Hansen, J. (Jorik) (2018) Diagnostiek en prognostiek van functionele gastro-intestinale aandoeningen bij kinderen. thesis, Medicine.
Full text available on request.Abstract
Introduction Functional gastrointestinal disorders (FGIDs) are common in children presenting at their general practitioner with abdominal pain and/or diarrhoea. However, FGIDs are difficult to diagnose considering the similarity in symptom presentation in organic diseases. The Rome-criteria, a symptom based criteria for FGIDs, has already been validated in adults. However, there is a lack of evidence based information about it’s validity in children. Furthermore, there is little information concerning prognostic predictors of symptom persistence and quality of life in children with FGIDs. Objective This study’s objective is to determine the diagnostic and prognostic value of the Rome-III criteria in children with chronic abdominal pain or diarrhoea, to find possible prognostic predictors in these children and to determine the quality of life in these children. Method Children with chronic abdominal pain and/or chronic diarrhoea were included in primary and specialist care. Children were divided in referred and non-referred children and the total group of children was also divided in children with IBS and without IBS. The probability of organic disease was tested for the Rome-criteria, alarm symptoms, faecal protein and a combination of these. The prognosis of abdominal pain and diarrhoea was also calculated and the associations of certain predictors with these complaints were studied. Lastly, quality of life was compared during follow-up. Organic disease was confirmed by endoscopic assessment and/or 1-year follow-up. Several questionnaires were used, namely Rome-III criteria, CHQ-questionnaires and symptom questionnaire. All the questionnaires were filled in at baseline and 12 months’ followup. Only the symptom questionnaire were also used at 3, 6 and 9 months’ follow-up. Results This study included 180 children. Absence of alarm symptoms or a normal faecal calprotectin value were of value in rule out organic disease (probability of organic disease 2%, p<0.001), but fulfilment of Rome-III alone is not (probability of organic disease 16%, p=0.134). All groups showed most improvement in the first 3 months. All groups had a lower quality of life on the physical functioning score (PhS) at baseline and 12 months compared to healthy children. Furthermore, more referred children had abdominal pain after 12 months’ follow-up than nonreferred children and had a worse PhS quality of life. In the IBS-group more children had abdominal pain at 9 months, had more diarrhoea during 12 months’ follow-up, and they also had a lower quality of life on the psychosocial health score (PsS) at baseline and at 12 months’ follow-up, p<0.05. A total of 6 and 7 predictors of the prognosis of chronic abdominal pain and chronic diarrhoea were found, respectively. Conclusion In primary care, the Rome-III criteria for IBS has no value in differentiating between organic and non-organic gastrointestinal disease. However, the Rome-III criteria for IBS and prognostic factors can help the GP in selecting patients who are at risk for persisting symptoms. For example, children with IBS, according to the Rome-III have a worse prognosis of chronic diarrhoea than children without IBS. More studies are needed to determine whether referral has a worse prognosis of chronic abdominal pain.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Discliplinegroep: Huisartsgeneeskunde UMCG and Begeleidster: and Holtman, Dr. G.A. and Facultair begeleidster: and Berger, Prof. Dr. M.Y. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1857 |
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