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Functional Gastrointestinal Disorders in Children: A Survey on Clinical Approach in the Mediterranean Area
Elena Scarpato1, Paolo Quitadamo, Enriqueta Roman
1*Department of Translational Medical Sciences, Section of Pediatrics, University Federico II, Naples, Italy†Department of Pediatrics, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain‡Department of Pediatrics, Institute for Child and Youth Health Care of Vojvodina, Medical Faculty Novi Sad, Novi Sad, Serbia§Referral Centre for Pediatric Gastroenterology and Nutrition, University Children's Hospital, Zagreb, Croatia||First Department of Pediatrics, University of Athens, Athens Children's Hospital "Agia Sophia", Athens, Greece¶Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel#Clinical Centre of Montenegro, Institute for Children's Disease, Podgorica, Montenegro**Children's Hospital, University Medical Centre, Ljubljana, Slovenia††Makassed University General Hospital, Beirut, Lebanon‡‡Department of Internal Medicine and Medical Specialties, University Sapienza, Rome, Italy.
Objectives:
Childhood functional gastrointestinal disorders (FGIDs) are common conditions associated with significant morbidity and high healthcare costs. This multicenter study aimed at assessing the clinical approach to infants (0-6 months) and children/adolescents (4-18 years) with suspected FGIDs by pediatricians from the Mediterranean Area.
Methods:
A survey evaluating the diagnostic approach, including the use of Rome II and III criteria, and the therapeutic management of some of the most prevalent FGIDs, such as irritable bowel syndrome (IBS), functional constipation (FC), and functional regurgitation (FR), was distributed to a sample of pediatricians.
Results:
We collected 278 questionnaires from 9 countries (Croatia, Greece, Israel, Italy, Lebanon, Montenegro, Serbia, Slovenia, and Spain). Rome III criteria are used to diagnose FC by 28.8%. Treatment of FC is based on dietary modifications (97.5%) and osmotic laxatives (93.5%). Rome III criteria are used to diagnose FR by 22.3% of the responders, in contrast to 79.5% who rely on personal experience for diagnosis. Reported treatments mainly consist of reassurance (96.8%) and thickened feedings (77.3%). Nevertheless, 21.2% prescribe proton pump inhibitors or H2-blockers to infants with FR. Rome III criteria are used to diagnose IBS by only 25.9%. Moreover, 86% of the pediatricians base IBS therapy on the predominant symptom. The most prescribed treatments are analgesics (36.6%) for pain control, dietary advice (41.5%) for diarrhea-predominant IBS, and dietary advice (47.8%) for constipation-predominant IBS.
Conclusions:
Our data show that the use of Rome III diagnostic criteria is not sufficiently widespread among pediatricians, and that large variability remains in the management of FGIDs within the different Mediterranean countries surveyed.
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