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Is visceral hypersensitivity correlated with symptom severity in children with functional gastrointestinal disorders?
Julie Castilloux1, Angela Noble, Christophe Faure
1Department of Pediatrics, Division of Pediatric Gastroenterology, Hôpital Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
Insights
In children with irritable bowel syndrome (IBS) and functional abdominal pain (FAP), rectal hypersensitivity does not directly correlate with symptom severity. Other factors beyond visceral hypersensitivity influence pain intensity in these pediatric conditions.
Area of Science:
- Pediatric Gastroenterology
- Visceral Pain Research
- Functional Gastrointestinal Disorders
Background:
- Irritable bowel syndrome (IBS) and functional abdominal pain (FAP) are common in children, often accompanied by rectal hypersensitivity.
- The relationship between rectal hypersensitivity and symptom severity in pediatric IBS and FAP requires further investigation.
Purpose of the Study:
- To investigate the association between rectal sensory threshold for pain (RSTP) and symptom severity in children diagnosed with IBS and FAP.
- To determine if rectal hypersensitivity is proportional to the severity of gastrointestinal symptoms in pediatric patients.
Main Methods:
- A cohort of 47 children (34 girls, median age 14.2 years) with IBS or FAP underwent rectal barostat examination to measure RSTP.
- Symptom severity was evaluated using validated questionnaires, visual analog scales, and body diagrams to map pain.
- Rome II criteria were used for patient diagnosis.
Main Results:
- The median RSTP was 16 mmHg, with 83% of patients exhibiting rectal hypersensitivity.
- No significant association was found between lower RSTP values and increased pain frequency, school absenteeism, or social activity limitations.
- Pain experienced during the barostat examination did not correlate with RSTP in the overall group or in those with rectal hypersensitivity.
Conclusions:
- Rectal hypersensitivity is prevalent in children with IBS and FAP but does not directly correlate with symptom severity.
- Factors beyond visceral hypersensitivity contribute to the overall symptom experience in pediatric IBS and FAP.
Background:
Abdominal pain related to irritable bowel syndrome (IBS) and functional abdominal pain (FAP) is frequent in children and can be of variable severity. Both IBS and FAP are associated with rectal hypersensitivity. We hypothesized that in children with IBS and FAP, the rectal sensory threshold for pain (RSTP) is associated with symptom severity.
Patients And Methods:
A total of 47 patients (34 girls; median age, 14.2 years) with IBS (n = 29) and FAP (n = 18), according to the Rome II criteria, underwent a rectal barostat examination to determine their RSTP. Gastrointestinal symptom severity was assessed by validated questionnaires. During the rectal barostat exam, symptoms were documented using a visual analog scale and by measuring the area coloured on a human body diagram corresponding to painful sensations.
Results:
The median RSTP was 16 mmHg and was similar in IBS and FAP patients. Eighty-three percent of the patients had rectal hypersensitivity (RSTP < or = 30.8 mmHg, the 5th percentile of control children studied in our laboratory). Fifty-one percent and 36%, respectively, reported missing school and social activities at least once per week. Increased frequency of pain, missed days of school, missed social activities, and pain during the barostat examination were not associated with lower RSTP values in either the whole group or in the subset of children with rectal hypersensitivity.
Conclusions:
Rectal hypersensitivity is not proportional to the severity of symptoms in children with IBS and FAP, indicating that symptom severity is influenced by other factors in addition to visceral hypersensitivity.
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