Functional Gastrointestinal Disorders (FGIDs), also known as disorders of gut-brain interaction, encompass a wide range of conditions that cannot be attributed to structural, biochemical, or organic abnormalities. These disorders vary significantly from infancy to adulthood, with distinct manifestations in neonates/toddlers and children/adolescents. The ROME criteria, updated periodically, currently in use is ROME IV, which facilitates early and accurate diagnosis of FGIDs. Despite their prevalence, pediatric FGIDs pose diagnostic and therapeutic challenges due to children's inability to articulate symptoms and the influence of developmental factors. These disorders often persist into adulthood, contributing to significant morbidity, absenteeism, healthcare expenditure, and reduced quality of life.
Pathophysiology
The exact pathophysiology of pediatric FGIDs remains elusive, though several factors have been implicated. Genetic predisposition, psychosocial stressors, gut dysbiosis, visceral hypersensitivity, and neuroimmune interactions are among the proposed mechanisms. The complex interplay between these factors leads to altered gut-brain communication, resulting in the manifestation of FGIDs.
Diagnosis
Diagnosing pediatric FGIDs can be challenging, often requiring a detailed history and thorough clinical examination. The ROME IV criteria, which are predominantly symptom-based, facilitate earlier diagnosis by excluding organic causes and minimizing unnecessary investigations. Physicians should be vigilant for red flag signs such as declining weight and height, delayed puberty, painful swallowing, persistent vomiting, bleeding, localized pain, fever, arthritis, perianal disease, and a family history of inflammatory bowel disease or celiac disease. Fecal calprotectin and celiac markers are cost-effective investigations for children with irritable bowel syndrome (IBS)-like symptoms. Early diagnosis, particularly during the first visit, significantly improves recovery outcomes.
Neonate/Toddler FGIDs
Child/Adolescent FGIDs
Management
Management of pediatric FGIDs involves a multidisciplinary approach, including dietary modifications, psychosocial interventions, neuro-stimulatory therapies, and pharmacological management. Fewer trials have focused on pediatric drug-based management, highlighting the need for further research. Providing reassurance, acknowledging symptoms, educating parents, and guiding them to appropriate therapy forms the cornerstone of successful management. Early identification and appropriate treatment hold the potential for cure and improvement in quality of life.
Conclusions
Pediatric FGIDs are complex disorders with a significant impact on children's health and quality of life. The ROME IV criteria facilitate earlier and more accurate diagnosis, while the multidisciplinary approach to management offers hope for improved outcomes. Further research is needed to unravel the exact pathophysiology and develop more effective treatment strategies for these challenging conditions.
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The study was recently published in the Journal of Translational Gastroenterology .
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Journal of Translational Gastroenterology
Pediatric Functional Gastrointestinal Disorders: Pathophysiology, Diagnosis and Management
28-Jun-2024