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Do Distinct Functional Dyspepsia Subtypes Exist in Children?
Rossella Turco1, Marina Russo, Massimo Martinelli
1Department of Translational Medical Science, Section of Pediatrics, University of Naples, "Federico II," Naplses, Italy.
Insights
Functional dyspepsia (FD) subtypes, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are identifiable in children. A significant overlap and subtype variation over time suggest a shared underlying mechanism in pediatric functional dyspepsia.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
- Dyspepsia Pathophysiology
Background:
- Functional dyspepsia (FD) in adults presents as epigastric pain syndrome (EPS) or postprandial distress syndrome (PDS).
- The presence and evolution of these FD subtypes in children have not been well-established.
Purpose of the Study:
- To determine the prevalence of FD subtypes (EPS, PDS, overlap) in children at diagnosis.
- To track changes in FD subtype classification over a 6-month follow-up period.
Main Methods:
- 100 children diagnosed with FD using pediatric Rome III criteria were enrolled.
- FD subtypes were classified using adult Rome III criteria at baseline (T0) and after 6 months (T1).
Main Results:
- At baseline, 17% had EPS, 47% had PDS, and 36% had overlap. Nausea and headache were more prevalent in PDS and overlap groups.
- Significant shifts in subtype classification were observed at follow-up, with patients moving between EPS, PDS, and overlap categories.
Conclusions:
- Two distinct FD subtypes, EPS and PDS, are identifiable in the pediatric population.
- A high degree of overlap and dynamic changes in subtype classification suggest a common pathophysiological basis for FD in children.
Background And Aim:
Two different subtypes of functional dyspepsia (FD) are recognized in adults: epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). The aim of the study was to assess the presence of FD subtypes in childhood at diagnosis and to observe changes at follow-up.
Methods:
A total of 100 patients with a diagnosis of FD based on pediatric Rome III criteria were consecutively enrolled. FD subtypes were successively classified through adult Rome III classification. Children were revaluated after 6 months of follow-up (T1).
Results:
At T0, 17 (17%) of 100 patients were classified as EPS, whereas 47 (47%) of 100 patients fulfilled criteria for PDS. In 36 (36%) of 100 children an overlap between the 2 subtypes was identified. Nausea was significantly higher in PDS and overlap groups when compared with EPS (χ = 21.7, P = 0.0001; χ = 20.7, P = 0.0001). Headache was significantly increased in PDS and overlap groups compared with patients with EPS (χ = 9.8, P = 0.001; χ = 13.1, P = 0.0001, respectively). At T1 among children belonging to PDS group at enrolment, 9 of 47 (19.1%) changed to EPS group, and 9 of 47 (19.1%) changed to the overlap group. Five (29.4%) of 17 patients and 2 (11.8%) of 17 children diagnosed as having EPS at T0 switched to PDS and overlap group, respectively. Of the 36 patients with overlap at enrollment, 11 (30.6%) satisfied criteria for PDS, and 7 (19.4%) switched to EPS group.
Conclusions:
Two distinct FD subtypes are identifiable in pediatric population. A high percentage of overlap and a variation of subtype over time were found, suggesting a common pathophysiologic mechanism.
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