Location: Children's Nutrition Research CenterTitle: Young Children with Functional Abdominal Pain (FAP) and Irritable Bowel Syndrome (IBS) Followed in Tertiary vs. Primary Care: Differences in Outcomes) Author
Submitted to: Gastroenterology
Publication Type: Abstract only
Publication Acceptance Date: 4/1/2009
Publication Date: 5/1/2009
Citation: Czyzewski, D.I., Weidler, E., Lane, M., Shulman, R.J. 2009. Young Children with Functional Abdominal Pain (FAP) and Irritable Bowel Syndrome (IBS) Followed in Tertiary vs. Primary Care: Differences in Outcomes [abstract]. Gastroenterology. 136(5 Suppl.1):A371 Interpretive Summary:
Technical Abstract: Despite the fact that the American Academy of Pediatrics suggests that general pediatricians (PED) manage children with FAP/IBS without alarm signs many children are cared for by pediatric gastroenterologists (GI). In a longitudinal examination of physical symptoms, healthcare use, quality of life (QOL), and disability, we tested the hypothesis that over time children in GI care would show less recovery from physical symptoms, more health care use, lower QOL, and greater disability than those remaining in PED care. Children with FAP/IBS initially recruited from GI and PED clinics were assessed 18-24 months later. Baseline and current symptoms were determined based on parent interview using Rome II criteria. Parents reported on FAP/IBS medical visits, tests, and medications in the interval between initial and follow-up assessments and parents and children completed questionnaires on current child quality of life (QOL) and functional disability. Thirty-nine GI and 37 PED subjects (mean ± SD age: 10.6 ± 1.8 yrs. vs. 9.8 ± 1.4, respectively) were followed up. Twenty-six percent no longer had symptoms, but the proportion without symptoms did not differ between groups. The GI group tended to have a greater number of physician visits for FAP/IBS (GI: 1.7 ± 4.2 vs. PED: 0.3 ± 0.5; P=0.07; excluding one outlier in the GI group P=0.04). The GI vs. PED group underwent more diagnostic testing (36% vs. 11%, respectively, P=0.03) and were taking more prescription GI medications (39% vs. 7%, respectively, P=0.004). Baseline (15.3 ± 12.8 vs. 7.2 ± 7.9) and follow-up (8.4 ± 8.8 vs. 5.2 ± 6.2) pain frequency per month were greater in the GI vs. PED group (P=0.01), and similar findings were noted for pain intensity (P=0.06). In both groups, mother-reported pain interference with activities (P=0.001) and pain frequency (P=0.001) improved over time, but the change over time did not differ between groups. Maximum reported pain severity did not improve with time in either group. QOL did not differ between groups at baseline, or follow up and did not improve with time. Functional disability (child and parent report) improved in both groups but tended to be poorer in the GI vs. PED group (P=0.07). The majority of children with FAP/IBS continued to have complaints albeit with less frequency and disability. Despite more physician visits, prescription medications, and GI tests in the GI vs. PED group, QOL did not differ or improve with time. The possibility of increased attention to symptoms with tests and medications promoting greater functional disability should be considered.