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Abdominal Wall Pain or Irritable Bowel Syndrome: Validation of a Pediatric Questionnaire
Murid Siawash1, Tijmen van Assen2, Walther Tjon A Ten3
1SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Department of Surgery, Máxima Medical Center, Veldhoven.
Insights
A new questionnaire effectively distinguishes anterior cutaneous nerve entrapment syndrome (ACNES) from irritable bowel syndrome (IBS) in children with chronic abdominal pain (CAP). This tool aids in accurate diagnosis, improving patient care for pediatric abdominal pain.
Area of Science:
- Pediatric Gastroenterology
- Pain Medicine
- Diagnostic Test Development
Background:
- Adult studies indicate overlap between irritable bowel syndrome (IBS) and abdominal wall pain syndromes like anterior cutaneous nerve entrapment syndrome (ACNES).
- Accurate differentiation is crucial for effective treatment of chronic abdominal pain (CAP) in children.
- A validated diagnostic tool for pediatric ACNES is lacking.
Purpose of the Study:
- To evaluate the utility of a pediatric questionnaire in diagnosing abdominal wall pain syndromes in children with CAP.
- To assess the questionnaire's ability to differentiate ACNES from IBS in a pediatric cohort.
Main Methods:
- An 18-item questionnaire was administered to three groups of children with CAP: surgically confirmed ACNES, clinically diagnosed ACNES, and IBS.
- Statistical analyses included internal consistency (Cronbach's alpha), cut-off point determination, and Receiver Operating Characteristic (ROC) curve analysis.
- Response rates varied from 69% to 92% across the study groups.
Main Results:
- The questionnaire demonstrated high discriminative power, with 17 out of 18 items distinguishing between ACNES and IBS (P < 0.01, Cronbach's alpha 0.74).
- A median score of 13 (range 8-17) indicated ACNES, while a median score of 8 (range 3-13) suggested IBS (P < 0.01).
- An 11-point cut-off score achieved 86% sensitivity and 89% specificity for ACNES diagnosis, with an Area Under the Curve (AUC) of 0.94.
Conclusions:
- The 17-item questionnaire exhibits favorable diagnostic properties for differentiating ACNES from IBS in pediatric patients.
- This tool can significantly aid clinicians in diagnosing ACNES in children presenting with chronic abdominal pain.
- Further validation may enhance its role in clinical decision-making for pediatric CAP.
Objectives:
A questionnaire study demonstrated that some adult patients who were diagnosed with irritable bowel syndrome (IBS) were in fact having an abdominal wall pain syndrome, such as anterior cutaneous nerve entrapment syndrome (ACNES). The aim of the present study was to investigate whether a pediatric version of this questionnaire was useful in diagnosing abdominal wall pain syndromes in children with chronic abdominal pain (CAP).
Methods:
An 18-item questionnaire was tested in 3 groups of children with CAP: group 1, children who underwent surgery for ACNES (n = 42); group 2, children who were found to have ACNES after an outpatient analysis (n = 57); and group 3, children diagnosed with IBS (n = 53). Qualities including internal consistency (Cronbach α), cut-off points and a ROC-curve were calculated using standard statistical analysis.
Results:
Questionnaire response rates in the three populations of CAP children ranged from 69% to 92%. When comparing ACNES and IBS groups, 17 of 18 questions were discriminative (P < 0.01, Cronbach α 0.74). Total questionnaire scores ranged from 0 (IBS likely) to 17 points (ACNES likely). A median 13-point score (range 8-17) was found in both ACNES groups. In contrast, a median 8-point score was calculated in children with IBS (range 3-13, P < 0.01). Using an 11-point cut-off score, a child with CAP was diagnosed with ACNES with 86% sensitivity and 89% specificity. A ROC curve with an AUC of 0.94 was obtained.
Conclusions:
A 17-item questionnaire showed good diagnostic test properties and may aid in distinguishing ACNES from IBS in pediatric populations with chronic abdominal pain.
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