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Urinary tract infection in infancy is a risk factor for chronic abdominal pain in childhood
John M Rosen1, Alyssa Kriegermeier, Papa N Adams
1*Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital, Kansas City, MO †Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago ‡Departments of Urology and Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Insights
Infant urinary tract infections (UTI) may increase the risk of childhood functional gastrointestinal disorders (FGIDs) and chronic abdominal pain (CAP). This study found a significant association between early UTI and CAP in children.
Area of Science:
- Pediatric gastroenterology
- Infectious disease epidemiology
- Pain research
Background:
- Adverse early life events are linked to functional gastrointestinal disorders (FGIDs).
- Urinary tract infection (UTI) in adults is associated with chronic pelvic pain.
- The link between childhood UTI and chronic pain is not well-established.
Purpose of the Study:
- To investigate if UTI in infancy increases the risk of FGIDs and chronic abdominal pain (CAP) in childhood.
- To explore the relationship between early-life UTI and the development of gastrointestinal and pain disorders in children.
Main Methods:
- Study included children (4-18 years) with a history of infant UTI and their siblings without UTI.
- Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III).
- Chronic abdominal pain (CAP) was defined by QPGS-III criteria with pain less than weekly.
Main Results:
- FGIDs were diagnosed in 11% of patients with UTI versus 2% of controls (P=0.06).
- Chronic abdominal pain (CAP) was identified in 18% of patients with UTI versus 3% of controls (P=0.02).
- No significant differences in sex, infecting organism, or treatment were noted between UTI patients with and without CAP.
Conclusions:
- Childhood UTI is associated with an increased risk of chronic abdominal pain (CAP).
- This is the first study to demonstrate a link between UTI and CAP in children.
- Pelvic organ sensory convergence is a potential mechanism explaining these findings.
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.
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