EVALUATION OF FUNCTIONAL DYSPEPSIA IN CHILDREN: PREVALENCE, RISK FACTORS AND CLINICAL OUTCOME.

Goodbody, S.; Rawat D.; Ahmed Z.

EVALUATION OF FUNCTIONAL DYSPEPSIA IN CHILDREN: PREVALENCE, RISK FACTORS AND CLINICAL OUTCOME.

All Authors

Goodbody, S.

Rawat D.

Ahmed Z.

LTHT Author

Rawat, Dinesh

LTHT Department

Leeds Children's Hospital
Abdominal Medicine & Surgery

Publication Date

2024

Item Type

Conference Abstract

Abstract

Functional dyspepsia (FD) is a common disorder of gut brain interaction in the paediatric population and is responsible for significant disruption to a child's physical, emotional and social wellbeing.1 2 Limited research exists on the efficacy of the different management options and no guidelines are available for the management of FD in children. We aim to characterise the symptoms, associated conditions as well as evaluate the response to treatment for children with FD. A prospective longitudinal study design was adopted to recruit patients who were attending a paediatric gastroenterology clinic over a 6-month period. Participants were required to meet the ROME-IV criteria for FD and were followed up after 3 months to assess clinical outcome. Data collected with a pre-designed proforma included symptoms (primary and secondary), relevant family history, associated conditions (food intolerance, atopy, joint hypermobility, obesity, autism etc.). Children were investigated and managed as per agreed pathway while response to treatment was assessed using binary outcome measures.3 Thirty participants (56.7% female, 43.3% male) were recruited who met the ROME-IV criteria after negative screening for organic conditions including helicobacter pylori infection, coeliac disease, inflammatory bowel disease. The commonest primary symptoms - defined as the presenting complaint - were regurgitation (76.7%), nausea (73.3%) and abdominal pain (70%). The commonest secondary symptoms - defined as those which must be elicited from the patient - were postprandial fullness and early satiety (96.7%), postprandial discomfort (86.7%) and constipation (63.3%). Delayed colonic transit (colonic transit time > 48 hours) was noted in 55%. Upper GI endoscopy (42%) and pH studies (33%) were normal. Clinical outcome was recorded as no change (36.7%), improvement or resolution of symptoms (63.3%). Management included dietary change, anti-reflux medications, prokinetics, antispasmodics as well as laxatives. Chi-square analysis demonstrated that no single intervention was significantly associated with a positive clinical outcome (p<0.05) compared to alternatives, though majority of children demonstrated improvement or complete resolution of symptoms (63%). These findings emphasise the need to elicit FD defining symptoms in children which can often co-exist with other disorders of gut brain interaction. Constipation can coexist in these patients and addressing colonic transit can help in symptom alleviation as part of biological approach within the biopsychosocial model. This approach will help minimise invasive investigations like endoscopy and support development of management guidelines.