Estudo prospectivo de pacientes pediátricos com dor abdominal crônica

Abstract

Endereço para correspondência: Elizete Aparecida L. C. Pinto Estrada da Rhodia, 7.250 -Condomínio Residencial Lagoa Serena, REsumoObjetivo: Classificar a dor abdominal crônica em crianças e adolescentes por meio dos critérios de Roma II e definir o desfecho diagnóstico em três anos de seguimento.Métodos: Durante um ano, 71 pacientes com dor abdominal crônica foram atendidos como casos novos num ambulatório terciário de gastroenterologia pediátrica. Causas orgânicas foram excluídas por bases clínicas e laboratoriais, e relatos clínicos foram avaliados especificamente quanto à possibilidade de preencherem os Critérios de Roma II para dor abdominal em crianças. Para estabelecer o diagnóstico definitivo, os pacientes foram seguidos por três anos, em média.Resultados: A alocação dos 71 pacientes segundo Roma II foi: doença orgânica (n=12), remissão dos sintomas após a primeira consulta (n=7), ou preencheram os critérios para dor funcional (n=52). Dos 12 pacientes de doença orgânica, nove foram diagnosticados como intolerantes à lactose, mas foram re-alocados para doença funcional no seguimento, visto que a dieta de isenção não aliviou a queixa. Dos 52 pacientes com doença funcional (idade mediana=9,3 anos, 50% meninos), nove, que inicialmente preencheram o critério para dor abdominal funcional, foram re-alocados no diagnóstico de constipação funcional e 43 mantiveram o diagnóstico funcional: 24 com dispepsia funcional, 18 com dor abdominal funcional e um com síndrome do intestino irritável.Conclusões: Dentre os casos de dor abdominal crônica, a dor do tipo funcional foi mais comum que as causas orgânicas e, dentre os seus subgrupos, a dispepsia funcional foi mais freqüente. O seguimento em longo prazo permitiu estabelecer o diagnóstico definitivo da origem da dor abdominal nessas crianças. Palavras-chave: dor abdominal; síndrome do intestino irritável; criança. AbstRActObjective: To classify chronic abdominal pain in children and adolescents, according to Rome II criteria and to define diagnosis outcome in a three-year follow-up period.Methods: During one year, 71 consecutive new patients with abdominal pain were seen in a tertiary pediatric gastroenterology outclinic. Organic diseases were excluded by physical examination and laboratory procedures, and clinical complaints were evaluated according to Rome II criteria for children abdominal pain. In order to establish definitive diagnosis, patients were followed for a mean of three years.

Functional abdominal pain: an integrative review study from a biopsychosocial view

“…Regarding the consensus employed for the FAP diagnosis, of the six studies included in this category [15][16][17][18][19][20] , three studies used the Rome III criteria. Regarding the other studies, one was based on the Rome III criteria.…”

“…Another important aspect is the fact that the Rome III criteria aimed at reducing the number of tests and the cost of the gastrointestinal diagnosis. However, three studies [16][17][18] pointed out the need to exclude the presence of an organic disease. By contrast, the new edition of the Rome IV 21 criteria brings an innovative concept in the FAP diagnosis, exempting the physician from the need of excluding organic causes for the abdominal pain to provide the diagnosis of abdominal pain functional disorders 22,23 .…”

“…Thus, in the abdominal pain functional disorders category, according to the Rome IV criteria, functional dyspepsia, irritable bowel syndrome, abdominal migraine, and unspecified FAP are included 22 . The three main criteria debated include the minimum consecutive period necessary for the clinical condition to meet the functional diagnosis, analysis of the children's evacuation characteristics, and the need for better specification on the exclusion of organic disease [16][17][18] . Some authors still mention that the diagnosis of some children is altered with time, after performing invasive exams 15 , such as children who initially received the FAP diagnosis and then were diagnosed with functional constipation 17 .…”

“…The three main criteria debated include the minimum consecutive period necessary for the clinical condition to meet the functional diagnosis, analysis of the children's evacuation characteristics, and the need for better specification on the exclusion of organic disease [16][17][18] . Some authors still mention that the diagnosis of some children is altered with time, after performing invasive exams 15 , such as children who initially received the FAP diagnosis and then were diagnosed with functional constipation 17 . Dorsa et al 17 e Rutten et al 19 indicate the need to pay more attention to the characteristics of constipation in children, with the possibility of functional gastrointestinal disorders.…”

“…Some authors still mention that the diagnosis of some children is altered with time, after performing invasive exams 15 , such as children who initially received the FAP diagnosis and then were diagnosed with functional constipation 17 . Dorsa et al 17 e Rutten et al 19 indicate the need to pay more attention to the characteristics of constipation in children, with the possibility of functional gastrointestinal disorders. In both studies, the authors suggest the hypothesis that these disorders are the same, but with different expressions.…”