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Title: Young children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) followed in pediatric gastroenterology (PED-GI) vs primary pediatric care (PED): Differences in outcomes

item SHULMAN, R - Children'S Nutrition Research Center (CNRC)
item CZYZEWSKI, D - Baylor College Of Medicine
item LANE, M - Baylor College Of Medicine
item BLATZ, A - Baylor College Of Medicine
item WEIDLER, E - Children'S Nutrition Research Center (CNRC)

Submitted to: Neurogastroenterology & Motility
Publication Type: Abstract Only
Publication Acceptance Date: 8/1/2008
Publication Date: 10/1/2008
Citation: Shulman, R.J., Czyzewski, D., Lane, M., Blatz, A., Weidler, E. 2008. Young children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) followed in pediatric gastroenterology (PED-GI) vs primary pediatric care (PED): Differences in outcomes [abstract]. Neurogastroenterology & Motility. 20(Suppl.1):76.

Interpretive Summary:

Technical Abstract: The American Academy of Pediatrics suggests that children with recurrent abdominal pain without alarm signs be managed in pediatric rather than specialty care. However, many of these children are seen in tertiary care. In a longitudinal examination of physical and psychological symptoms, we hypothesized that over time, children seeking PED-GI care would show more health care use and more pathology on various psychosocial dimensions than those remaining in PED care. Children with FAP/IBS initially recruited from PED-GI and PED clinics were followed up 18–24 months after the initial assessment. Current symptoms were assessed using an interview assessing Rome II symptom criteria. Parents reported on medical visits and use of medications for FAP/IBS in the interval between initial and follow-up assessment. Parents and children completed questionnaires assessing current quality of life(PedsQL), internalizing emotional symptoms (BASC), and functional disability (FDI). Thirty–nine PED-GI and 37 PED subjects (mean age 10.6 years) were followed up. Twenty-six percent of children no longer had symptoms and the proportion of children with resolved symptoms did not differ between groups. Number of visits to physicians for FAP/IBS symptoms tended to be greater in the PEDI-GI vs. PED group (1.66 ± 4.23 vs. 0.29 ± 0.53; t (1.54) = 1.71, P = 0.09; mean ± SD). PED-GI children were more likely to have had GI diagnostic tests since the initial assessment (v2; 2 (1, n = 50) = 5.09, P = 0.02), and more likely to be taking GI medications (v2; 2 (1, n = 56) = 8.11, P = 0.004) excluding antacids. The PEDGI group had a trend toward greater mother-reported pain severity and number of pain episodes per month (8.23 vs. 5.26). Child-reported functional disability was greater in the PED-GI group, t (1.39) = 2.33, P = 0.03). No differences were found for parent or child-reported child quality of life, child anxiety, or depression. Over time, the majority of children with FAP/IBS complaints continued to have complaints. While both groups had abdominal pain without alarm signs, children who were followed by PED-GI as compared to PED had more GI tests and medications and reported having more pain and disability related to abdominal complaints. While the direction of causality between symptoms and healthcare interventions is unclear, the possibility of increased attention to symptoms with tests and medications promoting greater functional disability should be considered.