[A cross-sectional questionnaire survey on the prevalence and risk factors of 4 major functional gastrointestinal disorders among children in Shanghai]

Abstract

Objective: To investigate the prevalence and risk factors of the 4 most common functional gastrointestinal disorders (FGID) among school-aged children in Shanghai. Methods: A cross-sectional questionnaire survey was conducted from January to December 2019. Using stratified cluster sampling, 26 097 students in grades 1-12 from Huangpu and Jiading District, Shanghai were enrolled. The questionnaire of pediatric gastrointestinal symptoms-Rome Ⅳ (QPGS-Ⅳ) and the pediatric quality of life inventory (PedsQL) were used to assess the prevalence and health-related quality of life (HRQoL) of functional dyspepsia (FD), irritable bowel syndrome (IBS), functional abdominal pain-not otherwise specified (FAP-NOS), and functional constipation (FC). Multivariate Logistic regression analysis was performed to identify correlations between sociodemographic factors, lifestyle habits, comorbidities and 4 major FGID. A trend chi-square test was used to explore the relationship between HRQoL scores and FGID prevalence. Results: A total of 26 097 valid participants (26 097/27 036, 96.5%) were included in the study, with the age of (10.8±3.1) years and 12 441 cases (47.7%) were female. The prevalence of FC was found to be the highest (5 537 cases, 21.2%), followed by IBS (797 cases, 3.1%), FAP-NOS (267 cases, 1.0%) and FD (218 cases, 0.8%). Multivariate Logistic regression analysis revealed the following findings: junior high school (FD: OR=1.88 (95%CI 1.35-2.61); IBS: OR=1.42 (95%CI 1.18-1.71); FAP-NOS: OR=1.39 (95%CI 1.02-1.90)), senior high school (FD: OR=2.67 (95%CI 1.84-3.86);IBS:OR=2.36 (95%CI 1.93-2.89) ;FAP-NOS: OR=2.20 (95%CI 1.56-3.11)) and frequent respiratory infections (FD: OR=2.15 (95%CI 1.45-3.18); IBS: OR=2.59 (95%CI 2.12-3.16); FAP-NOS:OR=1.49 (95%CI 1.00-2.21)) were common risk factors for FD, IBS and FAP-NOS. Allergic symptoms (FD: OR=2.21 (95%CI 1.56-3.14); IBS: OR=2.30 (95%CI 1.04-1.51); FAP-NOS: OR=2.54 (95%CI 1.85-3.50); FC: OR=1.09 (95%CI 1.01-1.17)) was a common risk factor for FD, IBS, FAP-NOS and FC. Family history of allergy was a risk factor for IBS (OR=1.41 (95%CI 1.20-1.65)) and FAP-NOS (OR=1.33 (95%CI 1.01-1.74)). Female exhibited increased risks for FD (OR=1.49 (95%CI 1.13-1.96)), IBS (OR=1.50 (95%CI 1.30-1.74)) and FC (OR=1.10 (95%CI 1.03-1.17)). The presence of dietary bias was associated with of IBS (OR=1.46 (95%CI 1.26-1.69)) and FC (OR=1.26 (95%CI 1.19-1.34)); late bedtime (OR=1.32 (95%CI 1.06-1.64)) and allergen exposure (OR=1.25 (95%CI 1.04-1.51)) were risk factors for IBS. Insufficient sleep (OR=1.11 (95%CI 1.02-1.21)), insufficient outdoor time (OR=1.20 (95%CI 1.01-1.43)) and severe lack of outdoor time (OR=1.48 (95%CI 1.23-1.76)) were significant risk factors for FC. Pet ownership (OR=1.39 (95%CI 1.07-1.81)) was a risk factor for FAP-NOS. HRQoL scores were significantly lower in children with FD, IBS, or FAP-NOS compared to non-FGID peers (all P<0.05). χ² trend test analysis showed that the Pearson correlation coefficients between the prevalence of FD, IBS, FAP-NOS, FC and HRQoL scores were -0.93, -0.93, -0.97 and -0.84, respectively. Conclusions: The prevalence of FGID among school-aged children in Shanghai varies by sub-type. FC was the most prevalence. Junior and senior high school, female sex, allergic symptoms and frequent respiratory infections were major risk factors. Meanwhile, dietary bias, late bedtime, insufficient outdoor time and pet ownership were associated with specific subtypes. The HRQoL is significantly reduced in children with FD, IBS and FAP-NOS.