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Symptomatic Treatment of Pain-Related Pediatric Functional Gastrointestinal Disorders in a Biopsychosocial Construct,
Shailender Madani1, Rohit Madani2, Suchi Parikh3
1Children's Hospital of Michigan, Troy, MI, USA.
Insights
Symptomatic treatment effectively improves pediatric functional gastrointestinal disorders (FGIDs). Rome III criteria accurately identify FGIDs, reducing the need for invasive testing in children with chronic abdominal pain.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
- Biopsychosocial Health
Background:
- Functional gastrointestinal disorders (FGIDs) are common in children with chronic abdominal pain.
- Evaluating the effectiveness of symptomatic treatment and diagnostic criteria is crucial for managing pediatric FGIDs.
- A biopsychosocial approach is increasingly recognized for understanding FGIDs.
Purpose of the Study:
- To assess the improvement in pain-related functional gastrointestinal disorders (FGIDs) using a biopsychosocial framework.
- To evaluate the diagnostic validity of the Rome III criteria in children with chronic abdominal pain.
- To determine the efficacy of symptomatic treatment for pediatric FGIDs.
Main Methods:
- A 1-year follow-up study of children with chronic abdominal pain.
- Diagnosis categorized into FGID or possible organic disease based on Rome III criteria and alarm signs.
- Assessment of treatment response to symptomatic management for FGID patients.
Main Results:
- Ninety percent of FGID patients showed improvement with symptomatic treatment within an average of 5.4 months.
- Rome III criteria demonstrated high specificity (0.90) and positive predictive value (0.98) for diagnosing FGIDs.
- The study identified 251 true FGID cases and 46 organic disease cases after 1 year.
Conclusions:
- Symptomatic treatment leads to significant clinical improvement in children with pain-related FGIDs.
- Rome III criteria are effective in ruling in FGID diagnoses, potentially reducing unnecessary investigations.
- This study supports a symptomatic and criteria-based approach to managing pediatric FGIDs.
Abstract:
Our study aims to assess improvement with symptomatic treatment of pain-related functional gastrointestinal disorders (FGIDs) in a biopsychosocial construct and evaluate validity of Rome III criteria. Children with chronic abdominal pain diagnosed with an FGID or organic disease were followed for 1 year: 256/334 were diagnosed with an FGID and 78/334 were diagnosed with a possible organic disease due to alarm signs or not meeting Rome III criteria. After 1 year, 251 had true FGID and 46 had organic diseases. Ninety percent of FGID patients improved with symptomatic treatment over an average of 5.4 months. With a 95% confidence interval, Rome criteria predicted FGIDs with sensitivity 0.89, specificity 0.90, positive predictive value 0.98, and negative predictive value 0.59. We conclude that symptomatic treatment of pain-related FGIDs results in clinical improvement and could reduce invasive/expensive testing. Rome III criteria's high specificity and positive predictive value suggest they can rule in a diagnosis of FGID.
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