Background & Aims
Exploring paediatric gastrointestinal (GI) diseases is a dynamic medical challenge. Children and adolescents present with unique symptoms that require careful assessment, especially in differentiating visceral pain from non-painful GI symptoms. These can range from mild discomfort to indicators of serious disease. The initial outpatient visit is crucial for diagnosis and treatment planning. Understanding the nature and spectrum of these symptoms is crucial for improving paediatric care. We aimed to improve the understanding of GI disorders in paediatric patients, utilising the recently validated paediatric (p)SAGIS questionnaire, which provides an unbiased assessment of symptoms.
Methods
From February 2016 to January 2023, all consecutive patients attending the outpatient GI clinic at St. Anna Kinderspital, Vienna, Austria, underwent a standard work-up to arrive at a final diagnosis. In addition, and independently, the patients and/or their caregivers completed the pSAGIS for standardised symptom assessment on the day of their appointment before meeting the paediatrician. pSAGIS consists of 21 GI-related questions (assessment of type and 5 severity grades within the previous week) to arrive at five symptom groups (abdominal pain, diarrhea, constipation, dysphagia, and dyspepsia). Pain was considered clinically relevant if the score was at least 1 (moderate pain) and severe if the score was ?2. Data were analyzed for functional bowel disorder (FBD) versus organic GI disease (OD), with a p-value <0.05 considered significant.
Results
1481 outpatients completed the pSAGIS questionnaire at their initial consultation. Patients were then followed up to establish a final diagnosis. 775 patients were diagnosed with organic disease, 441 patients were diagnosed with functional bowel disease, and 265 subjects were healthy or had a non-GI diagnosis or could not be definitively diagnosed.
In the whole group, abdominal pain was reported by 405 patients (27.3%) and severe pain by 140 patients (9.5%). 185 patients with organic disease (23.9%) but 199 patients with FBD (45.1%) reported abdominal pain (p>0.001), severe pain was reported by 42 (5.4%; OD) and 54 (12.2%; FBD) patients, respectively (p<0.001). Pain was reported as the main symptom by 105 OD patients (13.5%) vs. 113 FBD patients (25.6%) (p<0.001). Pain was present but not the main symptom in 64 (8.3%; OD) and 65 (14.7%; FBD) patients, respectively (p>0.01). Of the latter, 14 (1.8%; OD) and 18 (4.1%; FBD) patients reported severe pain.
Conclusions
Our study provides a comprehensive insight into paediatric gastrointestinal symptoms using the paediatric SAGIS questionnaire. The stark contrast in the prevalence of abdominal pain between patients with organic disease and functional bowel disorders underscores the complex landscape of paediatric GI problems. In particular, the high incidence of severe pain in functional bowel disorders challenges conventional perceptions of these disorders. Recognising pain as a prominent symptom in both organic and functional cases is critical for effective management. The findings underscore the critical role of standardised assessment tools, such as the pSAGIS questionnaire, in delineating the nuanced spectrum of paediatric GI symptoms and ultimately informing more targeted and comprehensive care strategies.
References
K Hammer, G Holtmann, J Hammer. Validation of the Structured Assessment of Gastrointestinal Symptoms Scale to Support Standardized Evaluation and Follow-up. J Pediatr Gastroenterol Nutr 2023;77:178-183