Disorders of gut-brain interaction are common diagnoses among infants and toddlers in gastroenterology practices in Latin-America.

OBJECTIVES: To assess the relative frequency and associated factors of disorders of gut-brain interaction (DGBIs) in outpatient gastrointestinal (GI) clinics in young children of Latin America. METHODS: Cross-sectional study in 10 pediatric GI outpatient clinics (private and public) in five countries of Latin America (El Salvador, México, Colombia, Panamá, and Nicaragua). Parents of patients 1 month 4 years of age from outpatient clinics complete/d a diagnostic questionnaire for DGBIs per Rome IV criteria (QPGS-IV, Spanish version). We conducted descriptive analysis, two-sample t-tests and chi-square tests, univariate analyses, and logistic regression to evaluate risk factors. RESULTS: We collected data from 783 children. In total, 34.5% had a DGBI. Overall, functional constipation (FC) was the most common diagnosis (23.4%) in children of all ages (infants, 16.1%, 1-4-years-old, 32.7%). In infants, the second most common DGBI was regurgitation (6.6%) and in 1-4-years-old and cyclic vomiting syndrome (4.1%). The diagnosis of a DGBI was significantly associated with a family history of DGBIs (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.61-5.57, p = 0.0001). Patients who identified as black (OR 2.25, 95% CI 1.28-3.92, p = 0.0021) or mixed race (OR 1.76, 95% CI 1.25-2.48, p = 0.0006) were also significantly associated with a higher likelihood of DGBIs. CONCLUSIONS: DGBIs are a common diagnosis in pediatric GI clinics of Latin America. Overall, FC was the most common DGBI.

Diagnostic Accuracy of the Rome IV Criteria for the Diagnosis of Functional Gastrointestinal Disorders in Children.

ABSTRACT: The diagnosis of functional gastrointestinal disorders (FGIDs) centers on symptoms-based criteria (Rome criteria). The last edition of the criteria was published in 2016. Still, few data on its validity support its use in children. We conducted a study aimed at determining the diagnostic accuracy of the Rome IV criteria through the application of questionnaires (Questionnaire of Pediatric Gastrointestinal Symptoms-Rome IV QPGS-IV) to diagnose FGIDs in children. We hypothesized that the Rome IV criteria has adequate diagnostic accuracy supporting its use for diagnosing FGIDs in children. METHODS: School children ages 10 to 18 years from Cali (Colombia) completed the Spanish version of the QPGS-IV. Children with FGIDs were matched with a group of children without FGIDs. Both groups had a medical consultation with a blinded experienced pediatric gastroenterologist (criterion standard) who provided his diagnosis. The questionnaire-based diagnoses were compared with the consultation's diagnoses. RESULTS: Of 487 schoolchildren surveyed with the QPGS-IV, 97 (20.8%) had FGIDs. Eighty-nine with FGIDs were matched with 92 children without FGIDs (mean age 13.1 years [±1.3]). We found a higher prevalence of FGIDs during the medical visit than using the self-report QPGS-IV (66.3% vs 49.2%, P = 0.001), mainly in abdominal pain disorders (19.3% vs 10.5%, P = 0.013). The Rome IV diagnostic criteria using the QPGS-IV had a sensitivity of 75% (95% confidence interval, 59-79) and 90% specificity (95% confidence interval, 83-98). Positive predictive value is 85.8%, and negative predictive value is 79.9%. CONCLUSION: Our study suggests that the QPGS-IV has adequate diagnostic accuracy.

Functional gastrointestinal disorders in children: agreement between Rome III and Rome IV diagnoses.

To evaluate the agreement between the Rome III and Rome IV criteria in diagnosing pediatric functional gastrointestinal disorders (FGIDs), we conducted a prospective cohort study in a public school in Cali, Colombia. Children and adolescents between 11 and 18 years of age were given the Spanish version of the Questionnaire on Pediatric Functional Gastrointestinal Disorders Rome III version on day 0 and Rome IV version on day 2 (48 h later). The study protocol was completed by 135 children. Thirty-nine (28.9%) children were excluded because of not following the instructions of the questionnaire. The final analysis included data of 96 children (mean 15.2 years old, SD ± 1.7, 54% girls). Less children fulfilled the criteria for an FGID according to Rome IV compared to Rome III (40.6% vs 29.2%, p=0.063) resulting in a minimal agreement between the two criteria in diagnosing an FGID (kappa 0.34, agreement of 70%). The prevalence of functional constipation according to Rome IV was significantly lower compared to Rome III (13.5% vs 31.3%, p<0.001), whereas functional dyspepsia had a higher prevalence according to Rome IV than Rome III (11.5% vs 0%).Conclusion: We found an overall minimal agreement in diagnosing FGIDs according to Rome III and Rome IV criteria. This may be partly explained by the differences in diagnostic criteria. However, limitations with the use of questionnaires to measure prevalence have to be taken into account. What is Known: • The Rome IV criteria replaced the previous Rome III criteria providing updated criteria to diagnose functional gastrointestinal disorders (FGIDs). • Differences found between Rome IV and historic Rome III FGID prevalence may have been affected by changes in prevalence over time or differences in sample characteristics. What is New: • We found a minimal agreement between Rome III and Rome IV FGID diagnosis, especially in the diagnoses of functional constipation, irritable bowel syndrome, and functional dyspepsia. • The minimal agreement may be partly explained by changes in diagnostic criteria, but limitations with the use of questionnaires to measure prevalence have to be taken into account.

The Relationship Between Prematurity, Method of Delivery, and Functional Gastrointestinal Disorders in Children.

OBJECTIVE: The pathogenesis of functional gastrointestinal disorders (FGIDs) remains unknown. Early life events including method of delivery and length of gestation may be risk factors for FGIDs. Data from studies on early life events and the development of FGIDs are scarce and contradictory. OBJECTIVE: The aim of the study was to assess the association between mode of delivery, length of gestation, and FGIDs in children. We hypothesized that delivery via Cesarean section and prematurity would be associated with an increased prevalence of FGIDs. METHODS: Questionnaires were mailed to families from 3 cities in Colombia. Parents provided information on mode of delivery, demographics, and medical history. School children completed the Spanish version of the Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV. Categorical data were analyzed using Fisher exact tests. Calculation of odds ratio with 95% confidence interval was performed. RESULTS: A total of 1497 children (535 preadolescents 10-12 years, 962 adolescents 13-18 years) participated. For participants born via Cesarean delivery, there was no significant increase in prevalence of any of the Rome IV FGIDs compared with vaginal delivery. There was a significant association between prematurity and FGIDs for those born between 28 and 32 weeks (confidence interval 0.99-3.37; P = 0.03). In this group, functional nausea was the only category of FGID to reach significance (0.16-112.23) (P = 0.02). However, statistical significance was lost when gestational ages were grouped together with multivariate analysis. CONCLUSIONS: Our findings provide evidence that Cesarean delivery and prematurity are not risk factors for the development of FGIDs. Future studies are indicated to further evaluate the relationship between early life events and FGIDs.

Colombian School Children With Functional Gastrointestinal Disorders Respond Differently to Family Stress Than Healthy Children.

Our objective is to compare coping methods, stress responses, and resilience in children with and without functional gastrointestinal disorders (FGIDs) in response to common sources of stress. We performed a case-control study. Children meeting criteria for FGIDs and matched controls completed measures of response to stress (Peer Stress, Family Stress, Academic Problems, and Recurrent Abdominal Pain versions of the Response to Stress Questionnaire) and resilience (Connor-Davidson Resilience Scale 10). We included 134 children with an FGID (57 with functional constipation and 74 with an abdominal pain-predominant FGID) and 135 controls. Children with FGIDs were more likely to take action (P < 0.001) and less likely to remain involuntarily engaged (P < 0.001) in response to family stress. Response to peer and academic stress and measures of resilience were similar between groups. Further research is needed to better understand the role that family stress and a child's response play in the pathophysiology of pediatric FGIDs.

Functional Gastrointestinal Disorders and Joint Hypermobility: A School-based Study.

The aim of the study was to assess the prevalence of joint hypermobility (JH) among school children with and without functional gastrointestinal disorders (FGIDs). School children completed validated Rome III questionnaires to diagnose FGID. Each child diagnosed with an FGID was matched for age and sex with a healthy control. The prevalence of JH in both groups was compared. A total of 654 school children participated in the study. One hundred forty-eight (22.6%) children were diagnosed with an FGID. Data from 136 FGIDs and 136 healthy controls were analyzed. Joint laxity was assessed to establish the Beighton score (≥4 was considered JH). There was no significant difference in JH between children with and without diagnoses of FGIDs odds ratio (OR) 1.03 (95% confidence interval [CI]: 0.59-1.81, P = 0.89). Multivariate analysis showed that younger age OR 2.31 (95% CI: 1.30-4.10, P = 0.004) and female sex OR 2.27 (95% CI: 1.22-4.24, P = 0.009) were significantly associated with JH. JH is equally prevalent in school children with and without FGIDs.

Prospective Study of Gastrointestinal Symptoms in School Children of South America.

OBJECTIVES: The aim of the study was to establish the prevalence of abdominal pain (AP) in school children in Pasto (Colombia) and determine the effect of AP on their daily activities; and compare the prevalence of AP and other gastrointestinal symptoms between school children from Pasto and Chicago. METHODS: Fourth- and fifth-grade students from a public school and a private school in Colombia were invited to participate in a prospective study using the same methods and questionnaires (Spanish version) as a previous study conducted in Chicago schools. Children completed weekly confidential surveys for 8 consecutive weeks. RESULTS: A total of 332 children participated in the study (40% girls, mean age 9.97 years, median 10, range 8-12 years): public school (288), private school (44). A total of 2425 surveys were analyzed. Out of 2656 possible weekly surveys (332 children × 8 weeks), 91.3% were completed. Overall weekly prevalence of gastrointestinal symptoms: AP (39%), nausea (29.5%), constipation (14%), diarrhea (10.5%), vomiting (9%). Children with AP reported interference with activities: gym (21.9%), school (17.3%), difficulty sleeping (13.7%), and social activities (12.6%). Out of all children, 8.4% sought medical attention for AP during the study period. CONCLUSIONS: Gastrointestinal symptoms are common in school-aged children in Colombia and interfere with both daily activities and school attendance. The prevalence of AP, diarrhea, and vomiting found in the present study was similar to published prevalence of American children using similar methods.

Multicountry cross-sectional study found that functional gastrointestinal disorders such as colic and functional dyschezia were common in South American infants.

AIM: Our aim was to perform a population-based study using Rome III criteria to describe the prevalence of functional gastrointestinal disorders (FGIDs) in infants in three countries in South America. METHODS: We conducted a multicountry, cross-sectional study to investigate the epidemiology of functional gastrointestinal disorders in children aged 0-12 months of age, using the Rome III criteria, in Colombia, Panama and Nicaragua. These patients presented for well-child visits in primary care clinics in the three countries between May 2015 and October 2016. A Spanish version of the Questionnaire on Paediatric Gastrointestinal Symptoms for Infants and Toddlers was used for the data collection. RESULTS: We included questionnaires completed by 351 parents, and they reported at least one FGID in 141 (40%) infants. The majority were male (56%), with a median age of seven months. Colic and functional dyschezia were the most commonly diagnosed disorders in the whole cohort, at 23% and 15%, respectively. The risk of developing FGIDs was not affected by the marital status of the mother, number of siblings, birth order and history of diarrhoea. CONCLUSION: Functional gastrointestinal disorders were common in infants from the South American countries of Colombia, Panama and Nicaragua, particularly colic and functional dyschezia.

Assessing Children's Report of Stool Consistency: Agreement Between the Pediatric Rome III Questionnaire and the Bristol Stool Scale.

OBJECTIVES: To assess the agreement between the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-RIII) and the Bristol Stool Scale (BSS) in evaluating stool consistency and the diagnosis of functional constipation in children. STUDY DESIGN: Children aged 8-18 years were asked to describe their stool consistency in the previous month according to the QPGS-RIII and the BSS. Stool consistency according to both instruments was categorized into 3 categories: "hard," "normal," and "liquid." The children's reported stool consistency using the QPGS-RIII and the BSS were compared, and the intrarater agreement between the 2 instruments was measured using the Cohen kappa coefficient (κ). The diagnosis of functional constipation was based on the Rome III criteria, incorporating the assessment of stool consistency according to the QPGS-RIII and the BSS. RESULTS: A total of 1835 children were included. Only slight agreement existed between the QPGS-RIII and the BSS for assessing stool consistency (κ = .046; P = .022). Significantly more children reported hard stools on the BSS compared to the QPGS-RIII (18.0% vs 7.1%; P = .000). The prevalence of functional constipation was 8.6% using the QPGS-RIII and 9.3% using the BSS (P = .134). CONCLUSIONS: Only slight agreement exists between the QPGS-RIII and the BSS in the evaluation of stool consistency in children. Better instruments are needed to assess the consistency of stools with a high degree of reliability, both in research and in the clinical setting.

Sex, Age, and Prevalence of Pediatric Irritable Bowel Syndrome and Constipation in Colombia: A Population-based Study.

OBJECTIVES: Our objective was to evaluate the role of sex and age in the prevalence of irritable bowel syndrome (IBS) and functional constipation (FC) in Colombian children. We hypothesized that the prevalence of IBS and FC would be higher in female adolescents than in younger female children, with no corresponding difference in boys. METHODS: We performed a cross-sectional study of Colombian children. Subjects completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III. Subjects were divided into child and adolescent age groups using 2 different cutoffs. Cutoffs were established at 12 and 13 years (CH-1 = 8-12 years, AD-1 = 13-18 years, CH-2 = 8-13 years, AD-2 = 14-18 years). RESULTS: A total of 3891 subjects (47.0% F, mean age 12.0 years) participated. One hundred eighty-seven (4.8%) met criteria for IBS. There was no difference in sex composition between CH-1/AD-1 (56.0%, 43.5% F) and CH-2/AD-2 (53.4%, 46.8% F). Prevalence of IBS among girls was higher in CH-1 than that in AD-1 (6.4%, 3.7%, P < 0.05) and overall prevalence was higher in CH-1 than in AD-1 (5.4%, 4.0%, P < 0.05). Four hundred ninety-four (12.7%) children met criteria for FC. There was no difference in sex composition between CH-1/AD-1 (47.6%, 48.7% F) and CH-2/AD-2 (47.7%, 49.0% F). Prevalence of FC among girls was higher in CH-1/CH-2 (14.6%, 14.1%) than in AD-1/AD-2 (10.4%, P < 0.01; 9.9%, P < 0.05). Prevalence of FC overall was higher in CH-1/CH-2 (14.5%, 14.0%) than in AD-1/AD-2 (10.0%, P < 0.0001; 9.3%, P < 0.0001). CONCLUSIONS: We did not find a significant female predominance among Colombian children with IBS or FC. Contrary to our hypothesis, IBS and FC prevalence was generally higher in younger children compared with adolescents regardless of sex.

A Population-Based Study on the Epidemiology of Functional Gastrointestinal Disorders in Young Children.

OBJECTIVE: To perform a population-based study with Rome III criteria to describe the prevalence of functional gastrointestinal disorders (FGIDs) in children in Colombia. STUDY DESIGN: We conducted a multicity cross-sectional study to investigate the epidemiology of FGIDs in children 0-48 months of age using the Rome III criteria in Colombia. Children with organic medical diseases were excluded. Parents provided demographic information and completed the Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms for Infants & Toddlers. RESULTS: Parents of 1231 subjects completed the questionnaires; 48 children were excluded due to presence of organic diseases and being older than 48 months of age. Four hundred eighty children (40.5%) were diagnosed with at least 1 FGID according to the Rome III diagnostic criteria (49% female, median 12 months). Functional constipation was the most commonly diagnosed disorder in infants (up to 12 months of age) and children of ages 13-48 months (16.1% and 26.8%, respectively). Analysis revealed that the prevalence of FGID was significantly greater in children who were the only child in the family (P = .003), children who were first-born (P = .007), and children with divorced or separated parents. (P = .001). CONCLUSIONS: FGIDs are common in children younger than 4 years of age. Functional constipation and infant colic were the most common FGIDs in infants (up to 12 months of age), and functional constipation and rumination were the most common FGIDs in children 13-48 months of age.

Using the Bristol Stool Scale and Parental Report of Stool Consistency as Part of the Rome III Criteria for Functional Constipation in Infants and Toddlers.

OBJECTIVES: To evaluate among parents of infants and toddlers the agreement between parental report and the Bristol Stool Scale (BSS) in assessing stool consistency and the effect of both methods on determining the prevalence of functional constipation (FC) according to the Rome III criteria. STUDY DESIGN: Parents of children ≤48 months of age who were seen for a well-child visit completed a questionnaire about their child's bowel habits during the previous month. Cohen kappa coefficient (κ) was used to measure intrarater agreement between parental report of stool consistency ("hard," "normal," "soft/mucous/liquid") and the BSS (types 1-2, hard; types 3-5, normal; types 6-7, loose/liquid). The prevalence of FC was assessed based on the questionnaire according to the Rome III criteria, comparing both methods of stool consistency assessment. RESULTS: Parents of 1095 children (median age, 15 months; range, 1-48) were included. Only fair agreement existed between the 2 methods of stool consistency assessment (κ = 0.335; P < .001). According to the Rome III criteria, using parental report the prevalence of FC was 20.5% and using the BSS the prevalence was 20.9% (P = .87). The agreement between these 2 methods for assessing the prevalence of FC was excellent (κ = 0.95; P < .001). CONCLUSIONS: Only fair agreement exists between the BSS and parental report of stool consistency among parents of infants and toddlers. Different methods of stool consistency assessment did not result in a difference in the prevalence of FC.

Is There an Association between Functional Constipation and Excessive Bodyweight in Children?

OBJECTIVES: To determine the prevalence of functional constipation, overweight, and obesity in a cross-sectional observational study among children in Colombia and to examine the association between functional constipation and excessive bodyweight in this population. STUDY DESIGN: Demographics, anthropometric data, and questionnaires were collected from 2820 children between 8 and 18 years of age across 4 regions in Colombia. A Spanish translation of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version was used to determine the prevalence of functional constipation. Anthropometric measurements of weight, height, and body mass index (BMI) were obtained following World Health Organization guidelines; overweight was defined as a BMI z-score (adjusted for sex and age) between 1 and 2, obesity was defined as a BMI z-score >2. RESULTS: A total of 368 children (13.0%) were found to have functional constipation, 542 children (19.2%) were overweight, and 188 children (6.7%) were obese. Functional constipation did not occur more frequently in children who were obese (14.9%) or overweight (13.1%) compared with children with normal weight (12.9%, P = .73). The prevalence of functional constipation, overweight, and obesity differed significantly between regions. Functional constipation and excessive bodyweight were significantly more common in children attending private schools compared with children attending public schools. CONCLUSIONS: Functional constipation, overweight, and obesity are commonly observed in children in Colombia. No association between functional constipation and overweight or obesity was found.

Prevalence of Functional Gastrointestinal Disorders in Schoolchildren in Ecuador.

The prevalence of functional gastrointestinal disorders (FGIDs) in children in Ecuador is unknown. We describe a survey study in 2 schools in Quito, Ecuador, using a Spanish translation of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-RIII). A total of 417 children (51% boys) with a mean age of 12.0 years were included. FGIDs were present in 95 children (22.8%) and occurred in 25% of girls and in 20.7% of boys (P = 0.296). Functional defecation disorders were found in 12.0% of children, 9.4% had an abdominal pain-related FGID and 3.8% was diagnosed with a vomiting or aerophagia FGID.

The prevalence of functional gastrointestinal disorders in children in Panama: a school-based study.

AIM: Functional gastrointestinal disorders (FGIDs) are common in children, but the epidemiology of FGIDs is incompletely understood. Our aim was to perform a population-based study using Rome III criteria to describe the prevalence of FGIDs in children in Panama. METHODS: We performed a cross-sectional study of children attending three schools in Panama City, Panama. Children with organic medical diseases were excluded. Subjects provided demographic information and completed the Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III Spanish version. RESULTS: A total of 321 subjects (61.1% female, median age 10 years, range 8-14 years) completed our study. A total of 92 subjects (28.7%) met criteria for an FGID. Gender, age and school type did not differ significantly between subjects with and without FGIDs. The most common FGIDs included functional constipation (15.9%), irritable bowel syndrome (5.6%), and functional abdominal pain or functional abdominal pain syndrome (4.0%). Abdominal pain-related FGIDs were present in 12.1%. CONCLUSION: FGIDs are common in school-aged children in Panama. The prevalence of abdominal pain-related FGIDs in children in Panama is similar to that described in other parts of the world. Further population-based studies utilising Rome III criteria to measure FGID prevalence in children are needed to advance our understanding of the pathogenesis of FGIDs.

Construct validity of the pediatric Rome III criteria.

OBJECTIVES: Functional gastrointestinal disorders (FGIDs) are common. The diagnosis of FGIDs is based on the Rome criteria, a symptom-based diagnostic classification established by expert consensus. There is little evidence of validity for the pediatric Rome III criteria. The construct validity of the criteria, an overarching term that incorporates other forms of validity, has never been assessed. We assessed the construct validity of the Rome III criteria. METHODS: Children from 2 schools in Colombia completed the Questionnaire on Pediatric Gastrointestinal Symptoms at baseline and weekly questionnaires of somatic symptoms and disability for 8 weeks (presence and intensity of gastrointestinal symptoms, nongastrointestinal symptoms, impact on daily activities). A total of 255 children completed at least 6 weekly surveys (2041 surveys). RESULTS: At baseline, 27.8% children were diagnosed as having an FGID. Prevalence of nausea (Δ 7.8%, 95% confidence interval [CI] 4.46-11.14), constipation (Δ 4.39%, 95% CI 1.79-6.99), diarrhea (Δ 6.69%, 95% CI 3.25-10.13), headache (Δ 7.4%, 95% CI 3.51-11.09), chest pain (Δ 9.04%, 95% CI 5.20-12.88), and limb pain (Δ 4.07%, 95% CI 1.76-6.37) and intensity of nausea (Δ 0.23, 95% CI 0.127-0.333), diarrhea (Δ 0.30, 95% CI 0.211-0.389), abdominal pain (Δ 0.18, 95% CI 0.069-0.291), headache (Δ 0.17, 95% CI 0.091-0.249), and limb pain (Δ 0.30, 95% CI 0.084-0.516) were higher in children with FGIDs (P < 0.001). Children with FGIDs had greater interference with daily activities (P < 0.001). CONCLUSIONS: Children with a Rome III diagnosis had significantly more gastrointestinal and nongastrointestinal complaints, and greater intensity of symptoms and disability than children without an FGID diagnosis. The study suggests that the Rome III pediatric criteria have adequate construct validity.

Utility of the Brussels Infant and Toddler Stool Scale (BITSS) and Bristol Stool Scale in non-toilet-trained children: A large comparative study.

BACKGROUND: One of the criteria for functional constipation (FC) in Rome IV criteria is the presence of hard or painful bowel movements. In adults and children, the Rome IV criteria recommend the use of the Bristol Stool Scale (BSS). This scale is thought not to be appropriate for evaluation of stool consistency in young children. The Brussels Infant and Toddler Stool Scale (BITSS) was developed as a scale for children wearing diapers. There are no prior studies comparing BITSS with BSS in a clinical setting. Our main aim was that BITSS behaves differently than the BSS as it reflects better stool characterization by parents. METHODS: Surveys were provided to parents of participants in two cities from Colombia which included the Rome IV-validated questionnaire and stool consistency assessment using pictures for BSS and BITSS. KEY RESULTS: A total of 666 responses were obtained for non-toilet-trained children, mean age was 16.6 months. Detection for normal stools was higher using BSS (58.6%) when compared to BITSS (13.6%), and conversely was more likely to be abnormal through BITSS (86.4%) than BSS (41.4%) (p < 0.0001). BITSS (57.4%) was better than BSS (25.3%) identifying hard stools in FC (p = 0.000). For hard stools per parental classification, BITSS' definition was better than BSS (75.8% vs 44%, respectively, p = 0.000). CONCLUSIONS: The BITSS and BSS behave differently. The BITSS seems to be more sensitive to detect hard stools and FC than BSS. More studies are needed to better define whether BITSS is appropriate to replace BSS in non-toilet-trained infants and toddlers.