Madani Shailender, Parikh Suchi, Madani Rohit S, Krasaelap Amornluck
The Carman Ann Adam Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA.
Cook Children's Physician Network, 2755 Miller Ave, Forth Worth, TX 76105, USA.
Gastroenterology Res. 2017 Apr;10(2):84-91. doi: 10.14740/gr798w. Epub 2017 Apr 19.
Our study evaluated progression of and identified potential factors contributing to outcomes of ROME III defined-functional gastrointestinal disorders (FGIDs) in children treated symptomatically in a biopsychosocial model of care with a long-term follow-up.
We performed a retrospective review of pediatric patients who were diagnosed with ROME III defined-FGIDs including functional abdominal pain, functional dyspepsia, irritable bowel syndrome and abdominal migraine. Patients were managed symptomatically in a biopsychosocial model of care from the time of initial diagnosis. Demographics, management, progression and response to treatment assessed as complete, partial, and no improvement were reviewed.
Two hundred fifty-eight patients were included with mean age of 10.6 years, female 55.4%, mean number of encounters 3.3 visits, and mean follow-up was 18.7 months (range 2 - 59, SD 15.8). Diagnoses were functional abdominal pain 45%, irritable bowel syndrome 20.9%, multiple 13.2%, functional dyspepsia 12.8%, and abdominal migraine 8.1%. Investigations were performed in most patients: laboratory studies in 93.4% (non-contributory abnormal 23.6%), imaging studies in 45.3% (non-contributory abnormal 5%) and endoscopies in 43.0% (non-contributory abnormal 1.2%). Treatment included medication in 93.7%, and surgery in 1.9% (normal pathology). There were new functional gastrointestinal diagnosis in 11.6%, evolution of FGIDs, from one to another in 12.0%, and recurrence found in 35.7% of patients. There were 60.1% patients in the complete improvement group (CIG) and 39.1% in the partial/no improvement group (PIG/NIG). No statistical difference was found between CIG and PIG/NIG regarding demographics or evaluation. PIG/NIG had more encounters (mean 3.63 vs. 3.11; P = 0.03), had non-contributory lab abnormalities (34.4% vs. 20.0%; P = 0.01), needed more endoscopies (52.4% vs. 36.8%; P = 0.02), required more treatment changes (mean 1.41 vs. 0.81; P < 0.01) and developed new functional gastrointestinal diagnoses (19.4% vs. 6.5%; P < 0.01) with long-term follow-up.
Patients with ROME III defined-FGIDs who experience partial or no improvement with treatment develop new FGID diagnosis, need more number of follow-up visits, require more number of endoscopies, need more treatment changes, and have more non-contributory laboratory abnormalities, compared to those who experience complete improvement. Symptomatic treatment offered in a biopsychosocial model of care is possibly beneficial in managing children with FGIDs.
我们的研究评估了在生物心理社会护理模式下接受对症治疗并长期随访的儿童中，罗马III型功能性胃肠疾病（FGIDs）的病情进展，并确定了影响其预后的潜在因素。
我们对被诊断为罗马III型FGIDs的儿科患者进行了回顾性研究，这些疾病包括功能性腹痛、功能性消化不良、肠易激综合征和腹型偏头痛。从初次诊断时起，患者就在生物心理社会护理模式下接受对症治疗。回顾了患者的人口统计学资料、治疗情况、病情进展以及对治疗的反应，治疗反应分为完全缓解、部分缓解和无改善。
共纳入258例患者，平均年龄10.6岁，女性占55.4%，平均就诊次数为3.3次，平均随访时间为18.7个月（范围2 - 59个月，标准差15.8）。诊断为功能性腹痛的患者占45%，肠易激综合征占20.9%，多种疾病并存占13.2%，功能性消化不良占12.8%，腹型偏头痛占8.1%。大多数患者进行了检查：93.4%的患者进行了实验室检查（无诊断意义的异常结果占23.6%），45.3%的患者进行了影像学检查（无诊断意义的异常结果占5%），43.0%的患者进行了内镜检查（无诊断意义的异常结果占1.2%）。93.7%的患者接受了药物治疗，1.9%的患者接受了手术治疗（病理结果正常）。11.6%的患者出现了新的功能性胃肠疾病诊断，12.0%的患者FGIDs病情从一种类型演变为另一种类型，35.7%的患者病情复发。完全缓解组（CIG）有60.1%的患者，部分缓解/无改善组（PIG/NIG）有39.1%的患者。在人口统计学资料或评估方面，CIG和PIG/NIG之间未发现统计学差异。PIG/NIG的就诊次数更多（平均3.63次对3.11次；P = 0.03），有更多无诊断意义的实验室异常结果（34.4%对20.0%；P = 0.01），需要更多的内镜检查（52.4%对36.8%；P = 0.02），需要更多的治疗调整（平均1.41次对0.81次；P < 0.01），并且在长期随访中出现新的功能性胃肠疾病诊断的比例更高（19.4%对6.5%；P < 0.01）。
与完全缓解的患者相比，接受治疗后部分缓解或无改善的罗马III型FGIDs患者会出现新的FGID诊断，需要更多的随访就诊次数，需要更多的内镜检查，需要更多的治疗调整，并且有更多无诊断意义的实验室异常结果。在生物心理社会护理模式下提供的对症治疗可能有助于管理患有FGIDs的儿童。
