Objectives and Study

BACKGROUND
Functional gastrointestinal disorders (FGID) are disorders of gut brain interaction. ROME criteria, a symptom-based criteria helps in early diagnosis of FGID.

OBJECTIVE
To identify the clinical spectrum of functional GI disorders (FGID) in children one month to 16 years in a tertiary care centre, overlap of FGIDs and impact of FGID on regular school visits.

Methods

STUDY DESIGN
Prospective observational study.

PARTICIPANTS
All children of age 1 month to 16 years with FGID diagnosed by ROME IV criteria.

INTERVENTION
All children 1 month to 16 years suspected to have FGID were evaluated and appropriate investigations were done to rule out organic diseases wherever necessary and diagnosed based on ROME IV criteria.

Results

OUTCOME AND RESULTS
Out of the 267 children with FGID, 28.46% belonged to infant/toddler (<4 years group) and 71.54% to the children/adolescent group (≥4 years group). In the infant/toddler group functional constipation (73.68%) was the most common FGID followed by infant regurgitation (21.05%). In children/adolescent cohort, functional defecation disorder was the most common FGID. Functional constipation (80.63%) was the main subtype. Functional abdominal pain disorders were seen in 44.5%, functional dyspepsia being the commonest. Overlap of FGID was seen in 29.31% (≥ 4 years group). 65.09% had school absence.

Conclusions

CONCLUSION
FGID is a positive diagnosis to make with ROME IV criteria which helps in limiting extensive investigations. Functional constipation is the most common FGID in both < 4 years and ≥4 years cohort in our study. Overlap of FGIDs needs to be looked at actively as adequate management of other associated clinical conditions is important to achieve optimal clinical outcome.

Objectives and Study

The aim of this study was to evaluate the efficacy of melatonin in combination with Lactobacillus rhamnosus GG (LGG) in relieving abdominal pain in children with functional abdominal pain disorders (FAPDs). The underlying hypothesis is that melatonin plus probiotics could have a synergistic effect on the brain-gut axis, mediating bi-directional communication.

Methods

This is a double-blind, randomized, placebo-controlled study in patients aged 4–18 years who met Rome IV diagnostic criteria for FAPDs. Patients were randomized to receive melatonin plus LGG (group 1) or a placebo plus LGG (group 2) for four weeks. The primary study endpoint was clinical improvement at week 12 (defined as at least a 50% reduction in the mean abdominal pain index (API) from baseline to week 12). Stool consistency based on the Bristol Stool Form Scale and side effects were also assessed.

Results

Forty-two patients were included (n=22 group 1, n=20 group 2). The most common diagnosis in both groups was irritable bowel syndrome. The primary endpoint was achieved in group 1 but not in group 2. The difference in the distribution of the variation of the scores between the two groups was not significant between baseline and week 12 (p=0.082), but significant between baseline and week 4 (p=0.001)(Figure). The changes in stool consistency were similar in the two groups. Neither new symptoms nor side effects were observed over the study period.

Figure. Distributions of the variations of the API scores between the two groups

Conclusions

Melatonin and LGG in combination appear to be useful in reducing the frequency and intensity of symptoms in children with FAPDs. The concept of a brain-gut microbiome axis was established, mediating bi-directional communication between the gut, its microbiome, and the nervous system. In this study, we hypothesized that the gut microbiota plays a role in ameliorating neurotransmitter secretion disorders in association with melatonin.

Objectives and Study

Functional gastrointestinal disorders (FGIDs) in infants are characterized by a variety of symptoms that are frequently age-dependent, chronic, or recurrent and are not explained by structural or biochemical abnormalities. There are studies in the literature reporting different results regarding the relationship between prematurity and FGIDs. The main objective of this study was to compare the frequency of FGIDs between preterm and term born infants. The secondary objective was to evaluate whether there was any association between feeding type during infancy and development of FGIDs.

Methods

A multicentre prospective cohort study that included preterm infants born before 37 weeks of gestation and healthy term infants was carried out. At 1, 2, 4, 6, 9, and 12 months of age, infants were assessed for the presence of FGIDs using the Rome IV criteria. In preterm born infants, an additional follow-up visit was made at 12 months corrected age.

Results

134 preterm and 104 term infants were enrolled in the study. Infantile colic, rumination syndrome, functional constipation, and infant dyschezia were more common in preterm infants. Incidence of other FGIDs (infant regurgitation, functional diarrhoea and cyclic vomiting syndrome) were similar among preterm and term born infants (Table). Exclusively breastfeed preterm infants in the first 6 months of life have a lower incidence of infantile colic (18.8% vs 52.1%, p=0.025). In terms of chronological age, FGIDs symptoms started later in preterm born infants; this difference was statistically significant for infantile colic and regurgitation (median age 2 months vs 1 month, p<0.001).

Conclusions

Prematurely born infants have a higher prevalence of FGIDs compared with term born controls. Therefore, especially if they have gastrointestinal complaints, they should be screened for FGIDs. Possibly due to maturational differences, the time of occurrence of FGIDs may differ in preterm infants. Infantile colic incidence decreases with exclusive breastfeeding.