Inpatient burden of childhood functional GI disorders in the USA: an analysis of national trends in the USA from 1997 to 2009

Abstract

BACKGROUND Functional Gastrointestinal Disorders (FGIDs) are among the most common outpatient diagnoses in pediatric primary care and gastroenterology. There is limited data on the inpatient burden of childhood FGIDs in the U.S. The aim of this study was to evaluate the inpatient admission rate, length of stay, and associated costs related to FGIDs from 1997–2009. METHODS We analyzed the Kids’ Inpatient Sample Database (KID) for all subjects in which constipation (ICD-9 codes: 564.0–564.09), abdominal pain (ICD-9 codes: 789.0–789.09), irritable bowel syndrome (IBS) (ICD-9 code: 564.1), abdominal migraine (ICD-9 code:346.80 and 346.81)dyspepsia (ICD-9 code: 536.8) or fecal incontinence (ICD-codes: 787.6–787.63) was the primary discharge diagnosis from 1997–2009. The KID is the largest publicly available all-payer inpatient database in the U.S., containing data from 2–3 million pediatric hospital stays yearly. KEY RESULTS From 1997–2009, the number of discharges with a FGID primary diagnosis increased slightly from 6,348,537 to 6,393,803. The total mean cost per discharge increased significantly from $6115 to $18,058 despite the length of stay remaining relatively stable. Constipation and abdominal pain were the most common FGID discharge diagnoses. Abdominal pain and abdominal migraine discharges were most frequent in the 10–14 year age group. Constipation and fecal incontinence discharges were most frequent in the 5–9 year age group. IBS discharge was most common for the 15–17 year age group. CONCLUSIONS AND INFERENCES Hospitalizations and associated costs in childhood FGIDs have increased in number and cost in the U.S. from 1997–2009. Further studies to determine optimal methods to avoid unnecessary hospitalizations and potentially harmful diagnostic testing are indicated.

Emergency Department Visits Related to Functional Abdominal Pain in the Pediatric Age Group

“…This validates data from an inpatient database, which noted a decrease in the number of FAP by 22.0% from 2003 to 2009 2. The reasons for this are not clear and further studies are needed to understand it.…”

“…In particular, constipation was found to be a secondary diagnosis in only 10% of ED visits for FAP. While laxative-therapy may improve chronic abdominal pain in children,7 FAP and functional constipation are believe to be unrelated entities in the majority of cases 2. Interestingly, asthma was the most common systemic disease condition associated with children seeking ED care for FAP.…”

“…In recent years, a significant amount of research has focused on hospitalizations associated with FGIDs including FAP. Analyses of national hospital databases have demonstrated that FAP is the leading inpatient discharge diagnosis for pediatric FGIDs 2. Interestingly, over the period 1997–2009, there appears to have been a decline in the number of inpatient hospitalizations for FAP 2…”

Age, Sex, Health Insurance, and Race Associated With Increased Rate of Emergent Pediatric Gastrointestinal Procedures

“…Functional gastrointestinal disorders (FGID) such as constipation, functional dyspepsia, and abdominal migraine are amongst the most common outpatient diagnoses in pediatric gastroenterology. However, results from one study discovered that inpatient costs for FGID have increased slightly between 1997–2009, with the average cost per hospitalization increasing roughly $12,000 over this 12-year period [4]. Although it is necessary to understand inpatient and outpatient health care costs over time, it is equally important to appreciate the factors influencing an individual to utilize inpatient care.…”

Cyproheptadine: A Potentially Effective Treatment for Functional Gastrointestinal Disorders in Children

“…4 It costs approximately $6,100 per patient for the initial gastroenterology consultation visit, 5 and an average of $18,000 per hospital stay. 6 Interactions of biological, psychological, and sociological factors contribute to its natural history. 7 Proposed mechanisms for FGIDs include altered gut motility, visceral hypersensitivity, altered gastrointestinal secretion, and brain-gut dysfunction.…”