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Gastrointestinal complaints and diagnosis in children: a population-based study
J Kokkonen1, M Haapalahti, S Tikkanen
1Department of Paediatrics, Oulu University Hospital, Oulu, Finland. jorma.kokkonen@ppshp.fi
Insights
Gastrointestinal complaints are common in children, with specific disorders like milk protein intolerance identified in 6% of cases. Early life factors and specific tests aid in diagnosing these food-induced conditions.
Area of Science:
- Pediatrics
- Gastroenterology
- Epidemiology
Background:
- Gastrointestinal (GI) complaints are prevalent in children, necessitating investigation into underlying causes, including food intolerances.
- Understanding the frequency and diagnostic yield of specific GI disorders in pediatric populations is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of various GI complaints in 10-11-year-old children.
- To assess the frequency of food-induced or other diagnostic disorders contributing to these symptoms.
- To identify risk factors associated with GI complaints in this age group.
Main Methods:
- A population-based survey of 404 children aged 10-11 years in rural Finland.
- Parental questionnaires on GI symptoms over two years, followed by clinical examinations for symptomatic children.
- Diagnostic tests included elimination challenges, lactose intolerance tests, endoscopy, and blood tests.
Main Results:
- 27% of children reported GI complaints; 16% met criteria for recurrent abdominal pain.
- Specific disorders were identified in 6% of children, with milk protein intolerance (2.2%) being most common, followed by lactose intolerance (2%) and celiac disease (1.2%).
- Significant risk factors for GI complaints included chronic diseases, short breastfeeding duration, and early-life GI problems or food intolerance.
Conclusions:
- Approximately one in five children with GI complaints has a specific organic disease, most commonly milk-induced.
- Diagnostic approaches like milk protein/lactose challenge tests and endoscopy are valuable for individual diagnosis.
- Early identification of risk factors can aid in managing pediatric GI issues.
Aim:
To find out the extent to which children at 10-11 y of age suffer from various gastrointestinal complaints and how often a food-induced or other diagnostic disorder might be assessed behind them, we carried out a population-based survey of 404 children in a rural Finnish town.
Methods:
A questionnaire filled in retrospectively by their parents was used to describe the frequency of various abdominal symptoms during the previous 2 y and to select the symptomatic subjects for closer clinical examination. In the clinical investigation of the children, an elimination challenge with milk protein and lactose intolerance tests, as well as endoscopic examinations in selected cases and blood tests, were performed.
Results:
In all, 110 (27%) subjects reported some gastrointestinal (GI) complaints during the last 2 y; 64 (16%) meeting the Apley criteria for recurrent abdominal pain. A specific organic or functional disorder was found in 26 subjects (6%), two having no GI symptoms. Milk protein intolerance was the most common specific disorder diagnosed in nine subjects (2.2%), followed by lactose intolerance in eight (2%), coeliac disease in five (1.2%) and Helicobacter pylori infection in three (0.7%). An endoscopic examination performed on 17 subjects (4.2%) and a colonoscopy on three revealed significant findings in 11; lymphonodular changes being most common, occurring in five subjects. Subjects with milk protein-induced disorders showed significantly lower IgA-class antibodies to milk and its fractions than the non-symptomatic controls. Chronic diseases, short breastfeeding, GI problems and food intolerance during the first year of life were observed as significant risk factors in determining whether a subject belonged to the group experiencing any GI complaints.
Conclusion:
We conclude that in one in five of those with any, even mild, GI complaints we were able to assess a specific organic disease; milk-induced disorders being most common. A milk protein and/or lactose load test, completed in some cases with an endoscopic examination, would help in assessing a proper individual diagnosis.
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