Tersteeg Seth M, Borowitz Stephen M
Department of Pediatrics, University of Virginia, Charlottesville, VA, United States.
Front Pediatr. 2024 Dec 12;12:1503783. doi: 10.3389/fped.2024.1503783. eCollection 2024.
Chronic abdominal complaints are common in school-aged children. Most affected children do not have underlying organic diseases but suffer from functional gastrointestinal disorders. While many children with chronic abdominal complaints experience school problems, no prospective studies have examined if school absenteeism is more common among children suffering from functional as opposed to organic gastrointestinal disorders. The purpose of this study was to determine if there is an association between school absenteeism and functional gastrointestinal disorders in children presenting to a pediatric gastroenterology clinic with chronic gastrointestinal complaints.
Over a single year, families of school-aged children presenting to a pediatric gastroenterology clinic with gastrointestinal complaints were asked how many days of school their child had missed in the previous month due to their symptoms. At least six months after their visit, each child's final diagnosis was established and categorized as a functional disorder or an organic disease. Differences between children suffering from each diagnosis type were compared using unpaired -tests.
Children with functional gastrointestinal disorders were more likely to experience significant school absenteeism than children with gastrointestinal diseases. Missing more than three days of school in the month prior to their visit had a negative predictive value of 82% for a gastrointestinal disease and being homebound from school during the month prior to their visit had a negative predictive value of 88% for a gastrointestinal disease. As compared to children with functional disorders, those with organic diseases were more likely to have missed three or fewer days of school in the previous month (sensitivity = 93%) and to have attended any school in the previous month (sensitivity = 99%).
Our data suggest children with functional gastrointestinal disorders are more likely to experience significance school absenteeism than children suffering from organic diseases. We suspect this may be due to higher perceived levels of pain and symptom catastrophizing caused by the duration and character of the diagnostic process, as well as biopsychosocial characteristics of these children.
慢性腹部不适在学龄儿童中很常见。大多数受影响的儿童没有潜在的器质性疾病，而是患有功能性胃肠疾病。虽然许多有慢性腹部不适的儿童存在学业问题，但尚无前瞻性研究探讨与器质性胃肠疾病相比，功能性胃肠疾病患儿的缺课情况是否更常见。本研究的目的是确定在因慢性胃肠不适就诊于儿科胃肠病诊所的儿童中，缺课与功能性胃肠疾病之间是否存在关联。
在一年的时间里，询问因胃肠不适就诊于儿科胃肠病诊所的学龄儿童家庭，他们的孩子在上个月因症状缺课了多少天。在就诊至少六个月后，确定每个孩子的最终诊断，并将其分类为功能性疾病或器质性疾病。使用非配对t检验比较每种诊断类型患儿之间的差异。
与患有胃肠疾病的儿童相比，功能性胃肠疾病患儿更有可能出现严重缺课情况。就诊前一个月缺课超过三天对胃肠疾病的阴性预测值为82%，就诊前一个月居家不上学对胃肠疾病的阴性预测值为88%。与患有功能性疾病的儿童相比，患有器质性疾病的儿童在上个月缺课三天或更少天数的可能性更大（敏感性=93%），且在上个月上学的可能性更大（敏感性=99%）。
我们的数据表明，与患有器质性疾病的儿童相比，功能性胃肠疾病患儿更有可能出现严重缺课情况。我们怀疑这可能是由于诊断过程的持续时间和特点以及这些儿童的生物心理社会特征导致的更高的疼痛感知水平和症状灾难化。
