratio of consultation for AP in symptomatic children. Future prospective studies should confirm our findings and investigate the factors influencing the medical consultation decision including parental awareness of childrens symptoms.

Nausea Predicts Delayed Gastric Emptying in Children

OBJECTIVES To assess whether the gastroparesis cardinal symptom index (GCSI), or any individual symptom, is associated with delayed gastric emptying in children, and to assess understanding of symptoms associated with delayed gastric emptying. STUDY DESIGN Fifty children (36 F), 5-18 years of age, undergoing gastric emptying scintigraphy (GES) at Lurie Childrens Hospital in Chicago, Illinois, completed Likert-type GCSI and symptom comprehension questionnaires. Correlation of GES results (normal or abnormal) with questionnaire results using the Wilcoxon rank sum test. RESULTS Seventy percent of subjects had a normal GES. Children reported understanding most terms of GCSI (average score 2.59, range 0-3). The GCSI was not associated with delayed gastric emptying. Nausea was associated with delayed gastric emptying only (numerical P = .04, word P = .02). Results were not altered when poorly understood terms were excluded. CONCLUSIONS The GCSI is not associated with delayed gastric emptying in children. Lack of association does not seem to be related to lack of understanding. Nausea alone was the only symptom that showed an association with delayed gastric emptying on GES.

Urinary tract infection in infancy is a risk factor for chronic abdominal pain in childhood

Objective: Adverse early life events are key factors for development of functional gastrointestinal disorders (FGIDs). Urinary tract infection (UTI) is associated with chronic pelvic pain in adults, a finding that has been recapitulated in murine models, but the relation between UTI and chronic pelvic and abdominal pain has not been studied in children. We hypothesized that UTI in infancy increases the risk of FGIDs and chronic abdominal pain (CAP) in childhood. Methods: The present study included children, ages 4 to 18 years, with a single UTI in the first year of life and their siblings with no history of UTI. Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms–Rome III Version (QPGS-III) by telephone. Children meeting QPGS-III criteria for FGIDs but with pain less than once weekly were considered to have CAP. Results: A total of 57 patients with UTI and 58 sibling controls were identified. Mean age at UTI was 4.8 months, and mean time since UTI was 9.3 years. At the time of survey, mean age of patients was 9.7 years (5–16 years, 40% boys) and that of controls was 9.6 years (range 4–17 years, 57% boys). FGIDs were diagnosed in 6 of 57 (11%) patients, and 1 of 58 (2%) controls (P = 0.06). CAP was identified in 10 of 57 (18%) patients and 2 of 58 (3%) controls (P = 0.02). Predominant sex (female), infecting organism (E coli), and treatment (third-generation cephalosporin) were similar in patients with UTI with and without CAP. Conclusions: We show for the first time that UTI is associated with CAP in childhood. We speculate that pelvic organ sensory convergence explains our findings.

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

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.

Umbilical hernia repair increases the rate of functional gastrointestinal disorders in children.

OBJECTIVES To hypothesize that hernia repair would not change the incidence of functional gastrointestinal disorders (FGIDs) due to the benign and limited nature of the procedure. STUDY DESIGN This cohort study assessed a randomized selection of children aged 4-18 years who underwent hernia repair more than 4 years prior at Ann and Robert H. Lurie Childrens Hospital of Chicago. Controls were siblings who had not undergone surgery previously. Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version by telephone for subjects and controls. The primary outcome was the presence of FGIDs. RESULTS Fifty children with hernia repair and 43 sibling controls were identified. At the time of survey, subjects with hernia repair were average age 12.9 years (range 5-18 years, 60% male) and controls were average age 12.2 years (range 4-18 years, 49% male). Average age at surgical repair was 5.2 years (median 5.2 years, range 0.2-10.4 years) and average time since surgical repair was 7.8 years (range 4.8-13.7 years). FGIDs were diagnosed in 10/50 (20%) cases of hernia repair and 2/43 (5%) controls (P = .033, Fisher 2-tailed test). CONCLUSIONS Umbilical hernia repair increases the likelihood of FGIDs in childhood. Additional studies are needed to identify aspects of surgery that may be associated with development of FGIDs.

Mo1213 Hernia Repair Increases the Rate of Functional Gastrointestinal Disorders in Children

Objectives To hypothesize that hernia repair would not change the incidence of functional gastrointestinal disorders (FGIDs) due to the benign and limited nature of the procedure. Study design This cohort study assessed a randomized selection of children aged 4-18 years who underwent hernia repair more than 4 years prior at Ann and Robert H. Lurie Children’s Hospital of Chicago. Controls were siblings who had not undergone surgery previously. Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version by telephone for subjects and controls. The primary outcome was the presence of FGIDs. Results Fifty children with hernia repair and 43 sibling controls were identified. At the time of survey, subjects with hernia repair were average age 12.9 years (range 5-18 years, 60% male) and controls were average age 12.2 years (range 4-18 years, 49% male). Average age at surgical repair was 5.2 years (median 5.2 years, range 0.2-10.4 years) and average time since surgical repair was 7.8 years (range 4.8-13.7 years). FGIDs were diagnosed in 10/50 (20%) cases of hernia repair and 2/43 (5%) controls (P = .033, Fisher 2-tailed test). Conclusions Umbilical herniarepairincreasesthelikelihoodofFGIDsin childhood.Additionalstudiesare needed to identify aspects of surgery that may be associated with development of FGIDs. (J Pediatr 2013;163:1065-8). F unctional gastrointestinal disorders (FGIDs) affect 2%-35% of children, 1-4 and have a profound impact on families and society. Children with chronic abdominal pain (CAP) have increased risk of anxiety and depression, poor quality of life, and school absenteeism. 5 Costs associated with FGIDs are high. More than

Abdominal pain and functional gastrointestinal disorders in children with celiac disease.

1.56 billion are spent annually in the management of irritable bowel syndrome (IBS) in the US alone. 6 FGIDs are etiologically multifactorial. The biopsychosocial model proposes contributions from biological, psychological, and social systems. Factors derived from any of these systems may initiate, exacerbate, or alter the course of a pain syndrome. 7 The relative contribution of each factor varies by case. Understanding the pathogenesis of FGIDs provides an opportunity to establish novel, individually tailored therapeutic strategies and advance the pursuit of preventative measures. The child’s early liferepresents aparticularly vulnerable period. Animal studies show that colon and bladder inflammation in the first days of life result in long-term visceral hyperalgesia, and similar inflammation later in life results in self-limited, transient hyperalgesia. 8,9 Cow’s milk allergy has been shown to increase the risk of CAP and FGIDs later in life. 10 Both human and animal studies suggest that orogastric suction at birth can predispose to FGIDs. 11,12 Abdominal surgery for pyloric stenosis in infancy is associated with a 4-fold greater likelihood of CAP in childhood. 13 Mechanisms involved in the pathogenesis of FGIDs in such patients remain incompletely understood. Gastrointestinal manipulation and incision may lead to organ inflammation and nerve sensitization. The use of antibiotics or gastric suction, common in major surgeries, may also lead to visceral hypersensitivity. Opioids and other perioperative medications may affect gastrointestinal motility. Other perioperative events may alter the intraluminal milieu and immune function, intestinal permeability, or ability to cope with illness and pain. Family distress can also affect the patient’s response to the biological and psychological stressors of surgery. One study prospectively assessed risk of FGID after major intra-abdominal surgery in adult patients. 14 No studies have been conducted in subjects that underwent relatively minor surgeries in any age group. To evaluate whether surgery per se increases the risk of abdominal pain and FGIDs in children, we studied a sample of children who underwent surgery without gastrointestinal incision. Abdominal hernia repair is commonly performed in children, is minimally invasive, includes no intestinal incision, has very infrequent operative complications, and rarely uses nasogastric tube placement or antibiotics. 15 The selection of subjects who had minimal manipulation of the intestine allowed us to evaluate whether the invasive nature of intra-abdominal surgery was a driving factor behind increased rates of FGIDs found after pyloromyotomy in children. We hypothesized that hernia repair would not increase the incidence of CAP or FGIDs because of the benign and limited nature of the procedure.