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"Child`s Health" 4 (47) 2013

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New approaches to the differential diagnosis of functional bowel diseases in children

Authors: Shadrin O., Platonova O., Starets O., «Institute of Pediatrics, Obstetrics and Gynecology, Academy of Medical Sciences", Kyiv, Odessa National Medical University

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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Keywords

functional bowel diseases, diagnosis, children

Background

The study was aimed to assess the prevalence of functional bowel diseases (FBD) among children and the adequacy of the use of the Rome criteria for pediatric practices in Ukraine.

Material and Methods

The study was conducted at the department of pediatric gastroenterology of the hospital №1 named after acad. BJ Reznik (Odessa). There were analyzed the results of work of the department during 2009-2012. The frequency of primary diagnosis among children with FBD and its confirmation after paraclinical examination. The total number of children included in primary sampling during retrospective analysis was 2777 persons.

Subclassification of IBS was used accordingly to Rome III criteria. Subtyping was based on stool consistency alone as IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), IBS mixed type (IBS-M), and IBS unsubtyped (IBS-U). Patients with IBS-M have both hard and loose stools over periods of hours or days, whereas IBS patients with alternating bowel habits change subtype over periods of weeks and months.

Results

It is shown that  at the prehospital stage there are observed numerous cases of improper use of diagnostic criteria of FBD. It is proved that Rome III criteria for review in pediatrics allow to accurately diagnose of FBD for older children, although a large group of patients with  FBD of unknown origin requires new approaches to diagnosis and implementation of the Rome criteria for specialists at the primary and secondary level of care is not active 50 % of the FBD in the outpatient stage is not diagnosed. Among the FBD the family physicians and general practitionerss often diagnose IBS, whereas functional abdominal diagnoses and functional diarrhea do not appear in the medical records.

The analysis of the false-positive cases of FBD demonstrated that 33.3 % of diagnoses were later disproved and organic pathology was diagnosed. The majority of diagnostic errors concerned the conditions that accompanied constipation syndrome. Most diagnostic errors were associated with the presence of parasitic infestations in patients (giardiasis and enterobiosis).

In hospital conditions there was observed the significant clinical polymorphism of FBD course. There was necessary to exclude lactase insufficiency, adverse effects of drugs, anatomic anomalies and surgical bowel disease. Thus, in patients with the diagnosis of FBD were verified in 5 (0.53 %) cases in 2009, in 2 (0.32 %) cases in 2010 and 1 (0.12 %) cases in 2011. Accordingly, parasitic infestations and bacterial infections occurred more frequently: in 2009 it there were diagnosed 108 (11.5 %) cases of giardiasis and 18 (1.9 %) cases enterobiosis. In 2010, the incidence for these diseases amounted to 57 (6.6%) and 15 (1.73 %), and in 2011 there were registered 102 (12.9 %) cases of giardiasis and 12 (1.5 %) cases enterobiosis. In 2010, there was only one (0.1 %) case of chronic colitis, as well as in 2011 and 7 (0.8 %) cases of enterocolitis of viral origin. During further observations there were observed also such diseases as sprue (celiac disease), chronic pancreatitis, endocrine diseases (diabetes, hyperthyroidism), intestinal neoplasms.

Conclusion

We discuss the need to develop algorithms for predicting FBD in childhood to improve the detection level of functional pathology of the gastrointestinal tract. It was stated that algorithms and inclusion and exclusion criteria used in a questionnaire study can affect the results. Cutoffs of severity and frequency scales are important and will determine who is included. Exclusions are also important because patients with the symptoms of the condition may be excluded depending on the criteria requirements.


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