University Children's Hospital of Basel, Spitalstrasse, 4055, Basel, Switzerland.
Children's Hospital of Aarau, Tellstrasse 9, 5001, Aarau, Switzerland.
Sci Rep. 2022 Jan 27;12(1):1467. doi: 10.1038/s41598-022-05380-y.
Functional dyspepsia is very common in children of all ages and has a significant impact on the patient's family and quality of life. Since the revision of the Rome IV criteria with the introduction of two subtypes, the prevalence of functional dyspepsia has increased, but currently no guidelines for the treatment are available. The aim of this study was to characterize patients, who have been diagnosed with functional dyspepsia and analyze the outcome of different treatments they received. This is a retrospective study of pediatric patients, diagnosed with functional dyspepsia between March 2017 and September 2020. All patients aged between 0 and18 years, who complained about gastric symptoms, have had a normal full blood count, a normal thyroid function, a negative coeliac screening, and most importantly normal macro- and microscopic findings on esophago-gastro-duodenoscopy were included in the study. Patient's data were extracted from the medical record and three months after the performance of the endoscopy, parents were interviewed about the effect of the treatment. A total of 154 patients (66.2% female, 33.8% male) between the age of 4 and 18 years were included. In 113 (73.4%) the leading symptom was epigastric pain, followed by nausea (22; 14.3%) and a fifth of the patients (females: 18.6%; males: 21.2%) self-reported a current stressor in clinic. After receiving the diagnosis of a functional nature, families chose following treatments: 50 STW5 (32.3%, overall, 10.4% added dietary changes, alternative treatment, and psychology support), psychological support (22.7%), alternative treatments (e.g., hypnotherapy, meditation; 19.5%), dietary changes (12.9%), lifestyle changes (9.7%), no treatment (11%) and in 10.4% no treatment was needed as symptoms resolved after endoscopy had been performed. Only lifestyle changes (p = 0.03) in females, dietary changes (p = 0.035 for girls, p = 0.06 for boys) and STW5 in males (p = 0.043) showed a statistically relevant correlation regarding duration of symptoms. There was no correlation between location of symptoms and effectiveness of treatment. It is recommended to treat patients from both subgroups of functional dyspepsia differently, in accordance with the currently available explanatory models of underlying pathophysiological processes. In this cohort of patients this could not be verified. As all patients did benefit from any treatment, it is likely that the treatment itself was not accountable for the relief of symptoms, but that most patients benefit from education on the diagnosis, reassurance and a recommendation of a healthy lifestyle. Some patients might benefit from medications, small changes in the diet, psychological support or alternative treatment, but success depends on individual, unpredictable factor.
功能性消化不良在各个年龄段的儿童中都很常见,对患者及其家庭的生活质量有重大影响。自罗马 IV 标准修订引入两种亚型以来,功能性消化不良的患病率有所增加,但目前尚无治疗指南。本研究旨在对诊断为功能性消化不良的患者进行特征描述,并分析他们接受不同治疗的效果。这是一项回顾性研究,纳入了 2017 年 3 月至 2020 年 9 月期间诊断为功能性消化不良的儿科患者。所有纳入研究的患者均为 0 至 18 岁,有胃部症状,全血细胞计数、甲状腺功能正常,无麸质不耐受,最重要的是上消化道内镜检查未见明显宏观和微观异常。从病历中提取患者数据,在进行内镜检查三个月后,对家长进行治疗效果的访谈。共纳入 154 名(66.2%为女性,33.8%为男性)年龄在 4 至 18 岁之间的患者。113 名(73.4%)患者的主要症状是上腹痛,其次是恶心(22 名;14.3%),五分之一的患者(女性:18.6%;男性:21.2%)在就诊时报告有当前的应激源。在诊断为功能性疾病后,患者家庭选择了以下治疗方法:50 名接受 STW5(32.3%,总体上 10.4%增加了饮食改变、替代治疗和心理支持)、心理支持(22.7%)、替代治疗(如催眠疗法、冥想;19.5%)、饮食改变(12.9%)、生活方式改变(9.7%)、未治疗(11%),10.4%的患者无需治疗,因为内镜检查后症状缓解。仅女性的生活方式改变(p=0.03)、女孩的饮食改变(p=0.035,男孩 p=0.06)和男孩的 STW5(p=0.043)与症状持续时间有统计学相关性。症状位置与治疗效果之间无相关性。建议根据目前功能性消化不良潜在病理生理过程的解释模型,对两种亚型的患者进行不同的治疗。但在本队列患者中,这一点尚未得到证实。由于所有患者均从任何治疗中获益,因此症状缓解可能不是治疗本身所致,而大多数患者受益于对诊断、安慰和健康生活方式的教育。一些患者可能受益于药物治疗、饮食的小改变、心理支持或替代治疗,但成功取决于个体的、不可预测的因素。
Sci Rep. 2022-1-27
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