Schnedl Wolfgang J, Schenk Michael, Michaelis Simon, Enko Dietmar, Mangge Harald
Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
General Internal Medicine Practice, Dr. Theodor Körnerstrasse 19b, A-8600 Bruck, Austria.
Children (Basel). 2023 Aug 24;10(9):1444. doi: 10.3390/children10091444.
Functional abdominal pain disorders (FAPDs) are among the most common types of chronic pain disorders in children. FAPD symptoms are characterized by chronic abdominal pain and changed bowel movements. The pathophysiology of FAPDs in children is unknown, but these conditions may have an imprecise clinical overlap to food intolerance/malabsorption. We report on 51 consecutive children (23/28 males/females; median age 15.3 years) with investigated FAPDs from 2017 to 2022 in this retrospective pilot study. Small intestinal biopsies in children demonstrated the association of lactase and diamine oxidase (DAO), which prompted us to perform hydrogen (H) breath tests for lactose intolerance (LIT) and determine serum DAO for the evaluation of histamine intolerance (HIT) in pediatric patients with FAPDs. To complete the food intolerance/malabsorption evaluation tests, we included a search for antibodies against tissue transglutaminase to find celiac disease (CD), performed H breath tests to detect fructose malabsorption (FM), and conducted a search for IgA antibodies against infection. The results demonstrate that all 51 children evaluated were diagnosed with food intolerance/malabsorption and/or various combinations thereof. Seven children showed FM, eight of the children had HIT, and eight children had LIT. The other children had combinations: thirteen children (25.5%) had HIT and LIT, seven children (9.8%) had FM with HIT, five children (13.7%) had FM and LIT, and three children (5.9%) had a triple combination of FM, HIT, and LIT. By describing this method of personalized investigation for food intolerance/malabsorption in children with FAPDs, we demonstrate that functional abdominal pain disorders may be associated with food intolerance/malabsorption. After such diagnosis in this pediatric population, a registered dietitian helped to establish a reduction and/or exclusion diet individually tailored to their symptomatology.
功能性腹痛障碍（FAPD）是儿童中最常见的慢性疼痛障碍类型之一。FAPD的症状以慢性腹痛和排便习惯改变为特征。儿童FAPD的病理生理学尚不清楚，但这些病症可能与食物不耐受/吸收不良存在不确切的临床重叠。在这项回顾性试点研究中，我们报告了2017年至2022年连续51例接受FAPD调查的儿童（23例男性/28例女性；中位年龄15.3岁）。对儿童进行的小肠活检显示了乳糖酶和二胺氧化酶（DAO）之间的关联，这促使我们对FAPD患儿进行乳糖不耐受（LIT）的氢（H）呼气试验，并测定血清DAO以评估组胺不耐受（HIT）。为了完成食物不耐受/吸收不良评估测试，我们进行了抗组织转谷氨酰胺酶抗体检测以查找乳糜泻（CD），进行H呼气试验以检测果糖吸收不良（FM），并进行了抗感染IgA抗体检测。结果表明，所有接受评估的51名儿童均被诊断为食物不耐受/吸收不良和/或其各种组合。7名儿童出现FM，8名儿童有HIT，8名儿童有LIT。其他儿童有多种组合：13名儿童（25.5%）有HIT和LIT，7名儿童（9.8%）有FM合并HIT，5名儿童（13.7%）有FM和LIT，3名儿童（5.9%）有FM、HIT和LIT的三联组合。通过描述这种针对FAPD患儿食物不耐受/吸收不良的个性化调查方法，我们证明功能性腹痛障碍可能与食物不耐受/吸收不良有关。在对该儿科人群进行此类诊断后，注册营养师帮助根据他们的症状制定了个性化的减少和/或排除饮食方案。
