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Functional abdominal pain disorders common in children with IBD
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More than a quarter of children with inflammatory bowel disease had an overlapping functional abdominal pain disorder in a recent study.
Further, these patients had worse anxiety, depression and quality of life compared with IBD patients without an overlapping functional abdominal pain disorder (FAPD), and girls were significantly more likely than boys to have comorbid IBD and FAPD.
Miguel Saps
“There is a high prevalence of comorbidity of inflammatory bowel disease and functional gastrointestinal disorders in children,” Miguel Saps, MD, of the division of gastroenterology, hepatology and nutrition at Nationwide Children’s Hospital in Columbus, Ohio, told Healio Gastroenterology. “Symptoms of abdominal pain and loose stools associated with functional gastrointestinal disorders in a patient with inflammatory bowel disease can be interpreted as a relapse. Recognizing the existence of this overlap may allow early treatment and avoid unnecessary testing.”
Saps and colleagues performed a prospective, single center, cross-sectional study of 128 IBD patients aged 8 years to 18 years, evaluating disease activity, lab studies and validated questionnaires to determine the prevalence, impact and predictors of IBD-FAPDs, including functional dyspepsia, functional abdominal pain, irritable bowel syndrome and abdominal migraine.
Of the 63% of patients who completed questionnaires, 36 were girls, 45 were boys, the mean age was 14.4 ± 2.6 years, 62 had Crohn’s disease, 19 had ulcerative colitis, 71 were in clinical remission and 10 had active disease.
Among patients in remission, 26% (95% CI, 20.6-79.4) met Rome III criteria for an FAPD (13.6% with IBS, 11% with abdominal migraine, 1% with functional abdominal pain, and 0% with functional dyspepsia).
Those with quiescent Crohn’s disease plus an overlapping FAPD had higher mean abbreviated Pediatric Crohn’s Disease Activity Index scores compared with Crohn’s patients without FAPD (6.18 vs. 1.81; P = .0002). Conversely, UC patients in remission with or without FAPD had comparable Pediatric Ulcerative Colitis Activity Index scores.
Significantly more girls had IBD-FAPD (66.7% vs. 33.3%; P = .038), and patients with IBD-FAPD were more likely to meet criteria for anxiety (14.3% vs. 2%; P = .06) and depression (23.8% vs. 2%; P = .006) and have lower GI-related quality of life scores (P = .008) compared with patients with IBD in remission and no overlapping FAPD.
“The prevalence of FAPDs in this study is greater than the historical prevalence of FAPDs found in healthy children in the U.S. using the same validated questionnaires and diagnostic criteria by twofold,” Saps and colleagues wrote. “Prior adult studies have found a 35% prevalence of IBS in patients with IBD, which is almost threefold higher than the prevalence of IBS found in our study, [which] may imply that, in some children, IBD-FAPD may develop over time.”
Long-term prospective studies are needed to identify predictors of developing FAPDs at different stages of life, they concluded. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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