The Rome II pediatric criteria for functional gastrointestinal disorders (FGIDs) were defined in 1999 to be used as diagnostic tools and to advance empirical research. In this document, the Rome III Committee aimed to update and revise the pediatric criteria. The decision-making process to define Rome III criteria for children aged 4-18 years consisted of arriving at a consensus based on clinical experience and review of the literature. Whenever possible, changes in the criteria were evidence based. Otherwise, clinical experience was used when deemed necessary. Few publications addressing Rome II criteria were available to guide the committee. The clinical entities addressed include (1) cyclic vomiting syndrome, rumination, and aerophagia; 2) abdominal pain-related FGIDs including functional dyspepsia, irritable bowel syndrome, abdominal migraine, and functional abdominal pain; and (3) functional constipation and non-retentive fecal incontinence. Adolescent rumination and functional constipation are newly defined for this age group, and the previously designated functional fecal retention is now included in functional constipation. Other notable changes from Rome II to Rome III criteria include the decrease from 3 to 2 months in required symptom duration for noncyclic disorders and the modification of the criteria for functional abdominal pain. The Rome III child and adolescent criteria represent an evolution from Rome II and should prove useful for both clinicians and researchers dealing with childhood FGIDs. The future availability of additional evidence-based data will likely continue to modify pediatric criteria for FGIDs.

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This study suggests that increased gastric mucosal production of the proinflammatory cytokines IL-1beta and IL-8 is probably involved in H. pylori-associated gastric damage in children and may be crucial in determining the different clinical outcomes.

SummaryTo evaluate the impact of malnutrition on the developing gut, we studied small bowel structure, epithelial renewal, and enzymes in suckling rats deprived of adequate nutrient from birth. Rat pups were suckled by foster dams fed ad libitum one of three isocaloric, semipurified diets containing 6,9, or 25% (control) protein throughout gestation and lactation. An additional control group consisted of pups raised with their natural, chow-fed mothers. Although survival of the pups, 98% in the chow-fed and 25% protein groups, decreased to 83% in the 9% groups and 53% in the 6% protein groups, body and gut weights were remarkably uniform within each study group. Mean body weight, gut weight, villus height, and crypt depth were markedly and significantly less in the 6 and 9% when compared with those in the chow and 25% control groups, the 6% group being significantly more affected was than the 9% group ( P < 0.001). Pups raised by chow-fed mothers also weighed significantly less (P < 0.001) than did those raised by dams fed the 25% protein diet. Total small intestinal protein and DNA content of mucosal scrapings were less in 6 than 9% rat pups ( P < 0.001), which in turn were less than those in the 25% group ( P < 0.05). The protein/DNA ratio in the small intestine of the 6% animals onlv was reduced when compared with the 25% group (P < 0.05). ~pithelial cell migration assessed by autoradiography with I3Hjthymidine was significantly slower in both proximal and distal intestinal segments of the 6% animals when compared with those from the 25% group ( P < 0.001). Incorporation of the 3H, seen by autoradiography after 1 hr, was also signficantly decreased in the 6% group ( P < 0.001). Calculated for the total small intestine, lactase, sucrase, alkaline phosphatase, and thymidine kinase activities were significantly diminished (P 5 0.001) in the 6% animals compared with 25% controls. Calculated in relation to mucosal protein content and compared with 25% controls, sucrase and alkaline phosphatase activities were significantly decreased (P < 0.001) in both proximal and distal small intestinal segments of the 6% animals, but thymidine kinase activity was decreased only in the distal segment (P < 0.001). However, lactase specific activity was increased in both proximal and distal segments from the 6% group (P < 0.001). Further studies of this phenomenon demonstrated a significant increase in intracellular acid P-galactosidase (P < 0.001), particularly in the distal intestinal segment, but also a marked increase in brush border P-galactosidase.Our data demonstrate that in the small intestinal mucosa of the suckling rat, chronic malnutrition causes a decreased number of cells and impaired epithelial proliferation. These abnormalities reflect a profound direct impact of malnutrition on the gut of the young animal and demonstrate a delay in the normal pattern of postnatal maturation of the small intestinal epithelium.In most mammalian species, the small intestinal epithelium undergoes significant development in early postna...