Predicting persistence of functional abdominal pain from childhood into young adulthood

Abstract

Background & aims: Pediatric functional abdominal pain has been linked to functional gastrointestinal disorders (FGIDs) in adulthood, but little is known about patient characteristics in childhood that increase the risk for FGID in young adulthood. We investigated the contribution of gastrointestinal symptoms, extraintestinal somatic symptoms, and depressive symptoms in pediatric patients with functional abdominal pain and whether these predicted FGIDs later in life.

Methods: In a longitudinal study, consecutive new pediatric patients, diagnosed with functional abdominal pain in a subspecialty clinic, completed a comprehensive baseline evaluation of the severity of their physical and emotional symptoms. They were contacted 5 to 15 years later and evaluated, based on Rome III symptom criteria, for abdominal pain-related FGIDs, including irritable bowel syndrome, functional dyspepsia, functional abdominal pain syndrome, and abdominal migraine. Controlling for age, sex, baseline severity of abdominal pain, and time to follow-up evaluation, multivariable logistic regression was used to evaluate the association of baseline gastrointestinal, extraintestinal somatic, and depressive symptoms in childhood with FGID in adolescence and young adulthood.

Results: Of 392 patients interviewed an average of 9.2 years after their initial evaluation, 41% (n = 162) met symptom criteria for FGID; most met the criteria for irritable bowel syndrome. Extraintestinal somatic and depressive symptoms at the initial pediatric evaluation were significant predictors of FGID later in life, after controlling for initial levels of GI symptoms. Age, sex, and abdominal pain severity at initial presentation were not significant predictors of FGID later in life.

Conclusions: In pediatric patients with functional abdominal pain, assessment of extraintestinal and depressive symptoms may be useful in identifying those at risk for FGID in adolescence and young adulthood.

Keywords: Depression; Functional Gastrointestinal Disorders; Irritable Bowel Syndrome; Prospective; Somatic Symptoms.

Figure 1

Study design. Ped-FAP = Pediatric functional abdominal pain. FGID-Neg = does not meet Rome III symptom criteria for functional gastrointestinal disorder at follow-up. FGID-Pos = meets Rome III symptom criteria for functional gastrointestinal disorder at follow-up.

Figure 2

The probability of Functional Gastrointestinal Disorder (FGID) at follow-up in adolescence or young adulthood based on baseline scores on the Children’s Depression Inventory (CDI), fixing all other variables to constant values (using the average value of each variable, or if a categorical variable, using the model-based reference group). Odds ratio between the 25% and 75% interquartile values of the CDI scores is shown.