Background & Aims

Patients with functional dyspepsia (FD) restrict oral intake due to symptoms, which may result in weight loss (1). Auricular Percutaneous Electrical Nerve Field Stimulation (PENFS), a non-pharmacologic approach has improved abdominal pain, and nausea in children with FD (2). We aimed to analyze changes in nutritional status with PENFS and associate with outcomes.

Methods

We retrospectively reviewed charts of FD patients (9-22y) undergoing PENFS and had diagnosed or suspected Avoidant Restrictive Feeding Intake Disorder (ARFID) based on Nine Item ARFID Screen (NIAS) questionnaire (picky eating, decreased appetite, avoiding foods due to GI symptoms and sensory aversions). We included demographics, medical history, and validated questionnaire responses collected prospectively during clinical care: Abdominal Pain Index (API), Nausea Severity Scale (NSS), Pain Catastrophizing Scale – Children (PCS-C), Children’s Somatization Inventory (CSI), Functional Disability Inventory (FDI), and Patient Health Questionnaire (PHQ-9) Depression Scale. Anthropometric and questionnaire data was assessed during and after 3 months of treatment.

Results

Ninety patients met criteria for ARFID (mean age 16.1 ± 2.6y, 87% female, 91% Caucasian). Forty-two% endorsed weight loss and 13% required enteral support. Overall, 37% of patients reported increased food intake after PENFS compared to 13% that stated increased food intake prior to PENFS (p=0.01). Weight and BMI improved at 4 weeks post-PENFS (p=0.02 and p=0.002 respectively) and sustained at 3 months (p<0.0001 and p=0.02 respectively). API, NSS, PCS-C, FDI, PHQ-9, and CSI scores improved at 4 weeks post PENFS (p<0.0001 for all). NSS (p=0.01), PCS (p=0.01), FDI (p=0.05), along with total (p=0.003) and GI-symptom related (p=0.0002) CSI scores were sustained 3 months post PENFS. During treatment, increased weight Z scores were associated with decrease in PHQ-9 (beta coefficient -11.5, p=0.04), NSS (-10.2, p=0.002), PCS-C (-5.0, p=0.007), and CSI scores (0.08, p=0.04).

Conclusions

In children with FD, PENFS increased weight, BMI and oral intake, sustained at 3 months. Decrease in nausea and depression was associated with the most increase in weight Z scores. PENFS may be an effective treatment to optimize nutrition in children with FD and ARFID.

References

1.Duboc H, Latrache S, Nebunu N, Coffin B. The Role of Diet in Functional Dyspepsia Management. Front Psychiatry. 2020 Feb 5;11:23.
2.Santucci NR, Beigarten AJ, Khalid F, El-Chammas KI, Graham K, Sahay R, Fei L, Rich K, Mellon M. Percutaneous Electrical Nerve Field Stimulation in Children and Adolescents With Functional Dyspepsia-Integrating a Behavioral Intervention. Neuromodulation. 2023 Aug 16:S1094-7159(23)00707-9.

Presenting Author

Neha R Santucci

Poster Authors

Neha Santucci

MD

Cincinnati Children's Hospital Medical Center

Lead Author

Umber Waheed

University of Cincinnati College of Medicine

Lead Author

Khalil El-Chammas

Cincinnati Children's Hospital Medical Center

Lead Author

Jesse Li

Cincinnati Children's Hospital Medical Center

Lead Author

Austin VonAxelson

University of Cincinnati College of Medicine

Lead Author

Sherief Mansi

Cincinnati Children's Hospital Medical Center

Lead Author

Kahleb Graham

Cincinnati Children's Hospital Medical Center

Lead Author

Jennifer Hardy

Cincinnati Children's Hospital Medical Center

Lead Author

Megan Miller

Cincinnati Children's Hospital Medical Center

Lead Author

Rashmi Sahay

Cincinnati Children's Hospital Medical Center

Lead Author

Lin Fei

Cincinnati Children's Hospital Medical Center

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Visceral Pain – Gastrointestinal/Abdominal