Functional defecation disorders in children: PACCT criteria versus Rome II criteria

Area of Science:

• Pediatric Gastroenterology
• Clinical Diagnostics
• Functional Gastrointestinal Disorders

Background:

• Pediatric functional defecation disorders (FDDs) require precise diagnostic criteria for effective management.
• Existing criteria, such as Rome II, may have limitations in capturing the full spectrum of FDDs in children.
• The Paris Consensus on Childhood Constipation Terminology (PACCT) offers a newer framework for FDD diagnosis.

Purpose of the Study:

• To compare the clinical validity and applicability of the PACCT criteria against the Rome II criteria for diagnosing FDDs in children.
• To assess the diagnostic yield of each criterion set in a cohort of referred pediatric patients.

Main Methods:

• A prospective longitudinal study enrolled 128 children (infancy to 17 years) with chronic constipation referred to a tertiary center.
• The Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) was utilized for diagnosing FDDs in different age groups.
• Diagnostic concordance was evaluated using Cohen's kappa test.

Main Results:

• Functional defecation disorders were diagnosed significantly more often using PACCT (88.9%) compared to Rome II criteria (47.6%) (P = .001).
• Poor agreement was observed between the two criteria sets (Cohen's kappa = .173), indicating they identify different patient populations.
• Scybalous, pebble-like stools and defecation with straining were the most prevalent symptoms (80%).

Conclusions:

• The PACCT criteria demonstrate superior applicability for diagnosing FDDs in pediatric populations compared to Rome II.
• The significant discrepancies highlight that these criteria do not identify the same patient cohorts.
• Symptoms such as defecation with straining, scybalous stools, and painful defecation are highly prevalent and warrant consideration in revised diagnostic criteria.