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Irritable bowel syndrome in children with chronic gastrointestinal symptoms in primary care
Esmee M Hogervorst1, Ilse N Ganzevoort1, Marjolein Y Berger1
1Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Insights
Children with Irritable Bowel Syndrome (IBS) in primary care experienced worse symptoms and quality of life compared to those without IBS. Differentiating IBS is crucial for appropriate treatment and prognosis in pediatric functional gastrointestinal disorders.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
- Primary Care Pediatrics
Background:
- Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder in children.
- Prognostic differences between pediatric IBS and other diagnostic subgroups in primary care are not well understood.
- The study addresses the need to characterize symptom trajectories and health-related quality of life (HRQoL) in children with chronic gastrointestinal issues.
Purpose of the Study:
- To describe the course of symptoms and HRQoL in children with chronic gastrointestinal symptoms, comparing those who meet Rome criteria for IBS with those who do not.
- To compare the diagnostic accuracy of General Practitioners (GPs) with the Rome criteria for IBS in children.
- To highlight potential differences in prognosis and management based on IBS diagnosis in primary care.
Main Methods:
- Prospective cohort study with a 1-year follow-up period.
- Inclusion of children aged 4-18 years presenting with chronic diarrhea and/or abdominal pain in primary care.
- Utilized Rome III questionnaire, Child Health Questionnaire, and symptom-specific questionnaires for data collection.
Main Results:
- 57.7% of children met the Rome criteria for IBS at baseline.
- Children with IBS showed increased referrals to secondary care, higher laxative use, and a greater likelihood of developing chronic diarrhea and reduced physical HRQoL over one year.
- GP diagnoses aligned with Rome criteria for IBS in only 10% of cases, with 'Constipation' being the most frequent alternative diagnosis.
Conclusions:
- Significant differences exist in symptom progression and HRQoL between children with and without IBS in primary care settings.
- The findings underscore the importance of distinguishing between IBS and other diagnoses in pediatric functional gastrointestinal disorders.
- Further research is needed to refine and validate criteria for IBS diagnosis across diverse healthcare settings.
Background:
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder in children. However, in primary care, it is still unknown whether there are differences in the prognosis of children with IBS compared to other diagnostic subgroups. Therefore, our aim was to describe the course of symptoms and health-related quality of life (HRQoL) for children with chronic gastrointestinal symptoms who either do or do not fulfil the Rome criteria for IBS in primary care. Second, we compared the diagnosis of the general practitioner (GP) with the Rome criteria.
Methods:
We conducted a prospective cohort study with 1-year follow-up, including children aged 4-18 years with chronic diarrhoea and/or chronic abdominal pain in primary care. During follow-up, the Rome III questionnaire, Child Health Questionnaire, and symptom questionnaires were completed.
Results:
A total of 60/104 children (57.7%) fulfilled the Rome criteria for IBS at baseline. Compared to children without IBS, children with IBS were more commonly referred to secondary care, used more laxatives, and more often developed chronic diarrhoea and low physical HRQoL during 1 year. The diagnosis "IBS" from the GP matched the Rome criteria for only 10% of children, as most were diagnosed with "Constipation."
Conclusions:
There seems to be a difference in the treatment and prognosis of symptoms and HRQoL between children with and without IBS in primary care. This suggests that it is relevant to differentiate between these groups. The evaluation and use of feasible criteria to define IBS in different healthcare settings remains subject for further studies.
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