Pediatric Patients With Dyspepsia Have Chronic Symptoms, Anxiety, and Lower Quality of Life as Adolescents and Adults

Abstract

Background & Aims Little is known about long-term health outcomes of children with dyspeptic symptoms. We studied the natural history of pediatric patients with dyspeptic symptoms, with and without histologic reflux, compared to healthy controls. Methods We performed a prospective study of consecutive new patients, ages 8–16 years, who underwent evaluation for dyspepsia, including upper endoscopy. Patients were assigned to groups with histologic evidence of reflux esophagitis (n=50), or normal histology results (n=53). Healthy children were followed as controls (n=143). Patients and controls were evaluated 5–15 years later. They provided self reports on severity of dyspeptic symptoms, use of acid suppression, quality of life, anxiety, and depression. Results When the study began, the groups with histologic evidence for esophagitis and normal histologies did not differ in severity of dyspeptic symptoms, functional disability, or depression. After a mean 7.6-year follow-up period, each group had significantly lower quality of life scores and more severe dyspeptic symptoms and functional disability than controls, but did not differ significantly from each other; both groups were significantly more likely than controls to meet criteria for an anxiety disorder. At time of follow-up, use of acid suppression medication was significantly greater in the group with histologic evidence for esophagitis, compared with patients that had normal histology findings when the study began. Conclusion Among pediatric patients with dyspepsia evaluated by endoscopy and biopsy, those with histologic evidence for esophagitis or normal histology findings are at increased risk for chronic dyspeptic symptoms, anxiety disorder, and reduced quality of life in adolescence and young adulthood.

Interacting influences of gender and chronic pain status on parasympathetically mediated heart rate variability in adolescents and young adults

“…Wendt, Neubert, Koenig, Thayer & Hamm [55] (p. 1161) postulated that resting HRV “may reflect the capacity of the prefrontal cortex to inhibit subcortical fear response in the presence of safety or when former threat cues are presented in the absence of threat,” and Pappens et al [28] (p. 9) speculated that low resting HRV might reflect subcortical “hard-wired defensive responding.” Thus, low resting HRV among the young women with persistent pain may reflect continuous difficulty adapting to routine changes in internal and external demands. The parasympathetic branch of the ANS is a “rest and digest” system that plays a restorative role during states of safety [31]; that is, application of the parasympathetic action puts a break on heart rate whereas withdrawal acts like an accelerator. Future research will need to address the question of whether ANS dysfunction, in the form of dominant sympathetic activation in the context of reduced parasympathetic activation, was present in childhood before symptoms of FAP occurred, and might even have contributed to the development and persistence of FAP or, alternatively, emerged subsequent to years of chronic pain.…”

“…The ANS is the primary pathway in brain-gut communication [21, 45], making it particularly relevant to gastrointestinal disorders, such as irritable bowel syndrome (IBS), characterized by functional abdominal pain (FAP). FAP often begins in childhood and may persist into adulthood [18, 26, 31, 33, 52]. …”

Self-Perceived Food Intolerances Are Common and Associated with Clinical Severity in Childhood Irritable Bowel Syndrome

“…24, 25 The total scores range from 0–60 with higher scores reflecting higher levels of perceived disability. 24, 26 …”

Functional dyspepsia is associated with duodenal eosinophilia in an Australian paediatric cohort

“…Several pathophysiologic mechanisms in FD, including delayed impaired gastric emptying or accommodation, hypersensitivity to duodenal lipid or acid exposure, abnormal duodeno‐jejunal motility and visceral hypersensitivity have been proposed . In addition, psychological distress such as anxiety and depression is associated with children with FD having lower quality of life scores and morbidity progressing into early adulthood . Duodenal eosinophilia was observed in 71–95% of paediatric FD patients , but whether this represents true pathology is yet to be confirmed.…”