Yield and Cost of Performing Screening Tests for Constipation in Children

BACKGROUND: Chronic constipation is one of the most common reasons for pediatric outpatient visits. Clinical guidelines recommend that the work-up for chronic refractory constipation include thyroid function tests, celiac serology, and measurement of calcium and lead levels. Data to justify routine screening of constipated children using these laboratory tests are lacking

ESPGHAN and NASPGHAN 2023 protocol for paediatric FAPD treatment guidelines (standard operating procedure)

Introduction To date, no international guidelines have been published for the treatment of paediatric functional abdominal pain disorders (FAPDs), subcategorised into functional abdominal pain–not otherwise specified (FAP-NOS), irritable bowel syndrome (IBS), functional dyspepsia and abdominal migraine (AM). We aim for a treatment guideline, focusing on FAP-NOS, IBS and AM, that appreciates the extensive array of available therapies in this field. We present the prospective operating procedure and technical summary protocol in this manuscript. Methods Grading of Recommendations, Assessment, Development and Evaluation (GRADE) will be followed in the development of the guideline, following the approach as laid out in the GRADE handbook, supported by the WHO. The Guideline Development Group (GDG) is formed by paediatric gastroenterologists from both the European Society for Pediatric Gastroenterology, Hepatology and Nutrition, as well as the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Also, one clinical psychologist with expertise in FAPDs is a voting member in the GDG. A final consensus list of treatment options is translated into ‘patient, intervention, comparison, outcome’ format options. Prospective agreement on the magnitude of health benefits or harms categories was reached through a Delphi process among the GDG to support grading of the literature. There will be a detailed technical evidence review with randomised controlled trial data that will be judged for risk of bias with the Cochrane tool. Recommendations are preferably based on GRADE but could also be best practice statements following the available evidence. A full Delphi process will be used to make recommendations using online response systems. This set of procedures has been approved by all members of the GDG

Yield and Cost of Performing Screening Tests for Constipation in Children

BACKGROUND: Chronic constipation is one of the most common reasons for pediatric outpatient visits. Clinical guidelines recommend that the work-up for chronic refractory constipation include thyroid function tests, celiac serology, and measurement of calcium and lead levels. Data to justify routine screening of constipated children using these laboratory tests are lacking

Gastric Motor Disorders: Gastroparesis and Dumping Syndrome

Normal gastric motor function requires coordination of the autonomic nervous system, neurotransmitters and enteric smooth muscle cells. Alterations at any level of these complex processes may result in gastric motility disorders. Gastric motility disorders are common in children, and their treatment is often daunting. This chapter provides a detailed insight into the etiologies and pathogenesis of gastric motility disorders and an overview of the treatment modalities. Various etiologies account for the numerous clinical sequelae associated with gastric dysmotility, along with poorly understood and complex pathophysiological mechanisms. Etiological factors associated with gastroparesis vary with the child’s age. Gastric electrical and motor activity matures with gestational age. Early life experiences including environmental and nociceptive factors may delay postnatal gastro-enteric motor maturation. Post-infectious gastroparesis is common in children. It is often transient and resolves completely over several months. Neural disorders such as peripheral neuropathies, Hirschsprung’s disease, and various CNS disorders including mitochondrial encephalopathies are associated with gastroparesis. Gastroparesis seen after thoracic and upper abdominal surgeries can be due to injury of the vagal nerve. Inflammatory myopathies such as polymyositis and dermatomyositis frequently present with slow gastric emptying. Gastroparesis is seen in common gastroenterological conditions such as cow milk protein allergy, celiac disease, and inflammatory bowel diseases. Patients with various endocrine disorders, caustic ingestions and those who are critically ill commonly present with delayed gastric emptying. Rapid gastric emptying can lead to dumping syndrome characterized by the onset of gastrointestinal and vasomotor symptoms following the ingestion of a meal. Early dumping syndrome occurs as a consequence of the rapid emptying of hyperosmolar contents of the stomach into the small intestine, resulting in a fluid shift from the intravascular compartment into the intestinal lumen. Late dumping syndrome occurs due to reactive hypoglycemia from rapid release of insulin into circulation secondary to brisk absorption of glucose from the small bowel. Treatment of dumping syndrome includes lifestyle modifications and dietary measures

Electrocardiograms changes in children with functional gastrointestinal disorders on low dose amitriptyline

To study the effects of low dose amitriptyline on cardiac conduction in children. Secondary analysis of data obtained from a double-blind, randomized placebo-controlled trial, evaluating low dose amitriptyline in children with a diagnosis of functional abdominal pain, functional dyspepsia, and irritable bowel syndrome according to the Rome II criteria. Children 8-17 years of age were recruited from the pediatric gastroenterology clinics of 6 tertiary care centers in the United States. The electrocardiograms (EKGs) done prior to initiation of amitrityline and 1 mo after initiation of amitriptyline were examined. The changes in cardiac conduction were evaluated in patients and controls. Thirty children were included in the study. There were 12 patients, ages 9-17 years of both genders, in the amitriptyline treatment group and 18 patients, ages 9-17 years of both genders, in the placebo treatment group. None of the patients had any baseline EKG abnormality. Amitriptyline use was associated with an increase in heart rate (P = 0.024) and QTc interval (P = 0.0107) as compared to pre-EKGs. Children in the placebo group were also noted to present a statistically significant increase in QTc interval (P = 0.0498). None of the patients developed borderline QTc prolongation or long-QT syndrome after they were started on amitriptyline. The study findings suggest that once patients with functional gastrointestinal disorders have been screened for prolonged QTc interval on baseline EKG, they probably do not need a second EKG for reevaluation of cardiac conduction after starting low dose amitriptyline