Childhood Functional Gastrointestinal Disorders: Child/Adolescent

Hyams, Jeff; Lorenzo, Cherubino Di; Saps, Miguel; Rj, Shulman; Staiano, Annamaria; Tilburg, Miranda A.L. van

doi:10.1053/j.gastro.2016.02.015

Cited by 959 publications

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“…Criterios de Roma IV para el diagnóstico de constipación funcional en niños menores de 4 años Para niños mayores de 4 años, la duración de los síntomas para el diagnóstico cambió de 2 meses a 1 mes, esto para evitar un retraso en el inicio del tratamiento; 2) Para niños menores de 4 años, se definieron nuevos criterios para niños que no usan pañal, y el síntoma de "incontinencia fecal" se movió a los "criterios adicionales para niños que no usan pañal", ya que el reconocimiento de la incontinencia fecal en pacientes que usan pañal no es confiable. 6,9 Las posturas de retención requieren especial atención, ya que con frecuencia los padres lo confunden con la acción del niño de estar "pujando" para poder evacuar; sin embargo, éstas no son más que el intento del niño de evadir la evacuación por medio de la contracción del esfínter anal exterior y los músculos glúteos -tí-picamente, el niño se esconde en una esquina y balancea su cuerpo hacia delante y hacia atrás.…”

Section: Diagnósticounclassified

“…6,13 De igual manera, la presencia de impactación fecal (incontinencia fecal, masa abdominal palpable, o por medio de tacto rectal) es importante para guiar el abordaje terapéutico. Sin embargo, la radiografía abdominal no se recomienda, ya que la interpretación del contenido fecal en el recto varía significativamente entre los diferentes radiólogos.…”

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“…El uso rutinario de exámenes de laboratorio tampoco es recomendado, con la única excepción de que se tenga sospecha de una etiología orgánica. 6,[11][12][13] Por tal motivo, el diagnóstico de constipación funcional es meramente clínico y basado en los criterios de Roma IV.…”

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Constipación funcional en pediatría: Criterios de Roma IV, diagnóstico y tratamiento

2018

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Este artículo debe citarse como INTRODUCCIÓNLa constipación (o estreñimiento) en pediatría es una de las entidades pediátricas más comunes que el médico general y el pediatra ven en la práctica diaria. Es la causa gastrointestinal más común que resulta en la derivación del paciente a especialistas, causa significativa de ansiedad en los padres. La constipación en pediatría es funcional en 90-95% de los casos. El diagnóstico continúa siendo basado en los criterios de Roma IV. El tratamiento consiste en una etapa de desimpactación y una de mantenimiento. 1-3 ETIOLOGÍA Y FISIOPATOLOGÍALa constipación es una entidad clínica caracterizada por una disminución de la frecuencia de las evacuaciones, retención de heces, evacuaciones dolorosas o duras, heces de gran tamaño e incontinencia fecal. Múltiples causas orgánicas han sido descritas; sin embargo, la causa más común es funcional (i.e. no existe evidencia de una etiología orgánica), lo cual corresponde a un 90-95% de los pacientes con constipación. La constipación funcional es un comportamiento o instinto aprendido causado principalmente por evacuaciones dolorosas y factores sociales. El paso de una evacuación dura y dolorosa genera miedo en el niño, provocando el instinto de retener las evacuaciones y un "círculo vicioso" (Figura 1). La constipación funcional es un www.actapediatrica.org.mx

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Constipación funcional en pediatría: Criterios de Roma IV, diagnóstico y tratamiento

2018

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“…Молодые люди больше подвержены развитию забо-левания, нежели лица старше 50 лет [10,19]. Часто-та встречаемости СРК у детей разных стран нахо-дится в диапазоне 1,2-5,4 % [17].…”

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“…Однако в двойном слепом рандомизированном клиниче-ском исследовании у детей с СРК (включало все подтипы) была доказана ее эффективность [17].…”

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The using of low-FODMAP diet is an important step in the treatment of children with irritable bowel syndrome

et al. 2017

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Diet therapy, in most cases, is the first stage of treatment of diseases of the gastrointestinal tract. Especially, this question remains relevant in patients suffering from functional gastrointestinal disorders. The irritable bowel syndrome is one of the most common of functional gastrointestinal tract disorders in the population. The Rome criteria IV are basic recommendations for the diagnosis and treatment of functional gastrointestinal disorders in patients of different ages. The diet with a reduced content of fermentable oligosaccharides (fructans and galactans), di- (lactose), monosaccharides (fructose) and polyols (FODMAP) is recommended by current international consensus for patients of different ages with irritable bowel syndrome. The article presents current findings on the low-FODMAP diet effect on the clinical manifestations of irritable bowel syndrome. The elimination of various foods in the diet of patients with different clinical variants of irritable bowel syndrome according to the low-FODMAP diet scheme leads to a decrease in gassing and normalization of contractile activity of the intestine. It significantly reduces the frequency of exacerbations of the disease and improves the quality of life of such patients. A number of clinical studies using the low-FODMAP diet in adult patients and children with irritable bowel syndrome are presented. It is concluded that further clinical studies to study the effectiveness of the low-FODMAP diet in patients with irritable bowel syndrome are needed. Especially this issue remains relevant in pediatric practice.

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Home-Based Hypnotherapy Self-exercises vs Individual Hypnotherapy With a Therapist for Treatment of Pediatric Irritable Bowel Syndrome, Functional Abdominal Pain, or Functional Abdominal Pain Syndrome

et al. 2017

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Individual gut-directed hypnotherapy (HT) is effective in pediatric irritable bowel syndrome (IBS) and functional abdominal pain or functional abdominal pain syndrome (FAP[S]). It is, however, unavailable to many children.OBJECTIVE To compare the effectiveness of HT by means of home-based self-exercises using a CD with that of individual HT (iHT) performed by qualified therapists. DESIGN, SETTING, AND PARTICIPANTSThis noninferiority randomized clinical trial with a follow-up of 1 year after the end of treatment was conducted from July 15, 2011, through June 24, 2013, at 9 secondary and tertiary care centers throughout the Netherlands. A total of 303 children were eligible to participate. Of those, 260 children (aged 8-18 years) with IBS or FAP(S) were included in this study. Children were randomized (1:1 ratio) to home-based HT with a CD (CD group) or iHT performed by qualified therapists (iHT group). No children withdrew from the study because of adverse effects. INTERVENTIONSThe CD group was instructed to perform exercises 5 times per week or more for 3 months. The iHT group consisted of 6 sessions during 3 months. MAIN OUTCOMES AND MEASURESPrimary outcomes were treatment success directly after treatment and after 1-year follow-up. Treatment success was defined as a 50% or greater reduction in pain frequency and intensity scores. The noninferiority limit was set at 50% treatment success in the CD group, with a maximum of 25% difference in treatment success with the iHT group after 1-year follow-up. Modified intention-to-treat analyses were performed.RESULTS A total of 132 children were assigned to the CD group and 128 to the iHT group; 250 children were analyzed (126 in the CD group and 124 in the iHT group) (mean [SD] age, 13.4 [2.9] years in the CD group and 13.3 [2.8] years in the iHT group; 94 female [74.6%] in the CD group and 85 [68.5%] in the iHT group). Directly after treatment, 46 children (36.8%) in the CD group and 62 (50.1%) in the iHT group were successfully treated. After 1-year follow-up, the 62.1% treatment success in the CD group was noninferior to the 71.0% in the iHT group (difference, −8.9%; 90% CI, −18.9% to 0.7%; P = .002). CONCLUSIONS AND RELEVANCELong-term effectiveness of home-based HT with a CD is noninferior to iHT performed by therapists in pediatric IBS or FAP(S). Treatment with hypnosis using a CD provides an attractive treatment option for these children.

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Childhood Functional Gastrointestinal Disorders: Child/Adolescent

Cited by 959 publications

References 80 publications

Constipación funcional en pediatría: Criterios de Roma IV, diagnóstico y tratamiento

Constipación funcional en pediatría: Criterios de Roma IV, diagnóstico y tratamiento

The using of low-FODMAP diet is an important step in the treatment of children with irritable bowel syndrome

Home-Based Hypnotherapy Self-exercises vs Individual Hypnotherapy With a Therapist for Treatment of Pediatric Irritable Bowel Syndrome, Functional Abdominal Pain, or Functional Abdominal Pain Syndrome

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