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