Functional Gastrointestinal Disorders Dominate Pediatric Gastroenterology Outpatient Practice

Rouster, Audra S.; Karpinski, Aryn C.; Silver, David; Monagas, Javier; Hyman, Paul E.

doi:10.1097/mpg.0000000000001023

Cited by 102 publications

(78 citation statements)

References 21 publications

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“…Studies from the pediatric literature suggest the prevalence of symptoms meeting criteria for CVS in children and adolescents in the general population are between 0.3% and 1.9%, as high as 6.1% in primary care populations, and 8% to 10% in a pediatric gastroenterology clinic . The prevalence in the latter two studies among children is similar to that observed in our study in adults.…”

Section: Discussionsupporting

confidence: 87%

Cyclic vomiting syndrome is a prevalent and under‐recognized condition in the gastroenterology outpatient clinic

Sagar

Sood

Gracie

et al. 2017

Neurogastroenterology Motil

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Section: Discussionsupporting

confidence: 87%

Cyclic vomiting syndrome is a prevalent and under‐recognized condition in the gastroenterology outpatient clinic

Sagar

Sood

Gracie

et al. 2017

Neurogastroenterology Motil

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“…Functional gastrointestinal (GI) disorders are highly prevalent, occurring in 10%–20% of population worldwide (Saito, Schoenfeld, & Locke III, ; Chang, Lu, & Chen, ; Lewis, Palsson, Whitehead, & van Tilburg, ). These disorders constitute the primary reason for GI referral in pediatric tertiary care centers (Rouster, Karpinski, Silver, Monagas, & Hyman, ) and do not respond well to gut‐targeted drug therapies (Drossman et al, ; Sobin, Heinrich, & Drossman, ). They encompass a range of problems with digestion, defecation, abdominal pain, vomiting, nausea, and swallowing without an identifiable structural pathology.…”

Section: Comorbidity Of Psychiatric and Gi Tract Pathology And Their mentioning

confidence: 99%

Traumatic stress and the autonomic brain‐gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology

Kołacz

Kovacic

Porges

2019

Developmental Psychobiology

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A range of psychiatric disorders such as anxiety, depression, and post‐traumatic stress disorder frequently co‐occur with functional gastrointestinal (GI) disorders. Risk of these pathologies is particularly high in those with a history of trauma, abuse, and chronic stress. These scientific findings and rising awareness within the healthcare profession give rise to a need for an integrative framework to understand the developmental mechanisms that give rise to these observations. In this paper, we introduce a plausible explanatory framework, based on the Polyvagal Theory (Porges, Psychophysiology, 32, 301–318, 1995; Porges, International Journal of Psychophysiology, 42, 123–146, 2001; Porges, Biological Psychology, 74, 116–143, 2007), which describes how evolution impacted the structure and function of the autonomic nervous system (ANS). The Polyvagal Theory provides organizing principles for understanding the development of adaptive diversity in homeostatic, threat‐response, and psychosocial functions that contribute to pathology. Using these principles, we outline possible mechanisms that promote and maintain socioemotional and GI dysfunction and review their implications for therapeutic targets.

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“…FGIDs such as IBS are frequently encountered in clinical practice, yet they are a group of disorders that elicit symptoms through an etiology that is poorly understood and currently not identifiable . Descriptive evidence demonstrates that patients feel that foods are involved in the etiology of their symptoms, and often foods containing fermentable carbohydrates are avoided in an attempt to reduce symptoms .…”

Section: Discussionmentioning

confidence: 99%

“…Bloating, abdominal pain/discomfort, and changes in bowel function, namely stool frequency and consistency, characterize IBS. GI symptom resolution is the primary reason patients seek medical treatment . Currently, IBS in pediatric patients is diagnosed by Rome IV criteria, and was previously diagnosed by Rome III criteria (Table ) .…”

Section: Introductionmentioning

confidence: 99%

Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review

2019

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Irritable bowel syndrome (IBS) is classified as a functional gastrointestinal (GI) disorder characterized by abdominal pain, bloating, and changes in bowel function. Although the pathophysiology of IBS is incompletely understood, fermentable carbohydrates are implicated as a potential cause of symptoms. An elimination diet, such as a low‐FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, represents a potential intervention for reducing GI symptoms in patients with IBS. The role of fermentable carbohydrates in symptom onset is well studied in adult patients with IBS; however, less research exists in the pediatric population. This review sought to explore evidence for the role of dietary fermentable carbohydrate elimination to reduce GI symptoms (abdominal pain, stool changes, abdominal bloating) in children and adolescents (4–19 years of age) diagnosed with IBS based on Rome III or IV criteria. Five studies of neutral to positive quality rating were identified and analyzed using the Academy of Nutrition and Dietetics Evidence Analysis Process. These studies demonstrate that dietary elimination of fermentable carbohydrates, such as through a low‐FODMAP diet, reduces the severity of 1 or more GI symptoms in about one‐quarter to one‐half of pediatric patients with IBS. Patients without improvement are considered “nonresponders” and may require an alternative intervention. More research is needed to establish the best way to identify patients who would respond to elimination diets vs other IBS treatment strategies.

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Functional Gastrointestinal Disorders Dominate Pediatric Gastroenterology Outpatient Practice

Abstract: More than half of new pediatric gastrointestinal clinic patients met the Rome 3 criteria for ≥1 FGIDs. Satisfying the criteria may facilitate diagnosis on the first visit.

Cited by 102 publications

References 21 publications

Cyclic vomiting syndrome is a prevalent and under‐recognized condition in the gastroenterology outpatient clinic

Cyclic vomiting syndrome is a prevalent and under‐recognized condition in the gastroenterology outpatient clinic

Traumatic stress and the autonomic brain‐gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology

Elimination of Fermentable Carbohydrates to Reduce Gastrointestinal Symptoms in Pediatric Patients With Irritable Bowel Syndrome: A Narrative Review

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