Next Article in Journal
Ileocolic Anastomosis Dehiscence in Colorectal Cancer Surgery
Next Article in Special Issue
Nocturnal Pain Is Not an Alarm Symptom for Upper Gastrointestinal Inflammation but May Be an Indicator of Sleep Disturbance or Psychological Dysfunction
Previous Article in Journal
Molecular Mechanisms and Mediators of Hepatotoxicity Resulting from an Excess of Lipids and Non-Alcoholic Fatty Liver Disease
Previous Article in Special Issue
On the Inheritance of Microbiome-Deficiency: Paediatric Functional Gastrointestinal Disorders, the Immune System and the Gut–Brain Axis
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Gastrointestinal Disorders
Volume 5
Issue 2
10.3390/gidisord5020021
gastrointestdisord-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Prevalence of Functional Gastrointestinal Disorders (Rome IV Criteria) among a Cohort of New Zealand Children

by
Angharad Vernon-Roberts
*,
India Alexander
and
Andrew S. Day
Department of Paediatrics, University of Otago, Christchurch, Christchurch 8011, New Zealand
*
Author to whom correspondence should be addressed.
Gastrointest. Disord. 2023, 5(2), 261-272; https://doi.org/10.3390/gidisord5020021
Submission received: 21 March 2023 / Revised: 2 June 2023 / Accepted: 7 June 2023 / Published: 9 June 2023
(This article belongs to the Special Issue Pediatric Functional Gastrointestinal Disorders: Challenges in Diagnosis and Treatment)
Browse Figures
Versions Notes

Abstract

:
Functional gastrointestinal disorders (FGIDs) are characterised by recurring gastrointestinal symptoms that are not secondary to organic disease. FGIDs may cause reduced quality of life, with approximately 22% of children experiencing at least one FGID. This study aimed to assess FGID prevalence among children attending a tertiary care hospital in New Zealand (NZ). Methods: Children aged ≥ four years were prospectively recruited from Christchurch Hospital, NZ. Data were collected on demographics, medical history, gastrointestinal symptoms (Rome IV), and quality of life (EQ-5D-Y). An analysis was carried out using analysis of variance and the chi-squared test of independence. Results: The cohort included 156 children, with a mean age of 9.5 years (SD 3.3), 56% male. According to the Rome IV criteria, 29% experienced at least one FGID, most commonly functional constipation and functional dyspepsia. FGID symptoms were associated with Māori ethnicity (p = 0.012) and parental FGID (p < 0.001). Quality of life was lower in the FGID group in the domain ‘Feeling worried, sad, or unhappy’ (p = 0.002). Conclusion: the association of FGIDs with worse quality of life, in particular relating to worry and sadness, should highlight the importance of providing support to school age children experiencing FGID symptoms.

1. Introduction

Functional gastrointestinal disorders (FGIDs) are characterised by recurring gastrointestinal (GI) symptoms that cannot be attributed to organic disease, structural, or biochemical causes [1]. FGID may be related to a combination of disturbances in gut motility and microbiota, central nervous system processing, visceral hypersensitivity, and altered immune and mucosal function [2].
Children with FGID may present with symptoms such as abdominal pain, nausea, vomiting, regurgitation, diarrhoea, or constipation [1], with these being some of the main reasons for presentation to a primary care physician [3]. FGIDs are strongly associated with interference of children’s normal activities, such as school attendance, social activities, and sleep, as well as being associated work absence for their parents [4,5,6]. In addition, children with FGID experience a reduced quality of life compared to healthy controls [4,7,8,9,10,11] and impaired psychosocial outcomes, such as anxiety and depression, coping, worry, and catastrophising [4,9,12]. FGID during childhood is also associated with increased healthcare utilisation, representing a significant burden to the primary, secondary, and tertiary healthcare systems [4,8,13,14]. Furthermore, up to 25% of children presenting with recurrent abdominal pain subsequently develop irritable bowel syndrome (IBS) as an adult, highlighting the possibility of childhood FGID progressing into adulthood [15].
Specific assessment tools have been developed for the clinical identification of FGIDs in children of all ages, namely the paediatric Rome IV criteria [1,16], symptom-based guidelines developed using scientific evidence, clinical experience, and iterative revisions from previous Rome criteria [17,18]. Rome IV parental reporting tools have also been developed in conjunction that enable data to be collected from a proxy source using a structured questionnaire to gather information from parents on their child’s GI symptoms and activity limitations. The parental report data are then assessed against criteria for the diagnosis of specific FGIDs. There are separate criteria for neonates/toddlers up to the age of four years [16], and for children aged 4–18 years [1]. For neonates and toddlers, these comprise infant regurgitation, infant rumination syndrome, cyclic vomiting syndrome, infant colic, functional diarrhoea, infant dyschezia, and functional constipation [16]. For children aged four and over, the criteria are cyclic vomiting, functional nausea, functional vomiting, rumination syndrome, aerophagia, functional dyspepsia, irritable bowel syndrome, abdominal migraine, abdominal pain not otherwise specified (NOS), functional constipation, and non-retentive faecal incontinence.
According to the Rome IV criteria, the most common FGID experienced by infants is infant regurgitation; for those aged 13–48 months, functional constipation and cyclic vomiting; and for those aged over four years, functional constipation, functional dyspepsia, and irritable bowel syndrome [19]. Various management options are available for FGIDs, these include dietary management, psychosocial input, complementary/alternative medicines, and pharmacological treatments. However, the evidence for their efficacy is mixed [20,21,22,23,24,25,26,27]. It is, therefore, important to develop strategies that may optimise outcomes and improve quality of life [28].
International studies report the prevalence of FGIDs among children according to the Rome IV criteria to range between 6 and 40%, with an overall estimate of 22% [19]. Little is known of the pattern of FGIDs among children in New Zealand, although among adults the prevalence is approximately 30% [29]. It is important to assess the prevalence within local populations to ensure that the diagnostic pathways and appropriate resources are in place that account for the specific epidemiology. The objective of this research was to carry out Rome IV parental report assessments among children attending a tertiary care centre in New Zealand with the aim of establishing local FGID prevalence, as well as to measure the association of FGIDs with independent variables such as quality of life and general well-being.

2. Results

2.1. Demographics and Health Information

One hundred and fifty-six children participated in the study, and they had a mean age of 9.5 years (SD 3.3), and 87 (56%) were male (Table 1). The majority were recruited from inpatient wards (surgical ward: 56 (36%); medical ward: 12 (8%); acute assessment: 38 (24%)) and the remainder from outpatient areas (outpatient clinics: 28 (18%); day ward: 22 (14%)). The reporting parent was female for 133 (85%) of the children. The parents had a mean age of 40.5 years (SD 7.7), and 24 (15%) parents self-reported that they had an FGID, all stating irritable bowel syndrome (IBS). Of the 47 (30%) children who were reported to have a chronic health condition, the most common conditions were asthma 17 (36%), eczema 7 (15%), epilepsy 4 (9%), and diabetes 4 (9%).

2.2. FGID Prevalence, Categories, and Disorders

From the overall cohort, 45 (29%) of the children experienced at least one FGID, with 34 (22%) having one FGID, 3 (2%) two FGIDs, 6 (4%) three FGIDs, and two (1%) four FGIDs. The FGID categories experienced most frequently were functional constipation (12%) and functional dyspepsia (10%), with no patients reporting symptoms that concurred with a diagnosis of aerophagia or non-retentive faecal incontinence (Figure 1). Of those with functional dyspepsia, 13 (8%) had post-prandial distress syndrome, and 3 (2%) had epigastric pain syndrome. When the FGID categories were combined, functional abdominal pain disorders (FAPDs) were the most common (19.9%), followed by functional defaecation disorders (FDDs) (12.2%) and functional nausea and vomiting disorders (FNVDs) (10.9%).

2.3. Association of FGID with Independent Variables

When the presence of FGID as a binary variable (yes/no) was tested for association with independent variables, it was shown that identifying as Māori ethnicity and having a parent with FGID were both associated with their child having FGID. When analysis was stratified by the gender of the parent, it was seen that the associations were not significant for females or males and that the association was for parents overall only (Table 2).
Individual FGIDs were also examined against these variables (Supplementary Materials Table S1), showing that functional constipation was associated with being of Māori heritage (χ2 8.4 (Phi 0.23), p = 0.009) and functional dyspepsia with children having allergies (χ2 4.8 (Phi 0.18), p = 0.020), as well as having a parent with FGID (χ2 6.7 (Phi 0.21), p = 0.02). Children having abdominal migraine was associated with those taking prescription medications (χ2 5.2 (Phi 0.18), p = 0.043), and IBS was associated only with a parent having FGID (all of whom self-reported as being IBS) (χ2 9.8 (Phi 0.25), p = 0.011).
When the FGID syndromes were tested for their association with the same independent variables, it was shown that FNVD had no correlation with any demographic or health factors. Children were more likely to experience FAPD if they were older (mean difference (MD) 1.4 years, p = 0.045), taking prescription medications (χ2 4.7 (Phi 0.17), p = 0.046), or had a parent with FGID (χ2 6.3 (Phi 0.2), p = 0.029). FDDs were associated with being of Māori heritage (χ2 8.4 (Phi 0.23), p = 0.009), however, with no children satisfying the criteria for non-retentive faecal incontinence; this result is the same for functional constipation.

2.4. Quality of Life

The ratings given to each EQ-5D-Y category were examined for those reporting limitations with and without an FGID (Figure 2). There was an association found among those with FGID having limitations in the category ‘Feeling worried, sad, or unhappy’ (χ2 10.3 (Phi 0.26), p = 0.002). Given the previous association between particular FGID and having a parent with FGID (Table 2 and Table S1) this variable was used as a control, with the repeat analysis showing that this association remained (χ2 7.7 (Phi 0.57), p = 0.01), suggesting an underlying relationship with their parent also having an FGID.
The associations between the EQ-5D-Y categories and specific FGID disorders were also examined. This analysis showed that children with FAPD were compromised in the domains of ‘Having pain or discomfort’ and ‘Feeling sad, worried, or unhappy’ when compared to children without these disorders (Table 3). When all analyses were controlled for the parent having FGID, the association was strengthened for children with FAPD in the domains ‘Having pain or discomfort’ (χ2 7.7 (0.21), p = 0.21) and ‘Feeling sad, worried, or unhappy’ (χ2 22.2 (0.3), p < 0.001). A relationship between children with FDD and parents having FGID also became evident in the domain of ‘Feeling sad, worried, or unhappy’ (χ2 6.7 (0.1), p = 0.035).

2.5. Overall Health

The overall health VAS section of the EQ-5D-Y showed a mean score of 70.6 (SD 23.1, range 10–100) and median of 80.0 (IQR 50–90), with frequencies indicating the majority scored over 50 out of the maximum of 100, with a score of 100 indicating the ‘The best health you can imagine’ (Figure 3). The VAS health rating was shown to be worse among children with FGID than those without FGID (MD 12.28, p = 0.003). It was also worse for those specifically with FNVD (MD 19.57, p = 0.004) and FAPS (MD 14.7, p = 0.003) but not FDD (MD 2.6, p = 0.65).

3. Discussion

The data presented in this study provide an estimate of FGID prevalence among a cohort of children attending a single tertiary care centre in New Zealand. Few demographic or health variables were shown to be associated with children experiencing FGID in this population, although two specific factors were identified: Māori ethnicity and parental FGID. Children with FGID experienced worse quality of life in specific domains, and overall health was compromised for those with FGID, specifically for children with FNVD and FAPD.
The most common FGID categories experienced in this study cohort were the same as in previous works among larger cohorts: functional constipation, functional dyspepsia, and IBS [8,30,31]. However, the cohort of children in this study reported a slightly higher prevalence of FGID (29%) than among the general population reported in a recent systematic review (22%) [19]. This may be explained by the studies in the review predominantly recruiting from schools and not from a healthcare environment as in this research [19]. FGIDs are associated with a number of chronic conditions, such as atopy [32,33], epilepsy [34], familial Mediterranean fever and Henoch–Schönlein purpura [35,36], as well as being a comorbidity of joint hypermobility [37] and obesity [38]. The Rome IV criteria no longer require exclusion of those with organic disease in recognition of pre-existing conditions also having comorbid FGID [1,17]. However, with 30% of the study cohort having a chronic condition, most frequently atopy and epilepsy, it could be expected that prevalence may be higher in this study cohort. With many children reporting more than one chronic illness, it was not possible to conduct a sensitivity analysis to identify whether these specific chronic conditions were mediating factors for children with FGID.
The independent variable shown to most frequently influence both the presence of FGID, FGID categories, and quality of life in this study was having a parent with an FGID. The relationship between parental FGID and their offspring having an FGID has been shown in a number of studies, specifically for IBS and functional abdominal pain, whereby children exhibit a greater frequency of GI symptoms, miss school more often, and have more frequent healthcare visits than healthy controls [39,40,41]. Inversely, mothers with IBS express concern about how their condition affects their child, worry about whether their child will also experience IBS, and have high levels of concern for their child’s overall health [42]. These coexisting relationships may be linked to social learning, whereby in the presence of a parent somatising FGID children learn how to interpret these symptoms and respond to their own symptom experience, as well as parental reinforcement of illness behaviours [43,44,45]. The frequency of children presenting with FGID symptoms increases following a parent’s experience of illness with associations reported between offspring developing IBS and anxiety [46]. The presence of parental IBS has also been shown to increase the likelihood not only of offspring developing FGID but also of them experiencing mental health disorders via cross-generational transmission [40]. The bidirectional relationship in the gut–brain axis is well known, with GI symptoms being reciprocal with psychosocial outcomes [47,48]. Previous work has shown that parental mental health and anxiety increases the likelihood of FGID in their children [49,50], although the association between parental FGID and influence on offspring quality of life has not been explored.
The association between being of Māori ethnicity and FGID seems moderated by the increased numbers of Māori participants having functional constipation (FC) compared to other ethnic groups. The context of this finding may be related to a number of variables that were not measured as part of this study. The high frequency of FC among children of Māori ethnicity is not unique, as treatment for constipation in children of Māori background has been shown to represent a substantial contribution towards avoidable hospital admissions when compared to non-Māori [51]. However, the reasons for these high rates are infrequently measured but are likely to be multifactorial. Previous reports suggest that the levels of exercise and healthy food intake in Māori children are low [52] while the levels of obesity are high [53]. There is a link between obesity and FGID, specifically FC, with children experiencing both conditions having worse pain and disruption of daily activities [38,54,55]. However, body mass index, activity levels, and food intake were not measured as part of the current study; consequently, any suggested links cannot be substantiated. While the number of Māori participants included in this subgroup analysis was relatively small (23 children (15%)), visual inspection of the difference between those with or without FGID in other ethnic groups (Table 2) provides a descriptive overview of the disparity for Māori participants. Māori people in New Zealand experience known inequalities in health access and engagement [56,57] as a result of cultural, structural, and communication barriers [58]. It is, therefore, of paramount importance that health disparities continue to be identified among this population in order to improve health interventions.

3.1. Strengths

This study provides data on the prevalence of FGID among a cohort of children with/without various chronic conditions. While children with organic diseases known to cause GI symptoms were excluded, this study provides comparative data to previous studies and reviews among the general, healthy population. Specific quality-of-life domains were shown to be compromised in the cohort of children with FGIDs that may be utilised to develop targeted interventions.

3.2. Limitations

The undertaking of this study in a single centre does introduce potential location sampling bias. However, the comprehensive study methodology could be replicated in other centres to establish the generalisability of these results. The use of self-reported FGID among parents as a comparator variable did not enable the formal documentation of parental diagnoses. However, somatic symptoms may manifest equally whether formally diagnosed or otherwise, so they may still exert an influence over their child’s outcomes. The small sample size recruited for this study may overestimate the true effect size of the subgroup analyses. The secondary findings were, therefore, considered to be hypothesis generating, not testing, and additional participants will be recruited in future studies to enable sufficiently powered comparisons.

3.3. Conclusions

This cross-sectional study reports the prevalence of FGIDs in a sample of children attending a tertiary care centre in New Zealand and presents data on variables associated with FGIDs, as well as quality of life. The association between children with FGIDs feeling worried, sad, and unhappy should highlight the importance of providing support to school age children experiencing FGID symptoms and promote the utilisation of tools, such as the Rome IV, to rapidly assess and identify those with FGID. The possible association between ethnicity and FGIDs should be further explored in multicentre studies with large sample sizes to allow sufficient comparisons among such important variables. Future work should also concentrate on additional sociodemographic indices, such as deprivation deciles, which may further refine where health promotion endeavours may be beneficial among children in New Zealand.

4. Materials and Methods

4.1. Ethics and Consent

Ethical approval was granted by the University of Otago Human Ethics Committee (Health), NZ (H21/019), and locality approval by the Canterbury District Health Board, Christchurch, NZ (RO#21038). All child participants provided written assent for their parent to provide their demographic and health information, and all parents provided written consent to take part.

4.2. Population

This cross-sectional study was conducted in one tertiary care centre: Christchurch Hospital, Christchurch, New Zealand. Participant inclusion criteria were children aged four years and over with one parent also willing to participate. Exclusion criteria were children with known/existent GI disease, neurodevelopmental disorders, and haematology/oncology conditions.

4.3. Outcome Measures

4.3.1. Demographic Information

Demographic and basic health information was collected on all paediatric participants: age, sex, ethnicity, postcode, parental education, household income, presence of a chronic health problem, prescribed medications, allergies, and medical history. Parents were asked to provide information on their age and sex, as well as to self-report whether they also considered themselves to have an FGID.

4.3.2. FGID Assessment

The FGID assessment was carried out using the Parent-Report form of the Rome IV Diagnostic Questionnaire for Pediatric Gastrointestinal Disorders for Children and Adolescents (Copyright 2016© by Rome Foundation) with permission granted from the Rome Foundation for study-specific use. All questionnaires can be requested from the Rome foundation (http://theromefoundation.org/, accessed on 9 January 2023). The Rome IV tool asks a series of questions in sections relating to abdominal pain, bowel movements, nausea and vomiting, and other symptoms [1]. The answers given to this assessment can then be utilised to confirm a diagnosis of individual categories of FGID: cyclic vomiting, functional nausea, functional vomiting, rumination syndrome, aerophagia, functional dyspepsia, irritable bowel syndrome, abdominal migraine, abdominal pain not otherwise specified (NOS), functional constipation, and nonretentive faecal incontinence. These categories may then be combined to define those with FGID disorders: functional nausea and vomiting disorders, functional abdominal pain disorders, and functional defecation disorders [1].

4.3.3. Quality of Life

Quality of life was assessed using the EQ-5D-Y™ (proxy version) tool [59], with permission granted from EuroQol for study-specific use. The purpose of the proxy tool is to explore how the parent rates the health of the child, not answering on behalf of the child but rating the child’s health as the proxy perceives it. The tool includes questions on mobility, self-care, ability to carry out usual activities, pain or discomfort, feeling worried, sad, or unhappy. It also asks parents to rate their child’s health that day on a scale of 1–100, with 100 representing the best health they can imagine.

4.4. Statistics

4.4.1. Sample Size

Previous work has studied FGIDs among children in a community setting, and the prevalence has varied from 23 to 28%; however, the research is limited among children in a hospital setting. It was estimated that the prevalence may be slightly higher at approximately 30% in a population of children attending hospital because of FGIDs being a comorbidity of a number of acute and chronic paediatric conditions. A sample size of 150 was proposed to enable adequate precision (±8%, 95% confidence interval) for the incidence of FGIDs among this cohort.

4.4.2. Analysis

Descriptive data are presented for the number and type of FGIDs experienced by the cohort overall. Between-group comparisons were performed using ANOVA for the linear variables or the Chi-squared (χ2) test of independence for the ordinal variables. The results of the ANOVA are presented as a mean difference and ordinal variables as the χ2 value and the Phi effect size, with results closer to 1.0 indicating a stronger effect size. The results in the EQ-5D-Y tool are reduced to binary categories of limitations/no limitations, as per the EuroQol analysis manual [60]. The results are considered significant at the level p < 0.05. The analysis was carried out using SPSS v27.0 (IBM Corp, Armonk, NY, USA) [61]

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/gidisord5020021/s1, Table S1: Association between individual FGID categories and independent variables among children in NZ.

Author Contributions

Conceptualisation, A.V.-R. and A.S.D.; methodology, A.V.-R., I.A. and A.S.D.; formal analysis, A.V.-R. and I.A.; investigation, A.V.-R. and I.A.; resources, A.S.D.; data curation, A.V.-R.; writing—original draft preparation, A.V.-R.; writing—review and editing, A.V.-R., I.A. and A.S.D.; supervision, A.V.-R. and A.S.D.; project administration, A.V.-R. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding. Professor Andrew Day is supported in his research by funding from Cure Kids New Zealand.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the of UNIVERSITY OTAGO Human Ethics Committee (Health), NZ (H21/019), and locality approval by the Canterbury District Health Board, Christchurch, NZ (RO#21038).

Informed Consent Statement

Written, informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data are available upon reasonable request to the corresponding author AVR.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Hyams, J.S.; Di Lorenzo, C.; Saps, M.; Shulman, R.J.; Staiano, A.; van Tilburg, M. Functional Disorders: Children and Adolescents. Gastroenterology 2016, 150, 1456. [Google Scholar] [CrossRef] [PubMed]
  2. Sperber, A.D.; Bangdiwala, S.I.; Drossman, D.A.; Ghoshal, U.C.; Simren, M.; Tack, J.; Whitehead, W.E.; Dumitrascu, D.L.; Fang, X.; Fukudo, S.; et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology 2021, 160, 99–114.e3. [Google Scholar] [CrossRef] [PubMed]
  3. Martins, G.P.; Sandy, N.S.; Alvarenga, L.R.; Lomazi, E.A.; Bellomo-Brandão, M.A. Functional abdominal pain is the main etiology among children referred to tertiary care level for chronic abdominal pain. Arq. Gastroenterol. 2022, 59, 97–101. [Google Scholar] [CrossRef] [PubMed]
  4. Saps, M.; Seshadri, R.; Sztainberg, M.; Schaffer, G.; Marshall, B.M.; Di Lorenzo, C. A Prospective School-based Study of Abdominal Pain and Other Common Somatic Complaints in Children. J. Pediatr. 2009, 154, 322–326. [Google Scholar] [CrossRef] [PubMed]
  5. Saps, A.M.; Velasco-Benitez, J.J.C.; Blom, A.P.; Benninga, X.M.; Nichols-Vinueza, X.D. Prospective Study of Gastrointestinal Symptoms in School Children of South America. J. Pediatr. Gastroenterol. Nutr. 2018, 66, 391–394. [Google Scholar] [CrossRef]
  6. Jansen, J.; Shulman, R.; Ward, T.M.; Levy, R.; Self, M.M. Sleep disturbances in children with functional gastrointestinal disorders: Demographic and clinical characteristics. J. Clin. Sleep Med. 2021, 17, 1193–1200. [Google Scholar] [CrossRef]
  7. Lewis, M.L.; Palsson, O.S.; Whitehead, W.E.; van Tilburg, M.A.L. Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents. J. Pediatr. 2016, 177, 39–43.e3. [Google Scholar] [CrossRef]
  8. Robin, S.G.; Keller, C.; Zwiener, R.; Hyman, P.E.; Nurko, S.; Saps, M.; Di Lorenzo, C.; Shulman, R.J.; Hyams, J.S.; Palsson, O.; et al. Prevalence of Pediatric Functional Gastrointestinal Disorders Utilizing the Rome IV Criteria.(Report). J. Pediatr. 2018, 195, 134. [Google Scholar] [CrossRef]
  9. Varni, J.W.; Bendo, C.B.; Denham, J.; Shulman, R.J.; Self, M.M.; Neigut, D.A.; Nurko, S.; Patel, A.S.; Franciosi, J.P.; Saps, M.; et al. PedsQL™ Gastrointestinal Symptoms Scales and Gastrointestinal Worry Scales in pediatric patients with functional and organic gastrointestinal diseases in comparison to healthy controls. Qual. Life Res. 2015, 24, 363–378. [Google Scholar] [CrossRef]
  10. Varni, J.W.; Bendo, C.; Nurko, S.; Shulman, R.J.; Self, M.M.; Franciosi, J.P.; Saps, M.; Pohl, J.F. Health-Related Quality of Life in Pediatric Patients with Functional and Organic Gastrointestinal Diseases. J. Pediatr. 2015, 166, 85–90.e2. [Google Scholar] [CrossRef]
  11. Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A. Quality of life and health care consultation in 13 to 18 year olds with abdominal pain predominant functional gastrointestinal diseases. BMC Gastroenterol. 2014, 14, 150. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  12. Warschburger, P.; Hänig, J.; Friedt, M.; Posovszky, C.; Schier, M.; Calvano, C. Health-Related Quality of Life in Children With Abdominal Pain Due to Functional or Organic Gastrointestinal Disorders. J. Pediatr. Psychol. 2014, 39, 45–54. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  13. Park, R.; Mikami, S.; LeClair, J.; Bollom, A.; Lembo, C.; Sethi, S.; Lembo, A.; Jones, M.; Cheng, V.; Friedlander, E.; et al. Inpatient burden of childhood functional GI disorders in the USA: An analysis of national trends in the USA from 1997 to 2009. Neurogastroent. Motil. 2015, 27, 684–692. [Google Scholar] [CrossRef] [PubMed]
  14. Livitz, M.; Friesen, A.S.; Glynn, E.F.; Schurman, J.V.; Colombo, J.M.; Friesen, C.A. Healthcare System-to-System Cost Variability in the Care of Pediatric Abdominal Pain-Associated Functional Gastrointestinal Disorders. Children 2021, 8, 985. [Google Scholar] [CrossRef]
  15. Jarrett, M.; Heitkemper, M.; Czyzewski, D.I.; Shulman, R. Recurrent Abdominal Pain in Children: Forerunner to Adult Irritable Bowel Syndrome? J. Spec. Pediatr. Nurs. 2003, 8, 81–89. [Google Scholar] [CrossRef]
  16. Benninga, M.A.; Faure, C.; Hyman, P.E.; St James Roberts, I.; Schechter, N.L.; Nurko, S. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology 2016, 150, 1443–1455.e2. [Google Scholar] [CrossRef]
  17. Koppen, I.J.N.; Nurko, S.; Saps, M.; Di Lorenzo, C.; Benninga, M.A. The pediatric Rome IV criteria: What’s new? Expert. Rev. Gastroent. 2017, 11, 193–201. [Google Scholar] [CrossRef] [Green Version]
  18. Caplan, A.; Walker, L.; Rasquin, A. Development and preliminary validation of the questionnaire on pediatric gastrointestinal symptoms to assess functional gastrointestinal disorders in children and adolescents. J. Pediatr. Gastroenterol. Nutr. 2005, 41, 296. [Google Scholar] [CrossRef]
  19. Vernon-Roberts, A.; Alexander, I.; Day, A.S. Systematic Review of Pediatric Functional Gastrointestinal Disorders (Rome IV Criteria). J. Clin. Med. 2021, 10, 5087. [Google Scholar] [CrossRef]
  20. Korterink, J.J.; Ockeloen, L.E.; Hilbink, M.; Benninga, M.A.; Deckers-Kocken, J.M. Yoga Therapy for Abdominal Pain-Related Functional Gastrointestinal Disorders in Children: A Randomized Controlled Trial. J. Pediatr. Gastroenterol. Nutr. 2016, 63, 481–487. [Google Scholar] [CrossRef] [Green Version]
  21. Thomassen, R.; Luque, V.; Assa, A.; Borrelli, O.; Broekaert, I.; Dolinsek, J.; Martin-De-Carpi, J.; Mas, E.; Miele, E.; Norsa, L.; et al. An ESPGHAN Position Paper on the Use of Low-FODMAP Diet in Pediatric Gastroenterology. J. Pediatr. Gastroenterol. Nutr. 2022, 75, 356–368. [Google Scholar] [CrossRef] [PubMed]
  22. Salvatore, S.; Barberi, S.; Borrelli, O.; Castellazzi, A.; Di Mauro, D.; Di Mauro, G.; Doria, M.; Francavilla, R.; Landi, M.; Miniello, V.L.; et al. Pharmacological interventions on early functional gastrointestinal disorders. Ital. J. Pediatr. 2016, 42, 68. [Google Scholar] [CrossRef] [Green Version]
  23. Saps, M.; Youssef, N.; Miranda, A.; Nurko, S.; Hyman, P.; Cocjin, J.; Di Lorenzo, C. Multicenter, Randomized, Placebo-Controlled Trial of Amitriptyline in Children With Functional Gastrointestinal Disorders. Gastroenterology 2009, 137, 1261–1269. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  24. Benninga, M.A.; Mayer, E.A. The Power of Placebo in Pediatric Functional Gastrointestinal Disease. Gastroenterology 2009, 137, 1207–1210. [Google Scholar] [CrossRef] [PubMed]
  25. Boradyn, K.M.; Przybyłowicz, K.E.; Jarocka-Cyrta, E. Low FODMAP Diet Is Not Effective in Children with Functional Abdominal Pain: A Randomized Controlled Trial. Ann. Nutr. Metab. 2020, 76, 334–344. [Google Scholar] [CrossRef] [PubMed]
  26. van Tilburg, M.A.; Carter, C.A. Integration of Biomedical and Psychosocial Treatments in Pediatrics Functional Gastrointestinal Disorders. Gastroenterol. Clin. N. Am. 2018, 47, 863–875. [Google Scholar] [CrossRef] [PubMed]
  27. Hoekman, D.R.; Zeevenhooven, J.; van Etten-Jamaludin, F.S.; Dekker, I.D.; Benninga, M.A.; Tabbers, M.M.; Vlieger, A.M. The Placebo Response in Pediatric Abdominal Pain-Related Functional Gastrointestinal Disorders: A Systematic Review and Meta-Analysis. J. Pediatr. 2017, 182, 155–163.e7. [Google Scholar] [CrossRef] [PubMed]
  28. Beinvogl, B.; Burch, E.; Snyder, J.; Schechter, N.; Hale, A.; Okazaki, Y.; Paul, F.; Warman, K.; Nurko, S. Multidisciplinary Treatment Reduces Pain and Increases Function in Children With Functional Gastrointestinal Disorders. Clin. Gastroenterol. Hepatol. 2019, 17, 994–996. [Google Scholar] [CrossRef]
  29. Wyeth, J.W. Functional gastrointestinal disorders in New Zealand. J. Gastroenterol. Hepatol. 2011, 26, 15. [Google Scholar] [CrossRef]
  30. Saps, M.; Velasco-Benitez, C.A.; Langshaw, A.H.; Ramírez-Hernández, C.R. Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents: Comparison Between Rome III and Rome IV Criteria. J. Pediatr. 2018, 199, 212–216. [Google Scholar] [CrossRef]
  31. Velasco-Benitez, C.A.; Axelrod, C.H.; Gutierrez, S.; Saps, M. The Relationship Between Prematurity, Method of Delivery, and Functional Gastrointestinal Disorders in Children. J. Pediatr. Gastroenterol. Nutr. 2020, 70, e37–e40. [Google Scholar] [CrossRef] [PubMed]
  32. Jones, M.P.; Walker, M.M.; Ford, A.C.; Talley, N.J. The overlap of atopy and functional gastrointestinal disorders among 23 471 patients in primary care. Aliment. Pharmacol. Ther. 2014, 40, 382–391. [Google Scholar] [CrossRef]
  33. Sjölund, J.; Kull, I.; Bergström, A.; Järås, J.; Ludvigsson, J.F.; Törnblom, H.; Simrén, M.; Olén, O. Allergy-related diseases in childhood and risk for abdominal pain-related functional gastrointestinal disorders at 16 years—A birth cohort study. BMC Med. 2021, 19, 214. [Google Scholar] [CrossRef] [PubMed]
  34. Aydemir, Y.; Carman, K.B.; Yarar, C. Screening for functional gastrointestinal disorders in children with epilepsy. Epilepsy Behav. 2020, 111, 107267. [Google Scholar] [CrossRef] [PubMed]
  35. Kisla Ekinci, R.M.; Balcı, S.; Mart, O.O.; Tumgor, G.; Yavuz, S.; Celik, H.; Dogruel, D.; Altintas, D.U.; Yilmaz, M. Is Henoch–Schönlein purpura a susceptibility factor for functional gastrointestinal disorders in children? Rheumatol. Int. 2019, 39, 317–322. [Google Scholar] [CrossRef]
  36. Ekinci, R.M.K.; Balcı, S.; Akay, E.; Tumgor, G.; Dogruel, D.; Altintas, D.U.; Yilmaz, M. Frequency of functional gastrointestinal disorders in children with familial Mediterranean fever. Clin. Rheumatol. 2019, 38, 921–926. [Google Scholar] [CrossRef]
  37. Kovacic, K.; Chelimsky, T.C.; Sood, M.R.; Simpson, P.; Nugent, M.; Chelimsky, G. Joint Hypermobility: A Common Association with Complex Functional Gastrointestinal Disorders. J. Pediatr. 2014, 165, 973–978. [Google Scholar] [CrossRef]
  38. Phatak, U.; Pashankar, D. Prevalence of functional gastrointestinal disorders in obese and overweight children. Int. J. Obes. 2014, 38, 1324–1327. [Google Scholar] [CrossRef]
  39. Bode, G.; Brenner, H.; Adler, G.; Rothenbacher, D. Recurrent abdominal pain in children: Evidence from a population-based study that social and familial factors play a major role but not Helicobacter pylori infection. J. Psychosom. Res. 2003, 54, 417–421. [Google Scholar] [CrossRef] [Green Version]
  40. Yeh, T.C.; Bai, Y.M.; Tsai, S.J.; Chen, T.J.; Liang, C.S.; Chen, M.H. Risks of Major Mental Disorders and Irritable Bowel Syndrome among the Offspring of Parents with Irritable Bowel Syndrome: A Nationwide Study. Int. J. Environ. Res. Public Health 2021, 18, 4679. [Google Scholar] [CrossRef]
  41. Levy, R.L.; Whitehead, W.E.; Walker, L.S.; Von Korff, M.; Feld, A.D.; Garner, M.; Christie, D. Increased Somatic Complaints and Health-Care Utilization in Children: Effects of Parent IBS Status and Parent Response to Gastrointestinal Symptoms. Am. J. Gastroenterol. 2004, 99, 2442–2451. [Google Scholar] [CrossRef] [PubMed]
  42. Murphy, L.K.; van Diggelen, T.R.; Levy, R.L.; Palermo, T.M. Understanding the Psychosocial and Parenting Needs of Mothers with Irritable Bowel Syndrome with Young Children. Children 2020, 7, 93. [Google Scholar] [CrossRef]
  43. Newton, E.; Schosheim, A.; Patel, S.; Chitkara, D.K.; van Tilburg, M.A.L. The role of psychological factors in pediatric functional abdominal pain disorders. Neurogastroent. Motil. 2019, 31, e13538. [Google Scholar] [CrossRef] [PubMed]
  44. van Tilburg, M.A.L.; Chitkara, D.K.; Palsson, O.S.; Levy, R.L.; Whitehead, W.E. Parental Worries and Beliefs About Abdominal Pain. J. Pediatr. Gastroenterol. Nutr. 2009, 48, 311–317. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  45. Van Oudenhove, L.; Levy, R.L.; Crowell, M.D.; Drossman, D.A.; Halpert, A.D.; Keefer, L.; Lackner, J.M.; Murphy, T.B.; Naliboff, B.D. Biopsychosocial Aspects of Functional Gastrointestinal Disorders: How Central and Environmental Processes Contribute to the Development and Expression of Functional Gastrointestinal Disorders. Gastroenterology 2016, 150, 1355–1367.e2. [Google Scholar] [CrossRef]
  46. Short, P.; Burklow, C.S.; Nylund, C.M.; Susi, A.; Hisle-Gorman, E. Impact of Parental Illness and Injury on Pediatric Disorders of Gut–Brain Interaction. J. Pediatr. 2021, 236, 148–156.e3. [Google Scholar] [CrossRef]
  47. Black, C.J.; Drossman, D.A.; Talley, N.J.; Ruddy, J.; Ford, A.C. Functional gastrointestinal disorders: Advances in understanding and management. Lancet 2020, 396, 1664–1674. [Google Scholar] [CrossRef]
  48. Koloski, N.A.; Jones, M.; Kalantar, J.; Weltman, M.; Zaguirre, J.; Talley, N.J. The brain–gut pathway in functional gastrointestinal disorders is bidirectional: A 12-year prospective population-based study. Gut 2012, 61, 1284. [Google Scholar] [CrossRef]
  49. Ramchandani, P.G.; Stein, A.; Hotopf, M.; Wiles, N.J. Early Parental and Child Predictors of Recurrent Abdominal Pain at School Age: Results of a Large Population-Based Study. J. Am. Acad. Child Adolesc. Psychiatry 2006, 45, 729–736. [Google Scholar] [CrossRef]
  50. Heuckendorff, S.; Johansen, M.N.; Overgaard, C.; Johnsen, S.P.; Thomsen, J.L.; Fonager, K. Six-year-old children had greater risks of functional gastrointestinal disorders if their parents had mental health conditions. Acta Paediatr. 2022, 111, 2029–2037. [Google Scholar] [CrossRef]
  51. Oben, G.; Crengle, S.; Kokaua, J.; Duncanson, M. Deprivation trends in potentially avoidable medical hospitalisations of under-25-year-old Māori and non-Māori non-Pacific in Aotearoa New Zealand: A 20-year perspective. J. R. Soc. N. Z. 2022, 1–15. [Google Scholar] [CrossRef]
  52. Stoner, L.; Matheson, A.; Hamlin, M.; Skidmore, P. Environmental determinants of childhood obesity: A specific focus on Māori and Pasifika in New Zealand. Perspect. Public Health 2016, 136, 18–20. [Google Scholar] [CrossRef] [Green Version]
  53. Littlewood, R.; Canfell, O.J.; Walker, J.L. Interventions to prevent or treat childhood obesity in Māori & Pacific Islanders: A systematic review. BMC Public Health 2020, 20, 725. [Google Scholar]
  54. Tambucci, R.; Quitadamo, P.; Ambrosi, M.; De Angelis, P.; Angelino, G.; Stagi, S.; Verrotti, A.; Staiano, A.; Farello, G. Association Between Obesity/Overweight and Functional Gastrointestinal Disorders in Children. J. Pediatr. Gastroenterol. Nutr. 2019, 68, 517–520. [Google Scholar] [CrossRef]
  55. Bonilla, S.; Wang, D.; Saps, M. Obesity predicts persistence of pain in children with functional gastrointestinal disorders. Int. J. Obes. 2011, 35, 517–521. [Google Scholar] [CrossRef] [Green Version]
  56. Wilson, D.; Moloney, E.; Parr, J.M.; Aspinall, C.; Slark, J. Creating an Indigenous Māori-centred model of relational health: A literature review of Māori models of health. J. Clin. Nurs. 2021, 30, 3539–3555. [Google Scholar] [CrossRef]
  57. Marriott, L.; Alinaghi, N. Closing the gaps: An update on indicators of inequality for Maori and pacific people. J. N. Z. Stud. 2021, 32, 2–39. [Google Scholar] [CrossRef]
  58. Jansen, P. Non-financial barriers to primary health care services for Maori. J. Prim. Health Care 2009, 1, 240. [Google Scholar] [CrossRef]
  59. Ravens-Sieberer, U.; Wille, N.; Badia, X.; Bonsel, G.; Burström, K.; Cavrini, G.; Devlin, N.; Egmar, A.-C.; Gusi, N.; Herdman, M.; et al. Feasibility, reliability, and validity of the EQ-5D-Y: Results from a multinational study. Qual. Life Res. 2010, 19, 887–897. [Google Scholar] [CrossRef] [Green Version]
  60. EuroQol Research Foundation. EQ-5D-Y User Guide 2020. Available online: https://euroqol.org/publications/user-guides (accessed on 20 February 2023).
  61. IBM Corp. IBM SPSS Statistics for Windows, 27th ed.; IBM Corp: Armonk, NY, USA, 2020. [Google Scholar]
Gastrointestdisord 05 00021 g001 550
Figure 1. Percentage of children with each FGID category (total: 156 children). The number of children that reported experiencing each FGID is presented at the end of each bar.
Figure 1. Percentage of children with each FGID category (total: 156 children). The number of children that reported experiencing each FGID is presented at the end of each bar.
Gastrointestdisord 05 00021 g001
Gastrointestdisord 05 00021 g002 550
Figure 2. Percentage of the group reporting limitations in the EQ-5D-Y categories grouped by the presence of no FGID/any FGID. p-Values for between-group differences (FGID/no FGID) presented at the top of each group-set.
Figure 2. Percentage of the group reporting limitations in the EQ-5D-Y categories grouped by the presence of no FGID/any FGID. p-Values for between-group differences (FGID/no FGID) presented at the top of each group-set.
Gastrointestdisord 05 00021 g002
Gastrointestdisord 05 00021 g003 550
Figure 3. Frequency of the scores given to the EQ-5D-Y VAS scale for the overall health of the children, as reported by their parent.
Figure 3. Frequency of the scores given to the EQ-5D-Y VAS scale for the overall health of the children, as reported by their parent.
Gastrointestdisord 05 00021 g003
Table
Table 1. Participant demographics and health information as reported by parents.
Table 1. Participant demographics and health information as reported by parents.
VariableCategoryValue, N (%)
Child’s age, mean (SD) 9.5 y (SD 3.3)
Child’s sexMale87 (56)
Female69 (44)
Ethnicity *
(N = 134 (86%))		NZ European123 (79)
Māori23 (15)
Pacific Islands16 (10)
Asian9 (6)
MELAA5 (3)
Other2 (1)
Household income
(N = 128 (82%))		Up to $50,00015 (9)
$50–100,00040 (25)
$100–150,00037 (24)
$150–200,00021 (13)
$200,000+15 (9)
Parent educationHigh school43 (28)
College38 (24)
University50 (32)
Post-graduate25 (16)
Urban/rural living
(N = 153 (98%))		Rural53 (35)
Urban100 (65)
Chronic health conditionYes47 (30)
Taking prescription drugsYes41 (26)
AllergiesYes47 (30)
Parent has FGID (all IBS)Yes24 (15)
Data presented for the whole cohort of 156, unless stated otherwise. * Participants could identify as more than one ethnicity, results equal > 100%. MELAA = Middle Eastern/Latin American/African; y = years; N = number; SD = standard deviation; FGID = functional gastrointestinal disorder; IBS = irritable bowel syndrome, $ = New Zealand Dollars
Table
Table 2. Association between presence of any FGID and independent variables in children from New Zealand.
Table 2. Association between presence of any FGID and independent variables in children from New Zealand.
VariableCategoryNo FGIDFGIDMean
Difference		p-Value
Age 9.4 y (SD 3.2)10.0 y (SD 3.5)0.60.313
VariableCategoryNo FGID FGIDχ2 (Phi)p-value
SexMale65 (75)22 (25)1.21 (0.09)0.290
Female46 (67)23 (33)
EthnicityNZ European91 (74)32 (26)2.3 (0.12)0.137
Māori11 (48)12 (52)7.2 (0.21)0.012
Pacific Islands14 (88)2 (12)2.3 (0.12)0.155
Asian8 (67)4 (33)0.1 (0.030.745
MELAA3 (60)2 (40)0.3 (0.05)0.627
Other1 (50)1 (50)0.4 (0.05)0.495
Household incomeUp to NZD 50,0009 (60)6 (40)3.0 (0.15)0.565
NZD 50–100,00025 (62)15 (38)
NZD 100–150,00029 (78)8 (22)
NZD 150–200,00015 (71)6 (29)
NZD 200,000+10 (67)5 (33)
Parent educationHigh school30 (70)13 (30)1.2 (0.09)0.762
College26 (68)12 (32)
University35 (70)15 (30)
Post-graduate20 (80)5 (20)
Urban/rural livingRural69 (69)31 (31)0.7 (0.07)0.456
Urban40 (75)13 (25)
Chronic health conditionNo81 (74)28 (26)1.8 (0.11)0.247
Yes30 (64)17 (36)
On medicationsNo 85 (75)29 (25)2.7 (0.13)0.112
Yes25 (61)16 (39)
AllergiesNo77 (71)32 (29)0.05 (0.02)0.99
Yes34 (72)13 (28)
Parent (overall) has FGID No101 (77)31 (23)12.0 (0.28)<0.001
Yes10 (42)14 (58)
Mother has FGIDNo4 (80)1 (20)2.3 (0.33)0.311
Yes7 (41)10 (59)
Father has FGIDNo1 (25)3 (75)0.69 (0.24)0.576
Yes4 (50)4 (50)
MELAA = Middle Eastern/Latin American/African; y = years; SD = standard deviation; FGID = functional gastrointestinal disorder.
Table
Table 3. Association between the presence of FGIDs and EQ-5D-Y categories in children.
Table 3. Association between the presence of FGIDs and EQ-5D-Y categories in children.
EQ-5D-Y CategoryFunctional
Nausea and
Vomiting Disorder		Functional
Abdominal
Pain Disorder		Functional
Defecation
Disorder
χ2 (Phi)p-Valueχ2 (Phi)p-Valueχ2 (Phi)p-Value
Mobility4.4 (0.17)0.061.1 (0.09) 0.370.4 (0.05)0.62
Looking after myself2.0 (0.1)0.220.01 (0.01)1.00.6 (0.06)0.46
Doing usual activities3.8 (0.16)0.072.9 (0.14)0.120.4 (0.05)0.63
Having pain or discomfort0.7 (0.07)0.545.1 (0.18)0.020.01 (0.01)1.0
Feeling Worried, Sad, or Unhappy1.7 (0.1)0.2414.8 (0.31)<0.0013.4 (0.15)0.09
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Vernon-Roberts, A.; Alexander, I.; Day, A.S. Prevalence of Functional Gastrointestinal Disorders (Rome IV Criteria) among a Cohort of New Zealand Children. Gastrointest. Disord. 2023, 5, 261-272. https://doi.org/10.3390/gidisord5020021

AMA Style

Vernon-Roberts A, Alexander I, Day AS. Prevalence of Functional Gastrointestinal Disorders (Rome IV Criteria) among a Cohort of New Zealand Children. Gastrointestinal Disorders. 2023; 5(2):261-272. https://doi.org/10.3390/gidisord5020021

Chicago/Turabian Style

Vernon-Roberts, Angharad, India Alexander, and Andrew S. Day. 2023. "Prevalence of Functional Gastrointestinal Disorders (Rome IV Criteria) among a Cohort of New Zealand Children" Gastrointestinal Disorders 5, no. 2: 261-272. https://doi.org/10.3390/gidisord5020021

Article Metrics

Back to TopTop