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Published on: July 21, 2023
Diagnostic outcomes following childhood non-specific abdominal pain: a record-linkage study
G C D Thornton1, M J Goldacre2, R Goldacre2
1Department of Paediatric Gastroenterology, Oxford University Hospitals Trust, Oxford, UK.
Insights
Children diagnosed with non-specific abdominal pain (NSAP) face an increased risk of subsequent bowel conditions, including Crohn's disease and irritable bowel syndrome (IBS). This elevated risk for bowel pathology persists for up to 10 years following the initial NSAP diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Clinical Epidemiology
Background:
- Non-specific abdominal pain (NSAP) is a frequent discharge diagnosis for pediatric abdominal pain admissions.
- Understanding long-term risks following NSAP is crucial for effective patient management.
Purpose of the Study:
- To determine the risk of subsequent hospital diagnoses of organic and functional gastrointestinal conditions after an initial NSAP diagnosis in children.
- To assess the duration and persistence of this risk.
Main Methods:
- A large cohort of 268,623 children diagnosed with NSAP (aged 0-16) was established using English Hospital Episode Statistics (1999-2011).
- A control cohort of 1,684,923 children hospitalized for unrelated conditions was used for comparison.
- Standardized rate ratios were calculated for clinically relevant outcomes.
Main Results:
- Children with NSAP had a significantly higher risk of later hospitalization for bowel pathology (5.8%) and functional disorders (5%).
- Specific increased risks included Crohn's disease (4.84 times), acute appendicitis (4.23 times), and irritable bowel syndrome (IBS) (7.22 times).
- Elevated risks for inflammatory bowel disease (IBD), IBS, and functional disorders persisted up to 10 years post-NSAP diagnosis, except in children under 2.
Conclusions:
- While a small percentage of children with NSAP develop underlying bowel pathology, their risk is notably increased.
- The heightened risk for bowel conditions following NSAP extends up to a decade.
- Refining diagnostic strategies and implementing active surveillance for children with NSAP are recommended.
Aims:
Non-specific abdominal pain (NSAP) is the most common diagnosis on discharge following admission for abdominal pain in childhood. Our aim was to determine the risk of subsequent hospital diagnosis of organic and functional gastroenterological conditions following a diagnosis of NSAP, and to assess the persistence of this risk.
Methods:
An NSAP cohort of 268,623 children aged 0-16 years was constructed from linked English Hospital Episode Statistics from 1999 to 2011. The control cohort (1,684,923 children, 0-16 years old) comprised children hospitalised with unrelated conditions. Clinically relevant outcomes were selected and standardised rate ratios were calculated.
Results:
From the NSAP cohort, 15,515 (5.8%) were later hospitalised with bowel pathology and 13,301 (5%) with a specific functional disorder. Notably, there was a 4.84 (95% CI 4.45 to 5.27) times greater risk of Crohn's disease following NSAP and a 4.23 (4.13 to 4.33) greater risk of acute appendicitis than in the control cohort. The risk of irritable bowel syndrome (IBS) was 7.22 (6.65 to 7.85) times greater following NSAP. The risks of inflammatory bowel disease (IBD), IBS and functional disorder (unspecified) were significantly increased in all age groups except <2-year-olds. The risk of underlying bowel pathology remained raised up to 10 years after first diagnosis with NSAP.
Conclusions:
Only a small proportion of those with NSAP go on to be hospitalised with underlying bowel pathology. However, their risk is increased even at 10 years after the first hospital admission with NSAP. Diagnostic strategies need to be assessed and refined and active surveillance employed for children with NSAP.
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