Problemi correnti
Il pediatra e i disturbi gastrointestinali funzionali
PAEDIATRICIANS AND FUNCTIONAL GASTROINTESTINAL DISORDERS
Giuseppe Primavera1, Giuseppe Magazzł2
1Pediatra di famiglia, Palermo
2UO di Gastroenterologia Pediatrica e Fibrosi cistica, Universitą di Messina
Maggio 2011 - pagg. 289 -295
Abstract
Even though functional gastrointestinal disorders (FGID) are often considered an example
of disease mongering, their reported prevalence and costs prompt to take into consideration
the most cost-effective approach that can be applied to primary care in order to avoid
stressful and useless investigations to patients and to decrease family and health system costs.
The aim of the present article is to point out the clinical criteria that can be useful in clinical
practice, as already done in some studies performed in primary care. The central role of the
family paediatrician in the FGID management and a simple approach are suggested. This
suggested solution allows an expensive diagnostic workup aimed at excluding improbable
organic causes and the referral to tertiary centers to be minimized, thus decreasing costs.
This approach is time-consuming and will require greater devotion to paediatricians but it
will provide satisfaction and more sense to their work. The results of the studies performed
in primary care highlight their importance for evaluating the effects of continuing medical
education, which should aim at changing behaviours in clinical practice.
Classificazione MeSH
Bibliografia
1. Rasquin A, Di Lorenzo C, Forbes D, et al.
Childhood functional gastrointestinal disorders:
child/adolescent. Gastroenterology
2006;130:1527-37.
2. Hyman PE, Milla PJ, Benninga MA, Davidson
GP, Fleisher DF, Taminiau J. Childhood
functional gastrointestinal disorders: neonate/
toddler. Gastroenterology 2006;130:1519-26.
3. http://www.occhioclinico.it/occhio/var-
2002/08bud.html.
4. http://incontumacia.blogspot.com/2010/
11/nasce-prima-il-farmaco-o-la-malattia.html.
5. Dhroove G, Chogle A, Saps M. A million-dollar
work-up for abdominal pain: is it worth it? J
Pediatr Gastroenterol Nutr 2010;51:579-83.
6. Rasquin-Weber A, Hyman PE, Cucchiara S,
et al. Childhood functional gastrointestinal disorders.
Gut 1999;45(Suppl 2):II60-8.
7. Caplan A, Walker LS, Rasquin A. Development
and preliminary validation of the questionnaire
on pediatric gastrointestinal symptoms
to assess functional gastrointestinal disorders
in children and adolescent. J Pediatr
Gastroenterol Nutr 2005;41:296-304.
8. Caplan A, Walker LS, Rasquin A. Validation
of the pediatric Rome II criteria for functional
gastrointestinal disorders using the questionnaire
on pediatric gastrointestinal symptoms.
J Pediatr Gatroenterol Nutr 2005;41:305-16.
9. Walker LS, Lipani TA, Greene JW, et al. Recurrent
abdominal pain: symptom subtypes
based on the Rome II criteria for pediatric
functional gastrointestinal disorders. J Pediatr
Gastroenterol Nutr 2004;38:187-91.
10. Van Ginkel R, Voskuijl WP, Benninga MA,
Taminiau JA, Boeckxstaens GE. Alteration in
rectal sensitivity and motility in childhood irritable
bowel syndrome. Gastroenterology
2001;120:31-8.
11. Di Lorenzo C, Youssef NN, Sigurdsson L,
Scharff L, Griffiths J, Wald A. Visceral hyperalgesia
in children with functional abdominal
pain. J Pediatr 2001;139:838-43.
12. Hyman PE, Bursch B, Sood M, Schwankovsky
L, Cocjin J, Zeltzer LK. Visceral painassociated
disability syndrome: a descriptive
analysis. J Pediatr Gastroenterol Nutr 2002;
35:663-8.
13. Voskuijl WP, Heijmans J, Heijmans HS, Taminiau
JA, Benninga MA. Use of Rome II criteria
in childhood defecation disorders: applicability
in clinical and research practice. J Pediatr
2004;145:213-7.
14. Loening-Baucke V. Functional fecal retention
with encopresis in childhood. J Pediatr
Gastroenterol Nutr 2004;38:79-84.
15. Chitkara DK, Camilleri M, Zinsmeister
AR, et al. Gastric sensory and motor dysfunction
in adolescents with functional dyspepsia.
J Pediatr 2005;146:500-5.
16. Miele E, Simeone D, Marino A, et al. Functional
gastrointestinal disorders in children:
an Italian prospective survey. Pediatrics 2004;
114:73-8.
17. Campanozzi A, Boccia G, Pensabene L, et
al. Prevalence and natural history of gastroesophageal
reflux: pediatric prospective survey.
Pediatrics 2009;123:779-83.
18. Primavera G, Amoroso B, Barresi A, et al.
Clinical Utility of Rome Criteria Managing
Functional Gastrointestinal Disorders in Pediatric
Primary Care. Pediatrics 2010;125:
e155-61.
19. Zeiter DK, Hyams JS. Recurrent abdominal
pain in children. Pediatr Clin North Am
2002;49:53-71.
20. Hyams JS. Irritable bowel syndrome, functional
dyspepsia, and functional abdominal
pain syndrome. Adolesc Med Clin 2004;15:1-
15.
21. Di Lorenzo C, Colletti RB, Lehmann HP, et
al. Chronic abdominal pain in children: a technical
report of the American Academy of
Pediatrics and the North American Society for
Pediatric Gastroenterology, Hepatology and
Nutrition. J Pediatr Gastroenterol Nutr 2005;
40:249-61.
22. Rowland M, Bourke B, Drumm B. Do the
Rome criteria help the doctor or the patient? J
Pediatr Gastroenterol Nutr 2005;41(Suppl.
1):S32-3.
23. Peratoner L. Tre consigli per una malattia:
la stipsi. Medico e Bambino 2002;21:655-8:
24. Vandenplas Y, Rudolph CD, Di Lorenzo C,
et al. Pediatric gastroesophageal reflux clinical
practice guidelines: joint recommendations of
the North American Society for Pediatric Gastroenterology,
Hepatology, and Nutrition
(NASPGHAN) and the European Society for
Pediatric Gastroenterology, Hepatology, and
Nutrition (ESPGHAN). J Pediatr Gastroenterol
Nutr 2009;49:498-547.
25. Savino F, Pelle E, Palumeri E, Oggero R,
Miniero R. Lactobacillus reuteri (American Type
Culture Collection Strain 55730) versus simethicone
in the treatment of infantile colic: a
prospective randomized study. Pediatrics
2007;119:e124-30.
26. Savino F, Cordisco L, Tarasco V, et al. Lactobacillus
reuteri DSM 17938 in infantile colic:
a randomized, double-blind, placebo-controlled
trial. Pediatrics 2010;126:e526-33.
27. Tommasini A, Not T, Kiren V, et al. Massscreening
for celiac disease using antihuman
transglutaminase antibody assay. Arch Dis
Child 2004;89:512-5.
28. Ford AC, Chey WD, Talley NJ, Malhotra A,
Spiegel BM, Moayyedi P. Yeld of diagnostic tests
for celiac disease in individuals with symptoms
suggestive of irritable bowel syndrome:
systematic review and meta-analysis. Arch Intern
Med 2009;169:651-8.
29. Chitcara DK, Rawad DJ, Talley NJ. The
epidemiology of childhood recurrent abdominal
pain in Western countries: a systematic review.
Am J Gastroenterol 2005;100:1868-75.
30. Ramchandani PG, Hotopf M, Sandhu B,
Stein A; ALSPAC Study Team. The epidemiology
of recurrent abdominal pain from 2 to 6
years of age: results from a large populationbased
study. Pediatrics 2005;116:46-50.
31. Apley J, Naish N. Recurrent abdominal
pain: a field survey of 1000 school children.
Arch Dis Child 1958;33:165-70.
32. Hyams JS, Davis P, Sylvester FA, Zeiter
DK, Justinich CJ, Lerer T. Dyspepsia in children
and adolescents: a prospective study. J
Pediatr Gastroenterol Nutr 2000;30:413-8.
33. Tam YH, Chan KW, To KF, et al. Impact of
pediatric Rome III criteria of functional dyspepsia
on the diagnostic yield of upper endoscopy
and predictors for a positive endoscopic
finding. J Pediatr Gastroenterol Nutr 2011;
52:387-91.
34. Huertas-Ceballos AA, Logan S, Bennett C,
Macarthur C. Pharmacological interventions
for recurrent abdominal pain (RAP) and irritable
bowel syndrome (IBS) in childhood. Cochrane
Database Syst Rev 2008;(1):CD003017.
35. Walker LS, Lipani TA, Greene JW, et al. Recurrent
abdominal pain: syntom subtypes based
on the Roma II criteria for pediatric functional
gastrointestinal disorders. J Pediatr Gastroenterol
Nutr 2004;38:187-91.
36. Huertas-Ceballos AA, Logan S, Bennett C,
Macarthur C. Dietary interventions for recurrent
abdominal pain (RAP) and irritable bowel
syndrome (IBS) in childhood. Cochrane Database
Syst Rev 2009;(1):CD003019.
37. Huertas-Ceballos AA, Logan S, Bennett C,
Macarthur C. Psychosocial interventions for
recurrent abdominal pain (RAP) and irritable
bowel syndrome (IBS) in childhood. Cochrane
Database Syst Rev 2008;(1):CD003014.
38. Levy RL, Langer SL, Walker LS, et al. Cognitive-
behavioral therapy for children with
functional abdominal pain and their parents
decreases pain and other symptoms. Am J Gastroenterol
2010;105:946-56.
39. Guandalini S, Magazzł G, Chiaro A, et al.
VSL#3 improves symptoms with irritable
bowel syndrome: a multicenter, randomized,
placebo-controlled, double blind, crossover
study. J Pediatr Gastroenterol 2010;51:20-30.
40. Romano C, Ferrał V, Cavataio F, et al. Lactobacillus
reuteri in children with functional
abdominal pain (FAP). J Paediatr Child Health
2010; July 8 (epub ahead of print).
41. Francavilla R, Miniello V, Magistą AM, et
al. A randomized controlled trial of Lactobacillus
GG in children with functional abdominal
pain. Pediatrics 2010;126:e1445-52.
42. Li BU, Balint JP. Cyclic vomiting syndrome:
evolution in our understanding of a braingut
disorder. Adv Pediatr 2000;47:117-60.
43. Gieteling MJ, Bierma-Zeinstra SM, van
Leeuwen Y, Passchier J, Berger MY. Prognostic
factors for persistence of chronic abdominal
pain in children. J Pediatr Gastroenterol
Nutr 2011;52:154-61.
44. Dengler-Crish CM, Horst SN, Walker LS.
Somatic complaints in childhood functional
abdominal pain are associated with functional
gastrointestinal disorders in adolescence and
adulthood. J Pediatr Gastroenterol Nutr 2011;
52:162-5.
45. Berger MY, Gieteling MJ, Benninga MA.
Chronic abdominal pain in children: a clinical
review. BMJ 2007;334:997-1002.
46. Helgeland H, Flagstad G, Grųtta J, Vandvik
PO, Kristensen H, Markestad T. Diagnosing
pediatric functional abdominal pain in childern
(4-15 years old) according to the Roma
III criteria: results from Norwegian prospective
study. J Pediatr Gastroenterol Nutr 2009;
49:309-15.
47. Saps M, Youssef N, Miranda A, et al. Multicenter,
randomized placebo-controlled trial
of amitriptyline in children with functional gastrointestinal
disorders. Gastroenterology
2009;137:1261-9.
48. Lane MM, Weidler EM, Czyzewski DI,
Shulman RJ. Pain symptoms and stooling patterns
do not drive diagnostic costs for children
with functional abdominal pain and irritable
bowel syndrome in primary or tertiary
care. Pediatrics 2009;123:758-64.
Corrispondenza: beppeprimavera@virgilio.it