Functional Gastrointestinal Disorders.

Los trastornos funcionales digestivos hacen parte de la patología gastrointestinal pediátrica. Son una combinación de síntomas gastrointestinales crónicos y recurrentes inexplicables secundarias a anomalías estructurales o bioquímicas. Involucran un espectro de entidades variadas, algunas de ellas consideradas como normales en el desarrollo del niño, y en las que los factores anatómicos, y afectivos cobran una especial importancia. SUMMARY The digestive functional disorders are part of the pediatric gastrointestinal pathology. They are a combination of secondary inexplicable chronic and recurrent digestives symptoms to structural or biochemical anomalies. They involve a series of varied entities, some of considered them like normal in the development of the children, and in whom the anatomical, and affective factors receive a special importance

Functional Abdominal Pain in Children

Approximately 50 years ago, Apley and Naish described children who presented with repeated episodes of abdominal pain for at least 3 months without any identifiable cause under the term recurrent abdominal pain (Apley and Naish 1958). Later studies showed that this term was a “waste basket” encompassing functional and organic conditions. More recent symptom-based criteria, known as Rome criteria, exclusively define those gastrointestinal conditions thought to be of functional origin and without clinical evidence of anatomical or structural abnormalities. The third edition of the Rome criteria (Rasquin 2006), classifies pain-predominant functional gastrointestinal disorders (FGIDs) in four different conditions

A million-dollar work-up for abdominal pain: is it worth it?

Pain-predominant-functional gastrointestinal disorders (PP-FGIDs) are common. The diagnosis is clinical and there are no biological markers to characterize these conditions. Despite limited evidence, investigations are commonly performed. The aim of the study was to investigate diagnostic practices, yield, and costs in children with PP-FGIDs. Charts of all of the children older than 4 years diagnosed as having abdominal pain were reviewed. Results and costs of diagnostic investigations were analyzed. Of 243 children with abdominal pain, 122 (50.2%) had PP-FGIDs (79 girls, mean age 12.7 years). All of the children underwent diagnostic work-up. Complete blood cell count was done in 91.8% of patients. None had elevated white blood cells, platelets, and low albumin. Six had either elevated erythrocyte sedimentation rate or C-reactive protein, but none had elevation of both; 4 of these 6 cases underwent endoscopies with normal results in 3 cases; Helicobacter pylori was found in 1 case. One child had elevated tissue transglutaminase 1 only antibodies with normal endoscopy. Amylase, lipase, direct bilirubin, stool cultures, and ova or parasites were always normal. One child had intermittent elevation of aspartate aminotransferase and alanine transaminase. There were no significant abnormalities in urinalysis or electrolytes. Abdominal x-rays were done in 38.5%, showing only retained stools in 13% of these patients. Abdominal ultrasound and computed tomography scan were done in 23.7% and 9% of cases, respectively, but were of no clinical value; 33.6% patients had esophagogastroduodenoscopy (9.7% abnormal: Helicobacter pylori, chemical gastritis, esophagitis) and 17.2% had colonoscopy (9.5% abnormal: rare fork crypts, lymphoid hyperplasia). Total costs: $744,726. Average cost per patient:$6104.30. In children with PP-FGIDs, investigations are common, costs are substantial, and yield is minimal

Henoch-Schonlein Purpura Leads to Functional Gastrointestinal Disorders

Pain predominant functional gastrointestinal disorders such as irritable bowel syndrome may develop as sequelae to acute infectious gastroenteritis. Henoch-Schonlein purpura is a vaculitis that causes an inflammatory insult to the intestinal mucosa. To assess whether patients with Henoch-Schonlein purpura are more likely to develop functional gastrointestinal disorders in long-term follow-up than controls. Families of children diagnosed with Henoch-Schonlein purpura from 2002 to 2009 were contacted at least 6 months after an acute episode. Parents completed a validated questionnaire to diagnose functional gastrointestinal disorders according to Rome III criteria. Thirty-eight patients (mean 9.9 years, range 3-22 years, 19 males) and 38 controls (mean 9.5 years, range 1-24 years, 21 males) were recruited. Of the patients, 81% had abdominal pain with Henoch-Schonlein purpura presentation. Initial abdominal pain had resolved in all cases. At the time of study, 60.5% patients and 2.6% controls had abdominal pain. Children in Henoch-Schonlein purpura group were diagnosed with various functional gastrointestinal disorders: Irritable bowel syndrome in 11%, functional abdominal pain syndrome in 8%, and functional abdominal pain in 2.8%. Steroid usage was associated with higher incidence of abdominal pain (87.5%) at the time of the study as compared to no steroid usage (40.9%), p = 0.0065. Patients with Henoch-Schonlein purpura are at an increased risk of developing pain predominant functional gastrointestinal disorders. The presence of abdominal pain and use of steroids at presentation of Henoch-Schonlein purpura are associated with higher incidence of pain predominant functional gastrointestinal disorders