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Current treatment practice of functional abdominal pain disorders in children: A multicenter survey
Anouk M Gorka1, Femke Nauta2, Merijn W Bijlsma3
1Department of Pediatrics, Tergooi Hospitals, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands.
Insights
Pediatricians show low adherence to the Dutch guideline for functional abdominal pain disorder (FAPD). This variation in managing FAPD in children highlights the need for guideline updates and improved implementation strategies.
Area of Science:
- Pediatric Gastroenterology
- Clinical Practice Guidelines
Background:
- Functional abdominal pain disorder (FAPD) affects approximately 90% of children with chronic abdominal pain.
- The Dutch guideline offers a stepwise approach for FAPD management.
Purpose of the Study:
- To assess adherence to the Dutch guideline for FAPD.
- To evaluate current clinical management practices for FAPDs in children.
Main Methods:
- A multicenter survey was distributed to pediatricians and residents in the Netherlands.
- Data were collected from October 2020 to March 2021, with specific exclusion criteria applied.
Main Results:
- 48.9% of invited clinicians completed the survey, with 80 included in analysis.
- Self-reported guideline adherence was 85%, but only 50% followed the initial three steps.
- Treatment approaches varied significantly across age groups.
Conclusions:
- Significant variation exists in managing pediatric FAPDs, linked to low guideline adherence.
- Updating the guideline with subtype-specific recommendations and enhancing implementation are crucial for improving care.
Background:
Approximately 90% of the children with chronic abdominal pain are diagnosed as having functional abdominal pain disorder (FAPD). The Dutch guideline "functional abdominal pain" provides a stepwise approach to treat FAPD. The aim of this survey was twofold first, to determine adherence to the Dutch guideline, and second to determine current management of FAPDs in clinical practice.
Methods:
A multicenter survey was designed. The survey was sent to pediatricians and pediatric residents in December 2020. The study ran from October 2020 until March 2021. Participants in ten hospitals in the western region of The Netherlands were invited to complete this survey. Respondents who indicated not to treat children with FAPDs or respondents who completed less than 3 steps of the survey were excluded.
Results:
In total, 85/174 (48.9%) respondents completed the survey. We included 80 respondents, 68 pediatricians and 12 pediatric residents, for analysis. Overall, self-reported guideline adherence was 85%. Self-reported adherence was higher than actual adherence. Only 50% of all respondents followed the first three steps of the guideline. The reported non-pharmacological and pharmacological treatments were diverse and varied between different age groups. The average follow-up duration was between 2 and 6 months, and the most regularly used outcome measures were attendance at school, quality of life, and adequate pain relief/reassurance.
Conclusion:
We reportedly observed a large variation in the management of children with FAPDs, due to low guideline adherence among clinicians. Improved guideline adherence may be accomplished by updating the guideline with specific recommendations per subtype, follow-up and outcome measures as well measures to improve guideline implementation.
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