Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis

Yang

J Neurogastroenterol Motil

2016

Background/AimsAbdominal pain-related functional gastrointestinal disorder (AP-FGID) is common in children and adults. However, the mechanism of AP-FGID is not clearly known. Recently, micro-inflammation, especially eosinophilia in the gastrointestinal tract, was suggested in the pathophysiology of AP-FGID in adults. The aim of this study was to evaluate the association of gastric and duodenal eosinophilia with pediatric AP-FGID. MethodsIn total, 105 pediatric patients with AP-FGID were recruited and classified into 4 subgroups based on the Rome III criteria. Eosinophil counts in the gastric and duodenal tissues of children with AP-FGID were compared to those from normal pathology references or those of children with Helicobacter pylori infection. Tissue eosinophil counts were also compared among the 4 subtypes of AP-FGID. ResultsEosinophil counts in the gastric antrum and body were significantly higher in children with AP-FGID than normal reference values. Duodenal eosinophil counts were higher in children with AP-FGID, but not significantly when compared with normal reference values. There were no significant differences in eosinophil counts of the stomach or duodenum among the 4 subtypes of AP-FGID. Eosinophils counts in the gastric antrum and body were significantly higher in children with H. pylori infection than in those with AP-FGID. Duodenal eosinophilia was prominent in cases of H. pylori infection, but not statistically significant when compared with AP-FGID. ConclusionsOur study revealed that gastric eosinophilia is associated with AP-FGID in children, regardless of the subtype of functional abdominal pain. This suggests some contribution of gastrointestinal eosinophils in the development of pediatric AP-FGID.

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of Gastric and Duodenal Eosinophils in Children with Abdominal Pain Related Functional Gastrointestinal Disorders According to Rome III Criteria

Yang

J Neurogastroenterol Motil

2016

“…According to a recent meta-analysis, FAP is common in youth, with a worldwide pooled prevalence rate of 13.5% [18]. Many youth with FAP either meet current Rome III criteria for functional Corresponding Author: Uma Rao, M.D., Address: University of Tennessee, CMHSRC, 122 Henson Hall, 1618 West Cumberland Avenue, Knoxville, Phone: (865) FAX: (865) 974-1662, urao@utk.edu.…”

Section: Introductionmentioning

confidence: 99%

(236) Impaired conditioned pain modulation in youth with functional abdominal pain

Morris

Walker

Bruehl

et al. 2016

The Journal of Pain

Functional abdominal pain (FAP) is associated with enhanced pain responsiveness. Although impaired conditioned pain modulation (CPM) characterizes adults with a variety of chronic pain conditions, relatively little is known about CPM in youth with FAP. The present study assessed CPM to evoked thermal pain in 140 youth (ages 10 to 17), 63 of whom had FAP and 77 of whom were healthy controls. Multilevel models demonstrated weaker CPM effects in FAP than healthy youth, as evident in slower within-person decreases in pain ratings during the conditioning phase. Weaker CPM effects were associated with greater somatic symptom severity and functional disability. Pain responses in FAP youth were heterogeneous, with 43% of youth showing an unexpected increase in pain ratings during the conditioning phase, suggesting sensitization rather than CPM-related pain inhibition. These findings highlight directions for future research on the emergence and maintenance of FAP in youth. Keywordsfunctional abdominal pain; FAP; CPM; DNIC; adolescents Functional abdominal pain (FAP) refers to either episodic or continuous abdominal pain that remains medically unexplained despite thorough physical examination [36]. According to a recent meta-analysis, FAP is common in youth, with a worldwide pooled prevalence rate of 13.5% [18]. Many youth with FAP either meet current Rome III criteria for functional Corresponding Author: Uma Rao, M.D., Address: University of Tennessee, CMHSRC, 122 Henson Hall, 1618 West Cumberland Avenue, Knoxville, Phone: (865) FAX: (865) 974-1662, urao@utk.edu. HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript gastrointestinal disorders, including irritable bowel syndrome (IBS), functional dyspepsia and abdominal migraine [2], or are at increased risk for developing functional gastrointestinal disorders over time [48]. FAP in youth is associated with significant functional disability, reflected in part by school absences [36], and is often persistent despite frequent utilization of health care services [13]. Although a variety of biological and psychosocial factors [48,49] have been implicated in the development and maintenance of FAP in youth, little is known about the impact of altered pain modulatory systems.Experimental pain responses, which may index functioning in pain modulatory systems, have proven useful as biomarkers of risk for chronic pain by discriminating clinical pain populations from healthy controls, correlating with changes in clinical pain, and predicting the development of chronic pain [11]. Pro-nociceptive pain modulation profiles are characterized by decreased inhibition and/or increased temporal summation to evoked pain [53]. One experimental method used to detect dysfunction in descending inhibitory pain modulatory systems is conditioned pain modulation (CPM; previously termed diffuse noxious inhibitory controls or DNIC), which refers to a reduction in perceived pain intensity for a test stimulus during application of a conditioning stimulus to...

“…(15,16) The FGID clinical guidelines, known as the Rome III criteria (17), define IBS as abdominal pain or discomfort occurring at least 3 days per month over the preceding 3 months with at least two of the following associated symptoms: improvement with defecation, change in frequency of stool, or change in form or character of stool. The cause is unknown, although a complex etiology with both neurological and intestinal inputs is likely.…”

mentioning

confidence: 99%

Quantitative Risk–Benefit Analysis of Probiotic Use for Irritable Bowel Syndrome and Inflammatory Bowel Disease

Bennett

2015

Drug Saf

Key Points1. Probiotics are widely used in both IBS and IBD, but published evidence is mixed for both safety and efficacy, and studies are very heterogenous. In general, the frequency of ADE and the efficacy are both close to placebo. 2. The risk-benefit plane for both IBS and IBD is broad. In IBS, most of the confidence region on the riskbenefit plane favors avoiding probiotic use. In IBD, most of the confidence region favors using probiotics.Word count (text) = 4286 Word count (abstract) = 241