Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 10, Number 2, April 2017, pages 84-91

Long-Term Study of Children With ROME III Functional Gastrointestinal Disorders Managed Symptomatically in a Biopsychosocial Model

**Table 1.** Demographic Information of All Patients With FGIDs
FGIDs: functional gastrointestinal disorders; FAP: functional abdominal pain; IBS: irritable bowel syndrome; FD: functional dyspepsia.
N	258
Mean age, years (range, SD)	10.6 (4 - 18, 3.9)
Female	143 (55.4%)
Race
Caucasian	180 (69.8%)
African American	46 (17.8%)
Middle Eastern	18 (7.0%)
Unknown	8 (3.1%)
Hispanic	6 (2.3%)
Initial FGIDs
FAP	116 (45.0%)
IBS	54 (20.9%)
Multiple	34 (13.2%)
FD	33 (12.8%)
AM	21 (8.1%)
Number of initial FGID diagnoses
1	224 (86.8%)
> 1	34 (13.2%)
Mean duration of symptoms in months (range, SD)	22.1 (1 - 135, 25.8)
Family history of FGID	40 (15.5%)
First degree (parent or sibling)	27 (10.5%)
Second degree	13 (5.0%)
Family history of IBS	37 (14.3%)
Family history of FGIDs other than IBS	3 (1.2%)
Psychiatric disorder	81 (31.4%)
Anxiety/anxiety symptoms	58 (22.5%)
Multiple disorders	14 (5.4%)
Depression	8 (3.1%)
Bipolar	1 (0.4%)

Table 1. Demographic Information of All Patients With FGIDs

FGIDs: functional gastrointestinal disorders; FAP: functional abdominal pain; IBS: irritable bowel syndrome; FD: functional dyspepsia.

258

Mean age, years (range, SD)

10.6 (4 - 18, 3.9)

Female

143 (55.4%)

Race

Caucasian

180 (69.8%)

African American

46 (17.8%)

Middle Eastern

18 (7.0%)

Unknown

8 (3.1%)

Hispanic

6 (2.3%)

Initial FGIDs

FAP

116 (45.0%)

IBS

54 (20.9%)

Multiple

34 (13.2%)

33 (12.8%)

21 (8.1%)

Number of initial FGID diagnoses

224 (86.8%)

> 1

34 (13.2%)

Mean duration of symptoms in months (range, SD)

22.1 (1 - 135, 25.8)

Family history of FGID

40 (15.5%)

First degree (parent or sibling)

27 (10.5%)

Second degree

13 (5.0%)

Family history of IBS

37 (14.3%)

Family history of FGIDs other than IBS

3 (1.2%)

Psychiatric disorder

81 (31.4%)

Anxiety/anxiety symptoms

58 (22.5%)

Multiple disorders

14 (5.4%)

Depression

8 (3.1%)

Bipolar

1 (0.4%)

**Table 2.** Diagnostic Testing and Results of All Study Patients With FGIDs
FGIDs: functional gastrointestinal disorders. Mildly abnormal and non-specific laboratory value/imaging finding. *Parietal cell hyperplasia, basal cell hyperplasia and juvenile polyp (that do not explain the cause of pain).
N	258
Laboratory testing	241 (93.4%)
Normal	180 (69.8%)
Abnormal*	61 (23.6%)
Imaging study	117 (45.3%)
Normal	104 (40.3%)
Abnormal*	13 (5%)
Endoscopy	111 (43.0%)
EGD	78 (30.2%)
EGD and colonoscopy	33 (12.8%)
Normal	108 (41.9%)
Abnormal**	3 (1.2%)

Table 2. Diagnostic Testing and Results of All Study Patients With FGIDs

FGIDs: functional gastrointestinal disorders. *Mildly abnormal and non-specific laboratory value/imaging finding. **Parietal cell hyperplasia, basal cell hyperplasia and juvenile polyp (that do not explain the cause of pain).

258

Laboratory testing

241 (93.4%)

Normal

180 (69.8%)

Abnormal*

61 (23.6%)

Imaging study

117 (45.3%)

Normal

104 (40.3%)

Abnormal*

13 (5%)

Endoscopy

111 (43.0%)

EGD

78 (30.2%)

EGD and colonoscopy

33 (12.8%)

Normal

108 (41.9%)

Abnormal**

3 (1.2%)

**Table 3.** Treatments Used for FGIDs
FGIDs: functional gastrointestinal disorders.
N	258
Received treatment	245 (95.0%)
Medications	242 (93.7%)
1 medication	98 (38.0%)
2 medications	115 (44.6%)
> 2 medications	29 (11.2%)
Cyproheptadine	124 (48.1%)
Acid reducer	118 (45.7%)
Antispasmodic	72 (27.9%)
Laxative	71 (27.5%)
Loperamide	8 (3.1%)
CoQ10	4 (1.6%)
Amitriptyline	1 (0.4%)
Herbal supplements	33 (12.8%)
Psychological intervention	31 (12.1%)
Surgery	5 (1.9%)
Combination of treatments	58 (22.5%)
Number of treatment changes, mean (range, SD)	1.05 (0 - 6, 1.2)

Table 3. Treatments Used for FGIDs

FGIDs: functional gastrointestinal disorders.

258

Received treatment

245 (95.0%)

Medications

242 (93.7%)

1 medication

98 (38.0%)

2 medications

115 (44.6%)

> 2 medications

29 (11.2%)

Cyproheptadine

124 (48.1%)

Acid reducer

118 (45.7%)

Antispasmodic

72 (27.9%)

Laxative

71 (27.5%)

Loperamide

8 (3.1%)

CoQ10

4 (1.6%)

Amitriptyline

1 (0.4%)

Herbal supplements

33 (12.8%)

Psychological intervention

31 (12.1%)

Surgery

5 (1.9%)

Combination of treatments

58 (22.5%)

Number of treatment changes, mean (range, SD)

1.05 (0 - 6, 1.2)

**Table 4.** Follow-Up and Outcome Data of All Study Patients With FGIDs
*Most common evolution was IBS to FAP in seven, followed by FAP to IBS in six patients. FGIDs: functional gastrointestinal disorders; FAP: functional abdominal pain; IBS: irritable bowel syndrome; FD: functional dyspepsia; AM: abdominal migraine.
N	258
Total number of encounters, mean (range, SD)	3.32 (1 - 12, 1.84)
Data available in months, mean (range, SD)	18.7 (2 - 59, 15.8)
1 - 30 months	201 (77.9%)
> 30 - 42 months	24 (9.3%)
> 42 - 60 months	33 (12.8%)
Complete improvement	155 (60.1%)
Partial improvement	77 (29.8%)
No improvement	26 (10.1%)
Recurrence	92 (35.7%)
New FGID diagnosis	30 (11.6%)
Total number of final FGID diagnoses
1 diagnosis	197 (76.4%)
2 diagnoses	55 (21.3%)
3 diagnoses	4 (1.6%)
4 diagnoses	2 (0.8%)
Evolution of FGID*	31 (12.0%)
Duration to final FGID diagnosis in months, mean (range, SD)	17.2 (1 - 55, 14.1)

Table 4. Follow-Up and Outcome Data of All Study Patients With FGIDs

*Most common evolution was IBS to FAP in seven, followed by FAP to IBS in six patients. FGIDs: functional gastrointestinal disorders; FAP: functional abdominal pain; IBS: irritable bowel syndrome; FD: functional dyspepsia; AM: abdominal migraine.

258

Total number of encounters, mean (range, SD)

3.32 (1 - 12, 1.84)

Data available in months, mean (range, SD)

18.7 (2 - 59, 15.8)

1 - 30 months

201 (77.9%)

> 30 - 42 months

24 (9.3%)

> 42 - 60 months

33 (12.8%)

Complete improvement

155 (60.1%)

Partial improvement

77 (29.8%)

No improvement

26 (10.1%)

Recurrence

92 (35.7%)

New FGID diagnosis

30 (11.6%)

Total number of final FGID diagnoses

1 diagnosis

197 (76.4%)

2 diagnoses

55 (21.3%)

3 diagnoses

4 (1.6%)

4 diagnoses

2 (0.8%)

Evolution of FGID*

31 (12.0%)

Duration to final FGID diagnosis in months, mean (range, SD)

17.2 (1 - 55, 14.1)

**Table 5.** Evaluation, Management and Treatment Outcome of FGIDs in Patients With and Without Complete Improvement
Total, N = 258	CIG, 155 (60.1%)	PIG/NIG, 103 (39.9%)	P value
CIG: complete improvement group; PIG: partial improvement group; NIG: no improvement group; FGIDs: functional gastrointestinal disorders. *Entries and numbers represent statistically significant values.
Mean age (years)	10.53	10.57	0.93
Female	80/155 (51.6%)	63/103 (61.2%)	0.16
Caucasian	110/155 (71.0%)	70/103 (68%)	0.68
Mean duration of symptoms (months)	23.1	20.5	0.43
Family history of FGID	24/155 (15.5%)	16/103 (15.5%)	1.00
Psychiatric disorder	43/155 (27.7%)	38/103 (36.9%)	0.13
Mean number of initial FGID diagnoses	1.15	1.13	0.64
Mean number of encounters*	3.11	3.63	0.03*
Available follow-up data (months)	17.42	20.54	0.12
Labs performed	145/155 (93.5%)	96/103 (93.2%)	1.00
Abnormal lab results*	29/145 (20.0%)	33/96 (34.4%)	0.01*
Imaging study performed	65/155 (41.9%)	52/103 (50.5%)	0.20
Abnormal imaging study	9/65 (13.8%)	4/52 (7.7%)	0.38
Endoscopy performed*	57/155 (36.8%)	54/103 (52.4%)	0.02*
EGD performed	40/155 (25.8%)	38/103 (36.9%)	0.07
EGD and colonoscopy performed	17/155 (11.0%)	16/103 (15.5%)	0.34
Abnormal scope results	0/155 (0%)	3/103 (2.9%)	0.11
Treatment received	145/155 (93.5%)	100/103 (97.1%)	0.25
Cyproheptadine	77/153 (49.7%)	47/103 (45/6%)	0.53
Acid reducer	65/153 (41.9%)	53/103 (51.5%)	0.16
Antispasmodic	40/153 (25.8%)	32/103 (31.1%)	0.40
Laxative	39/153 (25.2%)	32/103 (31.1%)	0.32
Herbal	17/153 (11.0%)	16/103 (15.5%)	0.34
Mean number of treatment changes*	0.81	1.41	< 0.01*
Recurrence	48/155 (31.0%)	44/103 (42.7%)	0.06
New FGID diagnosis*	10/155 (6.5%)	20/103 (19.4%)	< 0.01*
Mean total number of final FGID diagnoses	1.23	1.32	0.19
Mean duration from initial to final FGID diagnosis (month)	16.64	17.55	0.87

Table 5. Evaluation, Management and Treatment Outcome of FGIDs in Patients With and Without Complete Improvement

Total, N = 258

CIG, 155 (60.1%)

PIG/NIG, 103 (39.9%)

P value

CIG: complete improvement group; PIG: partial improvement group; NIG: no improvement group; FGIDs: functional gastrointestinal disorders. *Entries and numbers represent statistically significant values.

Mean age (years)

10.53

10.57

0.93

Female

80/155 (51.6%)

63/103 (61.2%)

0.16

Caucasian

110/155 (71.0%)

70/103 (68%)

0.68

Mean duration of symptoms (months)

23.1

20.5

0.43

Family history of FGID

24/155 (15.5%)

16/103 (15.5%)

1.00

Psychiatric disorder

43/155 (27.7%)

38/103 (36.9%)

0.13

Mean number of initial FGID diagnoses

1.15

1.13

0.64

Mean number of encounters*

3.11

3.63

0.03*

Available follow-up data (months)

17.42

20.54

0.12

Labs performed

145/155 (93.5%)

96/103 (93.2%)

1.00

Abnormal lab results*

29/145 (20.0%)

33/96 (34.4%)

0.01*

Imaging study performed

65/155 (41.9%)

52/103 (50.5%)

0.20

Abnormal imaging study

9/65 (13.8%)

4/52 (7.7%)

0.38

Endoscopy performed*

57/155 (36.8%)

54/103 (52.4%)

0.02*

EGD performed

40/155 (25.8%)

38/103 (36.9%)

0.07

EGD and colonoscopy performed

17/155 (11.0%)

16/103 (15.5%)

0.34

Abnormal scope results

0/155 (0%)

3/103 (2.9%)

0.11

Treatment received

145/155 (93.5%)

100/103 (97.1%)

0.25

Cyproheptadine

77/153 (49.7%)

47/103 (45/6%)

0.53

Acid reducer

65/153 (41.9%)

53/103 (51.5%)

0.16

Antispasmodic

40/153 (25.8%)

32/103 (31.1%)

0.40

Laxative

39/153 (25.2%)

32/103 (31.1%)

0.32

Herbal

17/153 (11.0%)

16/103 (15.5%)

0.34

Mean number of treatment changes*

0.81

1.41

< 0.01*

Recurrence

48/155 (31.0%)

44/103 (42.7%)

0.06

New FGID diagnosis*

10/155 (6.5%)

20/103 (19.4%)

< 0.01*

Mean total number of final FGID diagnoses

1.23

1.32

0.19

Mean duration from initial to final FGID diagnosis (month)

16.64

17.55

0.87