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Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis
Nicolaas Koen Vermeijden1,2,3,4, Leilani de Silva5, Supun Manathunga6
1Pediatric Gastroenterology, Hepatology and Nutrition, Emma's Children Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Insights
Functional abdominal pain disorders (FAPDs) affect over 11% of children globally, with higher rates in girls. Psychological factors like stress and anxiety are linked to increased FAPD prevalence.
Area of Science:
- Pediatric Gastroenterology
- Epidemiology
- Child Psychology
Background:
- Functional abdominal pain disorders (FAPDs) are common and debilitating conditions in children.
- The global prevalence and variations of FAPDs remain incompletely understood.
Purpose of the Study:
- To estimate the global prevalence of FAPDs in children aged 4-18 years.
- To analyze variations in prevalence based on diagnostic criteria, geography, gender, and age.
- To identify the most and least common types of FAPDs.
Main Methods:
- Systematic review and meta-analysis of epidemiological studies.
- Searched multiple databases (Medline, Embase, CINAHL, PsycInfo, Cochrane) up to October 2024.
- Included 66 studies with over 200,000 participants, using Rome criteria for diagnosis.
Main Results:
- Global pooled prevalence of FAPDs was 11.7%, with irritable bowel syndrome being the most common type.
- Prevalence varied by diagnostic criteria (Rome III vs. Rome IV) and was higher in girls than boys.
- No significant differences were found based on age, but prevalence was higher in Asia compared to Europe and North America.
Conclusions:
- FAPDs impact over 1 in 9 children worldwide.
- Higher prevalence in girls and association with psychological stressors highlight the need for targeted interventions.
- Further research is needed to address limitations like language restrictions and underrepresentation from Africa.
Context:
Functional abdominal pain disorders (FAPDs) are debilitating disorders with unknown current prevalence.
Objective:
To estimate global prevalence rates of FAPDs, their entities, and variations by diagnostic criteria, geography, gender, and age.
Data Sources:
Medline, Embase, CINAHL, PsycInfo, and Cochrane Library were searched through October 14, 2024.
Study Selection:
Epidemiological studies of birth cohorts, school based, and from general population samples reporting FAPD prevalence in children (aged 4-18 years) using the Rome criteria.
Data Extraction:
Two researchers independently performed screening, data extraction, and quality assessment.
Results:
A total of 66 studies, encompassing 201 134 participants from 29 countries, were included. The estimated global pooled prevalence of FAPDs was 11.7% (95% CI, 10.5%-13.1%). The most prevalent type was irritable bowel syndrome (5.8%; 95% CI, 4.5-7.4%), while functional abdominal pain-not otherwise specified was least prevalent (1.2%; 95% CI, 0.7%-2.1%)). Prevalence was highest using Rome III (13.2%; 95% CI, 11.3%-15.3%) and lowest under Rome IV criteria (9.0%; 95% CI, 6.7%-12.0%; P = .05). Girls had higher prevalence (14.4%; 95% CI, 12.5%-16.6%) than boys (9.4%; 95% CI, 7.8%-11.4%; P < .01). FAPDs were nonsignificantly more prevalent in Asia (13.0%; 95% CI, 10.4%-16.3%) compared to Europe (8.3%; 95% CI, 6.4%-10.7%) and North America (7.7%; 95% CI, 4.3-13.6; P = .09). No differences by age (P = .14) were recorded. Contributing factors include anxiety, depression, stress, negative life events, and poor sleep.
Limitations:
Language restrictions, significant interstudy heterogeneity, and underrepresentation from Africa.
Conclusions And Relevance:
FAPDs affect over 1 in 9 children worldwide, with higher prevalence in girls and those with psychological stressors.
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