Mo2020 - Perceptions of Pain Treatment in Pediatric Patients with Functional Gastrointestinal Disorders (original) (raw)
Related papers
Long Term Follow-Up in Infants with Gastroesophageal Reflux
Journal of Pediatric Gastroenterology and Nutrition, 2005
Introduction: Determining the definitive diagnosis for abdominal pain in children remains a challenge for pediatricians. Rome Criteria for pediatric functional gastrointestinal disorders is a tool to be tested. Methods: Eighty-four consecutive patients with abdominal pain seen at a tertiary pediatric gastrointestinal outpatient clinic, from 1999 to 2000, were interviewed at presentation and followed up for 3 years. The interview methods included the assessment of symptoms defined by the Pediatric Rome Criteria. Results: Patients were classified as follows: Thirty-two patients did not fulfill the subtypes of Rome Criteria for abdominal pain: 25 were diagnosed with an organic disease and 7 referred total remission of the symptom after the first clinical assessment. Fifty-two patients (median age 9.3 years, min. 5 years, max. 13 y; 50% boys) fulfilled the Pediatric Rome Criteria for abdominal pain: 26 (50%) patients fulfilled the Criteria for functional abdominal pain, 24 patients (46.2%) for functional dyspepsia (18 for dismotility-like dyspepsia and 6 for ulcer-like dyspepsia) and, one patient (3.8%) for irritable bowel syndrome. Patients' evolution in the three-year follow-up period was the following: Nine patients left the abdominal pain Rome criteria and were classified in the functional constipation criteria. Seven patients, from those 32 who had not fulfilled the Rome Criteria, could be inserted in the irritable bowel syndrome during the follow up, based on the fact that the initial diagnosis of lactose intolerance, which had been confirmed by oral tolerance test, could not be maintained after excluding lactose from the patients' diet. Conclusion: Lactose intolerance, functional constipation and irritable bowel syndrome were conditions that might lead to a misinterpretation in the use of the Rome Criteria for pediatric abdominal pain. ROUTINE COMBINED ESOPHAGEAL IMPEDANCE AND pH MEASUREMENT IN CHILDREN.
Management of Pediatric Dysphagia
Otolaryngologic Clinics of North America, 1998
Optimal management strategies are critical for infants and children with feeding and swallowing problems. Management decisions are made best through a team approach in which caregivers participate with medical and educational professionals to work toward maximizing each child's nutritional status in the context of safe and efficient feeding. These management decisions are typically made on the basis of clinic feeding observations and assessments. In addition, important information is obtained through a careful developmental, health, and feeding history. Frequently, an instrumental assessment is completed, particularly when pharyngeal phase function needs to be defined. The videofluoroscopic swallow study (VFSS) is most commonly used at present and is considered to be the "gold standard." Findings on VFSS affirm clinic observations in many instances, but may seem almost contradictory or surprising in relation to clinic observations in other instances. Clinic evaluation alone has been shown to be limited by failure to evaluate the pharynx in many adult patients.61 The definition of pharyngeal physiology by VFSS provides information that may alter feeding recommendations for infants and children. Management decisions may incorporate nutrition recommendations, medical and surgical decisions, position guidelines, oral-motor/swallow practice, and behavioral intervention. Goals are determined in light of health issues with adequate nutrition as the most important goal for longterm growth. Realistic short-and long-term goals are delineated to caregivers clearly and realistically. The entire family is disrupted when one member requires significant time from caregivers for meeting basic needs From the Speech-Language
Oropharyngeal dysphagia, an underestimated disorder in pediatrics
Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva, 2015
Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additional tests can be run like the water-swallowing test, the viscosity-volume test (which determines what kind of texture and how much volume the patient is able to tolerate), a fiberoptic endoscopy of swallowing or a videofluoroscopic swallow study, which is the gold standard for the study of swallowing disorders.It requires a multidisciplinary approach to guarantee an adequate intake of fluids and nutrients with minimal risk of aspiration. If these two conditions cannot be met, a gastrostomy feeding...
Children
Dysphagia is any impairment of swallowing that compromises the safety, efficiency, or adequacy of nutritional or liquid intake. It is common in children, especially in some clinical populations, and may result in failure to thrive and respiratory problems due to pulmonary aspiration. Swallowing disorders have a severe impact on children’s health, growth, and development, and on the quality of life of the child and family. Clinical evaluation cannot validly predict aspiration, which is mostly silent. A team management approach is advocated, including instrumental swallowing assessments. FEES has been proven to be safe and valid and is increasingly used in children of all ages. It allows the identification of structural abnormalities, assessment of the child’s diet with real-life food and liquids while the child holds the optimal or preferred position, examination during breastfeeding, and assessment of fatigue and treatment strategies. FEES is carried out following a protocol that co...
International Journal of Pediatric Otorhinolaryngology, 2017
Objective: Whereas the literature is replete with reports on complex children with dysphagia (DP), the parameters characterizing non-neurologically impaired (NNI) children have been underreported, leaving a substantial knowledge gap. We set to characterize a consecutive cohort of NNI children, their management, and outcomes. Methods: We undertook a retrospective case series. Children (<18 years old) attending a tertiary multidisciplinary swallowing clinic were eligible. Patients with neuro-developmental, neuromuscular, or syndromic abnormalities were excluded. Primary outcomes included demographics, co-morbidities, presentations, McGill score, swallowing and airway abnormalities (and their predictors). Secondary outcomes were interventions and management response. Results: From 171 consecutive patients (37-month period), 128 were included (69 males, median age 6.6 months (0.5-124.2)). Significant clinical presentations included recurrent pneumonias (20), cyanotic spells (14) and life-threatening events (10). Swallowing assessments revealed laryngeal penetration (67), aspiration (25). Other investigations included overnight oximetry (77), airway (70), and gastrointestinal endoscopy (24); revealing laryngomalacia (29), laryngeal mobility disorder (8), and subglottic stenosis (8). Non-surgical interventions involved oral diet modifications (85) and enteral nutrition (15). Surgical interventions included supraglottoplasties (18), endoscopic laryngeal cleft repair (14), and injection (19). 119 patients received intervention and at last follow-up (median 5.2 months (0.3-88.8)) 94 had improved. Of those treated 116 were on an unmodified oral diet, and 24 on a modified diet. ALTE and snoring predicted airway abnormalities, recurrent pneumonia predicted swallowing abnormalities, and age and airway lesions predicted the McGill score. Conclusion: a significant proportion of NNI children with DP harbor airway and swallowing abnormalities warranting endoscopic and instrumental assessment.
Gastro-oesophageal reflux and Gastro-oesophageal reflux disease in infants and children: an exploration of symptom-based questionnaires, 2023
In Pediatric patients, Gastro-oesophageal reflux (GER) and Gastro-oesophageal reflux disease (GERD) are common and constitute disorders with a large workload for pediatricians. Clinical symptoms and signs are variable and nonspecific, particularly in neonates and infants. Indeed, many symptoms/signs may be secondary to other diagnoses, such as cow's milk allergy, malformation, metabolic, renal, and neurologic disorders. Thus, this may lead to underdiagnosis, overdiagnosis, and unneeded treatment. Therefore, standardizing information regarding clinical information could help define the diagnosis, observe the therapeutic response, and allow the participation of parents and caregivers in the diagnosis-treatment process. For clinical practice, valid and reliable assessment tools can complement clinical assessment to guide decision-making. Parent-reported assessment tools can be used to compare symptoms between populations and longitudinally to measure change over time or in response to interventions. Few non-invasive Questionnaires are available to measure GER/GERD in infants and children. The primary purpose of this Mini review is to describe the main Symptom-Based Questionnaires.
Gastroesophageal reflux and unexplained chronic respiratory disease in infants and children
Pediatric Pulmonology, 1987
Thirty-eight children, aged from a few weeks to 7 years, with severe chronic pulmonary disease and without gastrointestinal symptoms, were investigated for gastroesophageal reflux (GER), using prolonged pH probe monitoring and gastroesophageal scintiscanning. All treatments were discontinued before testing. GER was found in 24 patients (63%) (group I) and it was not obsewed in 14 patients (group 11). All patients of group I received antireflux treatment, consisting of cisapride; in 22 of 24 patients, GER was controlled, as indicated by improvement of either pH monitoring or scintiscanning. or both. Eighteen of these 22 (8P/o) had femission of their pulmonary disease, and only two patients of group I 1 (14%) had spontaneous remission of the respiratory symptoms. We concluded that GER was probably the cause of the respiratory disease in 63% of our patients, since treatment of GER was followed by disappearance of the respiratory complaints in most of them. The combination of gastroesophageal scintiscanning and pH probe study improved the diagnostic accuracy. Pediatr Pulmonol 1987; 3208-213.
Gastro-esophageal reflux in children: Symptoms, diagnosis and treatment
Journal of Pediatric …, 2011
Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and is a normal physiologic process occurring several times per day in healthy individuals. In infants and toddlers, no symptoms allow to diagnose GERD or to predict response to therapy. In older children and adolescents, history and physical examination may be sufficient to diagnose GERD. Endoscopically visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Esophageal pH monitoring quantitatively measures esophageal acid exposure. The severity of pathologic acid reflux does not predict symptom severity or treatment outcome. Combined multiple intraluminal impedance and pH monitoring (MII-pH) measures both acid, weakly acid, non-acid and gas reflux episodes. MII-pH is superior to pH monitoring alone for evaluation of the temporal relationship between symptoms and GER. Barium contrast radiography is not useful for the diagnosis of GERD, but is useful to detect anatomic abnormalities. Tests on ear, lung and esophageal fluids for lactose, pepsin or lipid laden macrophages have all been proposed without convincing evidence. An empiric trial of acid suppression as a diagnostic test can be used in older children (> 10 years). Parental education, guidance and support are always required and usually sufficient to manage healthy, thriving infants with symptoms likely due to physiologic GER. Use of a thickened feed, by preference commercially available antiregurgitation formula, decrease visible regurgitation. Positional therapy brings additional benefit. Prone (beyond the age of sudden infant death syndrome) or left side sleeping position, and/or elevation of the head of the bed decrease GER. Chronic use of buffering agents or sodium alginate is not recommended for GERD since some have absorbable components that may have adverse effects with long-term use. Potential adverse effects of currently available prokinetic agents outweigh the potential benefits of these medications for treatment of GERD. Proton pump inhibitors (PPIs) are superior to histamine-2 receptor antagonists (H2RAs). Administration of long-term acid suppression without a diagnosis is not recommended. No PPI has been approved for use in infants < 1 year of age. The potential adverse effects of acid suppression, including increased risk of community-acquired pneumonias and gastrointestinal infections, need to be balanced against the benefits of therapy. Anti-reflux surgery is of benefit in selected children with chronic, relapsing GERD. Indications include failure of optimized medical therapy; dependence on long-term medical therapy; significant nonadherence with medical therapy; or pulmonary aspiration of refluxate.
1996
To identify the prevalence of reflux symptoms in normal infants, to characterize the diagnostic validity ofa previously described I38-item Infant Gastroesophageal Reflux Questionnaire (I-GERQ) for separating normal infants from those with gastroesophageal reflux disease (G,ERD), and to identify potentially provocative c~retaking practices, we administered the qu<;stionnaire to 100 infants attending a well-baby clinic (normals) and to 35 infants referred to the Gastroenterology Division for evaluation for GERD and testing positive on esophageal pH prob~or biopsy (GERD infants). Differences were analyzed by Chi-square, and odds ratios were defined. The diagnostic validity of a 25-point I-GERQ GERD score based on 11 items on the questionnaire was evaluated by calculating its sensitivity, specificity, and positive and negative predictive values. We found that normal infants had a high prevalence of reflux symptoms, such as daily regurgitation (40%), respiratory symptoms, crying more than an hour a day (17%), arching (10%), or daily hiccups (36%) but that many symptoms were significantly more prevalent in the GERD than in the normal infants (Chi-square P<.05), and odds ratios were above 3 for nearly 20 items. The positive and negative predictive values for the 25-point I-GERQscore were 1.00 and .94-.98, respectively. Environmental smoke exposure did not quite reach significance as a provocative factor for GERD. Although normal infants have a high prevalence of symptoms suggesting GERD, a simple questionnairebased score is a valid diagnostic test with high positive and negative predictive values.