Gastroenterology

Gastroenterology

Volume 130, Issue 5, April 2006, Pages 1527-1537
Gastroenterology

Introduction
Childhood Functional Gastrointestinal Disorders: Child/Adolescent

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The Rome II pediatric criteria for functional gastrointestinal disorders (FGIDs) were defined in 1999 to be used as diagnostic tools and to advance empirical research. In this document, the Rome III Committee aimed to update and revise the pediatric criteria. The decision-making process to define Rome III criteria for children aged 4–18 years consisted of arriving at a consensus based on clinical experience and review of the literature. Whenever possible, changes in the criteria were evidence based. Otherwise, clinical experience was used when deemed necessary. Few publications addressing Rome II criteria were available to guide the committee. The clinical entities addressed include (1) cyclic vomiting syndrome, rumination, and aerophagia; 2) abdominal pain-related FGIDs including functional dyspepsia, irritable bowel syndrome, abdominal migraine, and functional abdominal pain; and (3) functional constipation and non-retentive fecal incontinence. Adolescent rumination and functional constipation are newly defined for this age group, and the previously designated functional fecal retention is now included in functional constipation. Other notable changes from Rome II to Rome III criteria include the decrease from 3 to 2 months in required symptom duration for noncyclic disorders and the modification of the criteria for functional abdominal pain. The Rome III child and adolescent criteria represent an evolution from Rome II and should prove useful for both clinicians and researchers dealing with childhood FGIDs. The future availability of additional evidence-based data will likely continue to modify pediatric criteria for FGIDs.

Section snippets

Epidemiology

Rumination syndrome is most common in male infants and female adolescents.15, 16

H1a. Diagnostic Criteria for Adolescent Rumination Syndrome

Must include all of the following

  • 1

    Repeated painless regurgitation and rechewing or expulsion of food that

    • a

      begin soon after ingestion of a meal

    • b

      do not occur during sleep

    • c

      do not respond to standard treatment for gastroesophageal reflux

  • 2

    No retching

  • 3

    No evidence of an inflammatory, anatomic, metabolic, or neoplastic process that explains the subject’s symptoms

H2. Abdominal Pain–Related FGIDs

In children with abdominal pain–related FGIDs, the alarm features, signs, and symptoms listed in Table 2 are generally absent. The committee recognized the great variability in the severity and phenotypic presentation of children with abdominal pain–related FGIDs and therefore decided to split the previously inclusive category of functional abdominal pain into 2 separate disorders, childhood functional abdominal pain and childhood functional abdominal pain syndrome (FAPS), so that studies done

H3a. Functional Constipation

The term “functional constipation” describes all children in whom constipation does not have an organic etiology. Because functional constipation and functional fecal retention often overlap, the 2 disorders were merged into 1 category named “functional constipation.”3, 9

Recommendations for Future Research

Many of the recommendations listed by the Rome II committee remain valid. Other suggestions for future research topics in this area have recently been formulated by other committees of several pediatric gastroenterology societies.70, 71 The committee identified the following areas that are in need of research in the near future.

  • 1

    Further validation studies of the pediatric Rome criteria need to be developed. Such studies need to be performed in a wide range of clinical settings and patient

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