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Gastrointestinal symptoms in children: Primary care and specialist interface
Valeria Dipasquale1, Domenico Corica1, Simone M C Gramaglia1
1Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
Insights
Gastrointestinal symptoms in children are common, but many specialist consultations are unnecessary. Applying primary care guidelines can reduce referrals and improve management of pediatric gastrointestinal issues.
Area of Science:
- Pediatric Gastroenterology
- Primary Care Medicine
- Evidence-Based Practice
Background:
- Gastrointestinal (GI) symptoms are a leading cause of pediatric specialist referrals and hospitalizations.
- A significant portion of medical consultations for young children (<6 years) stem from GI issues.
- Despite available guidelines, suboptimal adherence leads to excessive and often unwarranted specialist consultations and evaluations.
Purpose of the Study:
- To review epidemiological and clinical aspects of common pediatric GI symptoms.
- To outline management strategies, identify pitfalls, and offer practical tips for primary care.
- To define appropriate indications for specialist consultations in pediatric gastroenterology.
Main Methods:
- Literature search of PubMed/Medline for English articles (2000-2018).
- Keywords included: gastrointestinal symptoms, functional gastrointestinal symptoms, children, primary care, specialist consultations, management.
- Emphasis on high-quality studies and evidence-based guidelines.
Main Results:
- Functional GI symptoms significantly impact children's quality of life and healthcare costs.
- A thorough medical history and physical examination are often adequate for primary care diagnosis, workup, and referral decisions.
- Primary care providers can effectively manage many cases without immediate specialist involvement.
Conclusions:
- Pediatric gastroenterology clinics face high patient volumes, largely due to functional GI symptoms.
- Improved adherence to established guidelines in primary care settings can substantially decrease the number of specialist referrals.
- Optimizing primary care management is key to reducing unnecessary consultations and healthcare expenditure.
Aims:
Gastrointestinal symptoms and diseases represent one of the major reasons for paediatricians' requests for specialist consultations and hospital admissions. One fourth of annual medical consultations for children younger than 6 years can be attributed to gastrointestinal symptoms. High-quality guidelines have been validated worldwide to provide clinical recommendations and support healthcare providers' practice. Nevertheless, overall compliance to standards of care is unsatisfactory, and children with gastrointestinal symptoms frequently undergo expensive, useless specialist consultations and laboratory evaluations. The aim of this study is to review the main epidemiological and clinical aspects, together with management strategies, of the most common gastrointestinal symptoms in children, pointing out pitfalls and practical tips in primary care management, and providing correct indications for specialist consultations.
Methods:
For this review, articles published in English from 2000 to January 2018 were identified from the PubMed/Medline (http://www.ncbi.nlm.nih.gov/pubmed/) database and selected on the basis of quality, relevance to the illness and importance in illustrating current management pathways. The search used the following keywords: gastrointestinal symptoms, functional gastrointestinal symptoms, children, primary care, specialist consultations and management. Particular emphasis was placed on evidence-based guidelines and high-quality studies.
Results:
Functional gastrointestinal symptoms have a high impact on the quality of life of children and families and on healthcare costs. A complete medical history and clinical examination are often sufficient to guide the primary care provider in the diagnosis, further workup or referral to a paediatric gastroenterologist.
Conclusion:
Paediatric gastroenterology outpatients' clinics are among the most crowded specialists, and functional gastrointestinal symptoms and disorders are the most frequent reason for counselling. The number of specialist consultations could be reduced if guidelines were applied in primary care settings.
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