Pediatric Functional Gastrointestinal Disorders: Challenges in Diagnosis and Treatment

A special issue of Gastrointestinal Disorders (ISSN 2624-5647).

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 16311

Special Issue Editors


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Guest Editor
Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
Interests: paediatric; inflammatory bowel disease; functional gastrointestinal disorders; coeliac disease; outcome meausures; non-clinical outcomes
Special Issues, Collections and Topics in MDPI journals
Royal Children’s Hospital & Murdoch Children’s Research Institute Melbourne, Parkville, Australia
Interests: disorders of gut–brain interaction; gastrointestinal motility; eosinophilic GI disorders; endoscopy

Special Issue Information

Dear Colleagues,

Functional gastrointestinal disorders (FGID) are relatively common conditions frequently experienced during childhood and more recently are known as disorders of gut–brain interaction (DGBI). They are characterized by recurrent gastrointestinal symptoms that have no biochemical or structural cause. These symptoms are thought to be related to any combination of motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, and altered central nervous system (CNS) processing.

FGID may present a significant symptom burden to children who experience them and are associated with reduced quality of life, missed education, and high health care expenditure. Pharmacological treatment options have shown limited efficacy, but research into dietary modification, psychological input, and complementary or alternative medicines have shown promise. This Special Issue aims to focus on the key aspects of pediatric FGID diagnosis, management, and outcomes associated with the condition. Original studies and reviews will be considered.

Dr. Angharad Vernon-Roberts
Prof. Dr. Andrew Day
Dr. Mark Safe
Guest Editors

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Keywords

  • Rome criteria
  • diet and nutrition
  • FODMAP
  • toddlers
  • children
  • adolescents
  • functional gut
  • quality of life
  • abdominal pain
  • irritable bowel syndrome

Published Papers (7 papers)

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Editorial

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5 pages, 223 KiB  
Editorial
Editorial: Pediatric Functional Gastrointestinal Disorders: Challenges in Diagnosis and Treatment
by Angharad Vernon-Roberts, Mark Safe and Andrew S. Day
Gastrointest. Disord. 2024, 6(1), 308-312; https://doi.org/10.3390/gidisord6010021 - 08 Mar 2024
Viewed by 889
Abstract
Functional gastrointestinal disorders (FGIDs) are classified as those with no organic cause and those not attributable to structural or biochemical abnormalities [...] Full article

Research

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12 pages, 590 KiB  
Article
Gastrointestinal Group Education for Children and Adolescents with Functional Abdominal Pain Disorders—A Feasibility Study of a Brief Intervention
by Emilia Löfgren, Perjohan Lindfors, Karin Nilsson, Jenny Wannstedt, Marianne Bonnert and Agneta Uusijärvi
Gastrointest. Disord. 2024, 6(1), 1-12; https://doi.org/10.3390/gidisord6010001 - 20 Dec 2023
Viewed by 1355
Abstract
Functional abdominal pain disorders are common and disabling in children, but treatment options are limited. In a pilot study, we aimed to investigate if a brief group education program for pediatric patients with functional abdominal pain disorders and their parents is feasible and [...] Read more.
Functional abdominal pain disorders are common and disabling in children, but treatment options are limited. In a pilot study, we aimed to investigate if a brief group education program for pediatric patients with functional abdominal pain disorders and their parents is feasible and acceptable. Group education in adult irritable bowel syndrome has shown large treatment effects, but it has not been evaluated in children. The gastrointestinal (GI) group education, delivered in the clinic to 23 child–parent dyads, consisted of lectures by a pediatric gastroenterologist, a psychologist, and a dietician. Validated digital questionnaires were filled in by children and parents before and after the intervention. Most participants in the GI group education attended all sessions, and credibility in treatment was deemed high. Children’s self-reported knowledge of functional abdominal pain disorders increased, and improvements in gastrointestinal symptoms were reported at the end of this study. Our findings indicate that group education for children and adolescents with functional abdominal pain disorders, and their parents, is acceptable and feasible and may improve symptoms. A brief group education program may be of benefit in the management of pediatric functional abdominal pain disorders in several cases and when the family needs more knowledge than can be provided in primary care. Full article
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7 pages, 257 KiB  
Article
Nocturnal Pain Is Not an Alarm Symptom for Upper Gastrointestinal Inflammation but May Be an Indicator of Sleep Disturbance or Psychological Dysfunction
by Jacob Cindrich, Chance Friesen, Jennifer Schurman, Jennifer Colombo and Craig A. Friesen
Gastrointest. Disord. 2023, 5(3), 310-316; https://doi.org/10.3390/gidisord5030025 - 31 Jul 2023
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Abstract
Alarm symptoms are widely used in pediatric gastroenterology to discern when abdominal pain needs further workup. Despite wide use, the data supporting the validity of these symptoms are not well established. This study explored one alarm symptom—nighttime waking with pain—and its associations with [...] Read more.
Alarm symptoms are widely used in pediatric gastroenterology to discern when abdominal pain needs further workup. Despite wide use, the data supporting the validity of these symptoms are not well established. This study explored one alarm symptom—nighttime waking with pain—and its associations with histologic inflammation of the upper gastrointestinal tract, psychological dysfunction, and disordered sleep. This retrospective study evaluated 240 patients with abdominal pain-related disorders of the gut–brain axis (AP-DGBI). Patients underwent questionnaires related to sleep disturbance, behavioral assessment, and gastrointestinal symptoms, including Rome IV criteria for AP-DGBI. Routine upper endoscopy with standardized biopsies was performed in 205 patients. Endoscopy results showed no association between esophageal, gastric, or duodenal histologic inflammation and nighttime waking with pain. Nocturnal pain was associated with increased scores for both psychological and sleep disorders, including social stress, depression, disorders of initiation and maintenance of sleep (DIMS), disorders of daytime somnolence (DOES), and sleep hyperhidrosis (SHY). This study concluded that nocturnal pain is not a reliable predictor of upper gastrointestinal inflammation but may be a prognosticator for psychological distress and sleep disturbances. Full article
12 pages, 1127 KiB  
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
Gastrointest. Disord. 2023, 5(2), 261-272; https://doi.org/10.3390/gidisord5020021 - 09 Jun 2023
Viewed by 2130
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 [...] Read more.
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. Full article
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Review

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8 pages, 229 KiB  
Review
An Overview of the Management of Functional Gastrointestinal Disorders in Infancy
by Laura Rishanghan and Rupert Hinds
Gastrointest. Disord. 2023, 5(4), 500-507; https://doi.org/10.3390/gidisord5040041 - 15 Nov 2023
Viewed by 1362
Abstract
This review article will address the frequently encountered functional gastrointestinal disorders (FGIDs) occurring in infancy. The clinical features and management of infant regurgitation, infant colic, infant dyschezia, and functional constipation are discussed with reference to the most recent literature and evidence. Management should [...] Read more.
This review article will address the frequently encountered functional gastrointestinal disorders (FGIDs) occurring in infancy. The clinical features and management of infant regurgitation, infant colic, infant dyschezia, and functional constipation are discussed with reference to the most recent literature and evidence. Management should be focused on ruling out organic causes with careful history and examination, and then reassurance for the caregiver in this often very stressful period of parenting. There is often no or minimal pharmacological treatment necessary for FGIDs and treatment should be individualised for each patient and family. Full article
24 pages, 1919 KiB  
Review
On the Inheritance of Microbiome-Deficiency: Paediatric Functional Gastrointestinal Disorders, the Immune System and the Gut–Brain Axis
by David Smith, Sohan Jheeta, Georgina I. López-Cortés, Bernadette Street, Hannya V. Fuentes and Miryam Palacios-Pérez
Gastrointest. Disord. 2023, 5(2), 209-232; https://doi.org/10.3390/gidisord5020018 - 15 May 2023
Cited by 1 | Viewed by 1974
Abstract
Like the majority of non-communicable diseases that have recently gained attention, functional gastrointestinal (GI) disorders (FGID) in both children and adults are caused by a variety of medical conditions. In general, while it is often thought that common conditions such as obesity may [...] Read more.
Like the majority of non-communicable diseases that have recently gained attention, functional gastrointestinal (GI) disorders (FGID) in both children and adults are caused by a variety of medical conditions. In general, while it is often thought that common conditions such as obesity may cause other problems, for example, asthma or mental health issues, more consideration needs to be given to the possibility that they could both be brought on by a single underlying problem. Based on the variations in non-communicable disease, in recent years, our group has been revisiting the exact role of the intestinal microbiome within the Vertebrata. While the metabolic products of the microbiome have a role to play in the adult, our tentative conclusion is that the fully functioning, mutualistic microbiome has a primary role: to transfer antigen information from the mother to the neonate in order to calibrate its immune system, allowing it to survive within the microbial environment into which it will emerge. Granted that the microbiome possesses such a function, logic suggests the need for a robust, flexible, mechanism allowing for the partition of nutrition in the mature animal, thus ensuring the continued existence of both the vertebrate host and microbial guest, even under potentially unfavourable conditions. It is feasible that this partition process acts by altering the rate of peristalsis following communication through the gut–brain axis. The final step of this animal–microbiota symbiosis would then be when key microbes are transferred from the female to her progeny, either live offspring or eggs. According to this scheme, each animal inherits twice, once from its parents’ genetic material and once from the mother’s microbiome with the aid of the father’s seminal microbiome, which helps determine the expression of the parental genes. The key point is that the failure of this latter inheritance in humans leads to the distinctive manifestations of functional FGID disorders including inflammation and gut motility disturbances. Furthermore, it seems likely that the critical microbiome–gut association occurs in the first few hours of independent life, in a process that we term handshaking. Note that even if obvious disease in childhood is avoided, the underlying disorders may intrude later in youth or adulthood with immune system disruption coexisting with gut–brain axis issues such as excessive weight gain and poor mental health. In principle, investigating and perhaps supplementing the maternal microbiota provide clinicians with an unprecedented opportunity to intervene in long-term disease processes, even before the child is born. Full article
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12 pages, 281 KiB  
Review
Evaluation and Management of Pediatric Feeding Disorder
by Rajmohan Dharmaraj, Rasha Elmaoued, Razan Alkhouri, Pankaj Vohra and Ricardo O. Castillo
Gastrointest. Disord. 2023, 5(1), 75-86; https://doi.org/10.3390/gidisord5010008 - 16 Feb 2023
Cited by 4 | Viewed by 6350
Abstract
Feeding disorders are increasingly common in children, especially as medical advancements improve the life expectancy of children born with prematurity and complex medical conditions. The most common symptoms include malnutrition, refusal to eat and drink, food pocketing, disruptive feeding behavior, slow feeding, food [...] Read more.
Feeding disorders are increasingly common in children, especially as medical advancements improve the life expectancy of children born with prematurity and complex medical conditions. The most common symptoms include malnutrition, refusal to eat and drink, food pocketing, disruptive feeding behavior, slow feeding, food selectivity or rigid food preferences, limited appetite, and delayed feeding milestones. A unifying diagnostic definition of pediatric feeding disorder has been proposed by a panel of experts to improve the quality of health care and advance research. Referral to specialized care should be considered when feeding problems are complex or difficult to resolve. In this review, we provide an overview of the evaluation and management of pediatric feeding disorders and information that may be useful when considering whether referral to specialized care may be beneficial. Full article
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