Paediatric functional gastrointestinal disorders: Prevalence, patient reported outcomes and guideline implementation

In this thesis, three aspects related to efficiency in healthcare, within the context of paediatric gastroenterology, are addressed. In Part I we studied the prevalence of functional gastrointestinal disorders (FGIDs) in different parts of Europe, to assess the scope of the problem. FGIDs are chronic or recurrent symptoms that cannot be explained by structural or biochemical abnormalities. FGIDs are common, but data regarding the prevalence in young children are scarce. In Part II we described the development of (patient reported) outcomes measures, to improve quality of care. Heterogeneity in definitions and outcomes hampers comparison of efficacy trial results. This issue can be solved by developing a core outcome set (COS) for future studies. A COS contains all outcomes that are considered relevant by stakeholders (healthcare professionals, parents and patients). We systematically reviewed whether heterogeneity in definitions and outcomes exists for infant colic and gastro-oesophageal reflux disease in children. To resolve the heterogeneity that we found, we developed a COS for infant colic and gastro-oesophageal reflux disease in infants. Previous studies demonstrated heterogeneity in definitions and outcomes for childhood constipation as well, thus we also developed a COS for functional childhood constipation. In Part III we investigated guideline implementation to bridge the research-practice gap. We studied implementation of ‘do not do’ recommendations from guidelines, with the aim to reduce inappropriate prescribing. We describe which interventions are effective in reducing inappropriate prescribing in general and we performed a multifaceted implementation strategy to reduce prescribing of acid-suppressants for gastro-oesophageal reflux(disease) in children