Middle East Consensus Statement on the Diagnosis and Management of Functional Gastrointestinal Disorders in &lt;12 Months Old Infants

Vandenplas, Yvan; Alturaiki, Muath Abdurrahman; Al-Qabandi, Wafa’a; Al-Refaee, Fawaz; Bassil, Ziad; Eid, Bassam; Beleidy, Ahmed El; Almehaidib, Ali; Mouawad, Pierre; Sokhn, Maroun

doi:10.5223/pghn.2016.19.3.153

Cited by 13 publications

(11 citation statements)

References 24 publications

(38 reference statements)

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“…Alarming symptoms and signs (red flags) that refer to the presence of underlying pathology (organic cause) must be carefully checked before reaching the diagnosis of FGIDs. These warning signs include failure of the newborn to pass the meconium in the first 24 hours after delivery, abdominal distention, bilious vomiting, failure to thrive, bloody or mucoid stool, delayed neurological development, anal or sacral abnormalities, and presence of signs of other organic causes (such as fever or urinary tract infections) [ 9 18 ].…”

Section: Resultsmentioning

confidence: 99%

Saudi Experts Consensus on Diagnosis and Management of Pediatric Functional Constipation

Alshehri

Sindi

AlMusalami

et al. 2022

Pediatr Gastroenterol Hepatol Nutr

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Although functional gastrointestinal disorders (FGIDs) are very common in pediatric patients, there is a scarcity of published epidemiologic data, characteristics, and management patterns from Saudi Arabia, which is the 2nd largest Arabic country in terms of area and the 6th largest Arabic country in terms of population, with 10% of its population aged <5 years. Functional constipation (FC) is an FGID that has shown a rising prevalence among Saudi infants and children in the last few years, which urges us to update our clinical practices. Nine pediatric consultants attended two advisory board meetings to discuss and address current challenges, provide solutions, and reach a Saudi national consensus for the management of pediatric constipation. The pediatric consultants agreed that pediatricians should pay attention to any alarming signs (red flags) found during history taking or physical examinations. They also agreed that the Rome IV criteria are the gold standard for the diagnosis of pediatric FC. Different therapeutic options are available for pediatric patients with FC. Dietary treatment is recommended for infants with constipation for up to six months of age. When non-pharmacological interventions fail to improve FC symptoms, pharmacological treatment with laxatives is indicated. First, the treatment is aimed at disimpaction to remove fecal masses. This is achieved by administering a high dose of oral polyethylene glycol (PEG) or lactulose for a few days. Subsequently, maintenance therapy with PEG should be initiated to prevent the re-accumulation of feces. In addition to PEG, several other options may be used, such as Mg-rich formulas or stimulant laxatives. However, rectal enemas and suppositories are usually reserved for cases that require acute pain relief. In contrast, infant formulas that contain prebiotics or probiotics have not been shown to be effective in infant constipation, while the use of partially hydrolyzed formula is inconclusive. These clinical practice recommendations are intended to be adopted by pediatricians and primary care physicians across Saudi Arabia.

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Section: Resultsmentioning

confidence: 99%

Saudi Experts Consensus on Diagnosis and Management of Pediatric Functional Constipation

Alshehri

Sindi

AlMusalami

et al. 2022

Pediatr Gastroenterol Hepatol Nutr

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“…For bottle-fed infants, a partially hydrolyzed formula with Galacto-Oligosaccharides/Fructo-Oligosaccharides and added β-palmitate might be beneficial in cases where CMPA is not suspected. The mother can also use a formula containing prebiotics and/or ferments or a lactose-reduced formula[ 122 ].…”

Section: Cow’s Milk-related Functional Gastrointestinal Disordersmentioning

confidence: 99%

Cow’s milk-induced gastrointestinal disorders: From infancy to adulthood

Al‐Biltagi¹,

Saeed²,

Bediwy³

et al. 2022

World J Clin Pediatr

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Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders. Cow’s milk protein allergy (CMPA) is the most common food allergy, especially in infancy and childhood, which may persist into adulthood. There are three main types of CMPA; immunoglobulin E (IgE)-mediated CMPA, non-IgE-mediated CMPA, and mixed type. CMPA appears before the first birthday in almost all cases. Symptoms may start even during the neonatal period and can be severe enough to simulate neonatal sepsis. CMPA (often non-IgE mediated) can present with symptoms of gastroesophageal reflux, eosinophilic esophagitis, hemorrhagic gastritis, food protein-induced protein-losing enteropathy, and food protein-induced enterocolitis syndrome. Most CMPAs are benign and outgrown during childhood. CMPA is not as common in adults as in children, but when present, it is usually severe with a protracted course. Lactose intolerance is a prevalent condition characterized by the development of many symptoms related to the consumption of foods containing lactose. Lactose intolerance has four typical types: Developmental, congenital, primary, and secondary. Lactose intolerance and CMPA may be the underlying pathophysiologic mechanisms for many functional gastrointestinal disorders in children and adults. They are also common in inflammatory bowel diseases. Milk consumption may have preventive or promoter effects on cancer development. Milk may also become a source of microbial infection in humans, causing a wide array of diseases, and may help increase the prevalence of antimicrobial resistance. This editorial summarizes the common milk-related disorders and their symptoms from childhood to adulthood.

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“…For infants requiring CM elimination, all guidelines on the management of CMA recommend continued breast feeding, with the mother avoiding all dairy products, as the ideal nutrition [ 44 , 61 , 63 , 121 , 123 , 124 , 125 , 143 , 158 , 159 , 160 , 161 ]. A maternal CMP elimination diet during breast feeding requires close supervision and support to protect the nutritional safety of both mother and baby, in accordance with published guidelines [ 122 ].…”

Section: Food Allergy-associated Constipation Managementmentioning

confidence: 99%

Cows’ Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review

et al. 2022

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Constipation is a very common disorder, mostly functional in nature, that may persist for years in up to 35–52% of children. Food allergy prevalence, severity and persistence are increasing over time, and cows’ milk protein is the commonest food allergen recognised to affect gastrointestinal motility in children. There is mounting evidence of the role of cows’ milk (CM) allergy (CMA) in children with constipation. With this narrative review, we aim to provide clinicians with an updated and critical overview of food allergy-associated constipation. We searched Embase, Medline and the Cochrane Library, using keywords related to the topic. Only reviews and studies including children aged 0–17 years that were published in English were considered. Constipation has been reported in 4.6% of infants with CMA; the prevalence of food allergy underlying chronic constipation in children resistant to conventional treatment and presenting to tertiary clinics ranges between 28% and 78%. The identification of predisposing risk factors and of a specific phenotype of food allergy-induced constipation remains elusive. No allergic tests or radiological or motility investigations reach a high sensitivity and specificity in screening children for CMA-related constipation. A 4-week cows’ milk protein (CMP) elimination diet may be considered for children with chronic constipation resistant to conventional treatment and who lack alarm sign/symptoms of organic diseases. In subjects with ameliorated symptoms on CMP elimination, the diagnosis of CMA should be confirmed by a food challenge to avoid an unnecessary protracted diet.

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Middle East Consensus Statement on the Diagnosis and Management of Functional Gastrointestinal Disorders in <12 Months Old Infants

Cited by 13 publications

References 24 publications

Saudi Experts Consensus on Diagnosis and Management of Pediatric Functional Constipation

Saudi Experts Consensus on Diagnosis and Management of Pediatric Functional Constipation

Cow’s milk-induced gastrointestinal disorders: From infancy to adulthood

Cows’ Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review

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