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

Dolor abdominal funcional

Los trastornos gastrointestinales funcionales (TGF), frecuentemente afectan a los niños y están asociados con morbilidad a corto y largo término. Estos TGF asociados con dolor incluyen el Síndrome de intestino irritable (SII), la Dispepsia funcional (DF), el Dolor abdominal funcional (DAF), el Síndrome de dolor abdominal funcional (SDAF), y la Migraña abdominal. Aunque la patogénesis de dolor asociado a los TGF es poco clara, la mayoría de los investigadores están de acuerdo, en una etiología multifactorial y la presencia de una interacción alterada intestino cerebro. Una continua interrelación de factores ambientales y genéticos, parece que hacen parte del desarrollo del sistema nervioso central y entérico. El modelo biopsicosocial es el arma operacional común para los niños con TGF, y reconoce la interacción entre las influencias sociales y ambientales y los procesos psicológicos y fisiológicos. El modelo biosicosocial propone que los cambios específicos de susceptibilidad genética, las experiencias tempranas de la vida, los cambios socioculturas, y los mecanismos de imitación, podrían explicar la variabilidad en la presentación clínica y los resultados entre los individuos

How do we define therapy-resistant Constipation in Children 4-18 years old? A systematic review with meta-narrative synthesis Data extraction

Background Therapy resistant constipation often is a frustrating clinical entity recognised by the persistence of infrequent and painful bowel movements fecal incontinence and abdominal pain despite intensive treatment. It is important to clearly define therapy resistant constipation before children are subjected to invasive diagnostic and therapeutic procedures. Aim To conduct a systematic review determining how pediatric interventional studies define therapy resistant constipation. Method We searched CENTRAL, MEDLINE, Embase, WHO ICTR and ClinicalTrials.gov. Studies that included patients with therapy resistant constipation were identified. Data were extracted on criteria used for defining therapy resistant constipation and reported using meta-narrative approach highlighting areas of convergence and divergence in the findings. Results A total of 1553 abstracts were screened in duplicate, and 47 studies were included in the review. There were at least 7 definitions used in the paediatric literature to define medically resistant constipation. The term intractable was used in 24 articles and 21 used the term refractory to describe therapy resistant constipation. Out of them only 14 articles have attempted to provide an explicit definition including a predefined time and prior therapy. There were 10 studies without a clear definition for therapy resistant constipation. The duration before being diagnosed as therapy resistant constipation varied from 1 months to 2 years among studies. Seven studies employed the Rome criteria (Rome III or Rome IV) to characterising constipation, while 5 adopted the Rome III and European and North American paediatric societies definition of paediatric gastroenterology, hepatology and nutrition guideline of management of constipation in children. Conclusion The current literature has no explicit definition for therapy resistant constipation in children. There is a need for a detailed consensus definition to ensure consistency of future research and to avoid unnecessary, and maybe even harmful, invasive diagnostic and therapeutic interventions

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