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Long-Term Study of Children With ROME III Functional Gastrointestinal Disorders Managed Symptomatically in a
Shailender Madani1, Suchi Parikh2, Rohit S Madani3
1The Carman Ann Adam Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA.
Insights
Children with functional gastrointestinal disorders (FGIDs) not fully improving require more medical interventions and develop new diagnoses. Symptomatic care within a biopsychosocial model shows potential benefits for managing pediatric FGIDs.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
- Biopsychosocial Healthcare
Background:
- Functional gastrointestinal disorders (FGIDs) are common in children.
- Understanding FGID progression and contributing factors is crucial for effective management.
- Long-term outcomes in pediatric FGIDs treated symptomatically require further evaluation.
Purpose of the Study:
- To evaluate the progression of ROME III-defined FGIDs in children.
- To identify factors associated with treatment outcomes in pediatric FGIDs.
- To assess the long-term follow-up of children managed with a biopsychosocial model.
Main Methods:
- Retrospective review of pediatric patients diagnosed with ROME III FGIDs.
- Analysis of demographics, management strategies, and treatment response (complete, partial, no improvement).
- Long-term follow-up data collection on disease progression and outcomes.
Main Results:
- 258 children included; mean age 10.6 years, 55.4% female, mean follow-up 18.7 months.
- Common FGIDs: functional abdominal pain (45%), IBS (20.9%), functional dyspepsia (12.8%), abdominal migraine (8.1%).
- Partial/no improvement group showed more encounters, lab abnormalities, endoscopies, treatment changes, and new FGID diagnoses compared to complete improvement.
Conclusions:
- Children with ROME III FGIDs experiencing partial/no improvement have poorer outcomes.
- These patients require more follow-up visits, investigations, and treatment modifications.
- Symptomatic treatment within a biopsychosocial model may benefit pediatric FGID management.
Background:
Our study evaluated progression of and identified potential factors contributing to outcomes of ROME III defined-functional gastrointestinal disorders (FGIDs) in children treated symptomatically in a biopsychosocial model of care with a long-term follow-up.
Methods:
We performed a retrospective review of pediatric patients who were diagnosed with ROME III defined-FGIDs including functional abdominal pain, functional dyspepsia, irritable bowel syndrome and abdominal migraine. Patients were managed symptomatically in a biopsychosocial model of care from the time of initial diagnosis. Demographics, management, progression and response to treatment assessed as complete, partial, and no improvement were reviewed.
Results:
Two hundred fifty-eight patients were included with mean age of 10.6 years, female 55.4%, mean number of encounters 3.3 visits, and mean follow-up was 18.7 months (range 2 - 59, SD 15.8). Diagnoses were functional abdominal pain 45%, irritable bowel syndrome 20.9%, multiple 13.2%, functional dyspepsia 12.8%, and abdominal migraine 8.1%. Investigations were performed in most patients: laboratory studies in 93.4% (non-contributory abnormal 23.6%), imaging studies in 45.3% (non-contributory abnormal 5%) and endoscopies in 43.0% (non-contributory abnormal 1.2%). Treatment included medication in 93.7%, and surgery in 1.9% (normal pathology). There were new functional gastrointestinal diagnosis in 11.6%, evolution of FGIDs, from one to another in 12.0%, and recurrence found in 35.7% of patients. There were 60.1% patients in the complete improvement group (CIG) and 39.1% in the partial/no improvement group (PIG/NIG). No statistical difference was found between CIG and PIG/NIG regarding demographics or evaluation. PIG/NIG had more encounters (mean 3.63 vs. 3.11; P = 0.03), had non-contributory lab abnormalities (34.4% vs. 20.0%; P = 0.01), needed more endoscopies (52.4% vs. 36.8%; P = 0.02), required more treatment changes (mean 1.41 vs. 0.81; P < 0.01) and developed new functional gastrointestinal diagnoses (19.4% vs. 6.5%; P < 0.01) with long-term follow-up.
Conclusions:
Patients with ROME III defined-FGIDs who experience partial or no improvement with treatment develop new FGID diagnosis, need more number of follow-up visits, require more number of endoscopies, need more treatment changes, and have more non-contributory laboratory abnormalities, compared to those who experience complete improvement. Symptomatic treatment offered in a biopsychosocial model of care is possibly beneficial in managing children with FGIDs.
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