Aggiornamento
Il dolore addominale ricorrente: tante novità, nessuna novità
Recurrent abdominal pain: lots of news, no news
Claudio Romano
UO di Gastroenterologia Pediatrica e Fibrosi Cistica, Dipartimento di Patologia Umana e dell’Età Evolutiva, Università di Messina
Ottobre 2023 - pagg. 495 -500 | DOI: 10.53126/MEB42495
Abstract
ecurrent abdominal pain of functional origin remains one of the most important challenges for the paediatrician. In most cases, the symptom reveals a functional cause. About 25 years ago, an international group of researchers and clinicians met in Rome to develop a classification system for DAR in functional gastrointestinal disorders that supports its diagnosis, standardization of research, and dissemination of information. Recurrent abdominal pain of functional origin is managed using a biopsychosocial model. Pain is the result of psychological and psychosocial factors as well as of events that have occurred from the earliest years of life. The pathogenesis is related to dysmotility, visceral hypersensitivity, changes in some transmission processes from the periphery to the central nervous system (CNS), changes in the mucosal-gut immune response and in the microbiota composition. There are numerous critical problems in the diagnosis and treatment: symptom-based diagnoses, high costs, uncontrolled use of drug therapies and lack of knowledge of the main strategies of approach. Dietary interventions (lactose, gluten, fibres and fermentable oligosaccharides) are very common in the adult population, but there is no evidence that they can be helpful in children.
Riassunto
Il dolore addominale ricorrente (DAR) di origine funzionale continua a essere una delle più importanti sfide per i pediatri. Nella gran parte dei casi, il sintomo riconosce una causa funzionale. Circa 25 anni addietro, un gruppo internazionale di ricercatori e clinici si è riunito a Roma per stabilire un sistema di classificazione del DAR nell’ambito dei disordini funzionali gastrointestinali (DFGI) per aiutare nella diagnosi, nella standardizzazione della ricerca e nella disseminazione delle informazioni. I DAR di origine funzionale sono gestiti utilizzando un modello bio-psicosociale. Il dolore è il risultato di fattori psicologici, psicosociali e di eventi relativi anche ai primi anni di vita. La patogenesi è correlata a disordini della motilità, ipersensibilità viscerale, alterazioni di alcuni processi di trasmissione dalla periferia al sistema nervoso centrale (SNC), alterazioni della risposta immune mucosale-intestinale e la modifica del microbiota. Sono numerose le criticità relativamente alla diagnosi e alla gestione del DAR: poche diagnosi basate sui sintomi, elevati costi, utilizzo incontrollato di terapie farmacologiche (senza alcuna evidenza) e scarsa conoscenza delle più importanti strategie di approccio. Gli interventi dietetici (lattosio, glutine, fibre ed oligosaccaridi fermentabili) sono molto frequenti nella popolazione adulta ma non vi è alcuna evidenza che siano utili nel bambino con DAR.
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Corrispondenza: claudio.romano@unime.it