Abstract
Functional gastrointestinal disorders have been known as a diagnosis of exclusion since the Rome Foundation first created these criteria in 1990. Since that time, a large amount of research and clinical data has better clarified the mechanisms and treatment options for these. Functional dyspepsia is caused by physiologic, genetic, environmental, and psychological factors, as well as various functional abnormalities, such as increased sensitivity to acid, increased sensitivity to duodenal lipids and low-grade inflammation. This disorder has significant symptom overlap between other functional disorders, such as irritable bowel syndrome and gastroparesis, but has differential criteria and two new subclasses: postprandial distress syndrome and epigastric pain syndrome. Diagnosis of functional dyspepsia should be based upon appropriate clinical evaluation in tandem with Rome IV criteria. In recent years, many treatment measures for functional dyspepsia have been studied, such as pharmacologic intervention, behavioral therapy, or alternative therapy, an example being hypnotherapy. These treatment measures have proven to be effective in symptom reduction in pediatrics. Though this disorder is functional, it has been shown to cause a significant impact on pediatric patients’ quality of life continuing into adulthood.
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References
Koppen IJ, Nurko S, Saps M, et al. The pediatric Rome IV criteria: what’s new? Expert Rev Gastroenterol Hepatol. 2017;11:193–201.
Turco R, Russo M, Martinelli M, et al. Do distinct functional dyspepsia subtypes exist in children? J Pediatr Gastroenterol Nutr. 2016;62:387–92.
Park R, Mikami S, LeClair J, et al. Inpatient burden of childhood functional GI disorders in the USA: an analysis of national trends in the USA from 1997 to 2009. Neurogastroenterol Motil. 2015;27:684–92.
de Silva PSA, Fishman LN. The transition of the gastrointestinal patient from pediatric to adult care. Pediatr Clin North Am. 2017;64:707–20.
Kim YS, Kim N. Functional dyspepsia: a narrative review with a focus on sex-gender differences. J Neurogastroenterol Motil. 2020;26:322–34.
Kumagai H, Yokoyama K, Imagawa T, et al. Functional dyspepsia and irritable bowel syndrome in teenagers: internet survey. Pediatr Int. 2016;58:714–20.
Colman RJ, Rosario NBS, Gutierrez Bonilla A, et al. Prevalence of functional GI disorders among pediatric patients with persistent asthma. J Dig Dis. 2018;19:522–8.
Tambucci R, Quitadamo P, Ambrosi M, et al. Association between obesity/overweight and functional gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr. 2019;68:517–20.
Penzol MJ, Salazar de Pablo G, Llorente C, et al. Functional gastrointestinal disease in autism spectrum disorder: a retrospective descriptive study in a clinical sample. Front Psychiatry. 2019;10:179.
Madra M, Ringel R, Margolis KG. Gastrointestinal issues and autism spectrum disorder. Child Adolesc Psychiatr Clin N Am. 2020;29:501–13.
Feinle-Bisset C, Vozzo R, Horowitz M, et al. Diet, food intake, and disturbed physiology in the pathogenesis of symptoms in functional dyspepsia. Am J Gastroenterol. 2004;99:170–81.
Faussone-Pellegrini MS, Matini P, Stach W. Differentiation of enteric plexuses and interstitial cells of Cajal in the rat gut during pre- and postnatal life. Acta Anat (Basel). 1996;155:113–25.
Wester T, O’Briain DS, Puri P. Notable postnatal alterations in the myenteric plexus of normal human bowel. Gut. 1999;44:666–74.
Caldarella MP, Azpiroz F, Malagelada JR. Antro-fundic dysfunctions in functional dyspepsia. Gastroenterology. 2003;124:1220–9.
Samsom M, Verhagen MA, vanBerge Henegouwen GP, et al. Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients. Gastroenterology. 1999;116:515–20.
Futagami S, Itoh T, Sakamoto C. Systematic review with meta-analysis: post-infectious functional dyspepsia. Aliment Pharmacol Ther. 2015;41:177–88.
Control CfD. Youth and Tobacco Use In. Centers for Disease Control and Prevention; 2021. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm.
Chumpitazi BP, Robayo-Torres CC, Tsai CM, et al. Demographic and clinical correlates of mucosal disaccharidase deficiencies in children with functional dyspepsia. J Pediatr Gastroenterol Nutr. 2018;66(Suppl 3):S52–5.
Talley NJ, Locke GR 3rd, Lahr BD, et al. Functional dyspepsia, delayed gastric emptying, and impaired quality of life. Gut. 2006;55:933–9.
Li X, Cao Y, Wong RK, et al. Visceral and somatic sensory function in functional dyspepsia. Neurogastroenterol Motil. 2013;25:246-253.e165.
Friesen CA, Lin Z, Hyman PE, et al. Electrogastrography in pediatric functional dyspepsia: relationship to gastric emptying and symptom severity. J Pediatr Gastroenterol Nutr. 2006;42:265–9.
Haag S, Senf W, Tagay S, et al. Is there any association between disturbed gastrointestinal visceromotor and sensory function and impaired quality of life in functional dyspepsia? Neurogastroenterol Motil. 2010;22:262-e279.
Overland MK. Dyspepsia. Med Clin North Am. 2014;98:549–64.
Wauters L, Nightingale S, Talley NJ, et al. Functional dyspepsia is associated with duodenal eosinophilia in an Australian paediatric cohort. Aliment Pharmacol Ther. 2017;45:1358–64.
Nocerino R, Di Costanzo M, Bedogni G, et al. Dietary treatment with extensively hydrolyzed casein formula containing the probiotic lactobacillus rhamnosus gg prevents the occurrence of functional gastrointestinal disorders in children with cow’s milk allergy. J Pediatr. 2019;213:137-142.e132.
Scarpellini E, Deloose E, Vos R, et al. The effect of arabinoxylooligosaccharides on gastric sensory-motor function and nutrient tolerance in man. Neurogastroenterol Motil. 2016;28:1194–203.
Schurman JV, Karazsia BT, Friesen CA. Examination of competing diagnostic models of functional gastrointestinal disorders related to pain in children. Neurogastroenterol Motil. 2017;29:e13126.
Schurman JV, Singh M, Singh V, et al. Symptoms and subtypes in pediatric functional dyspepsia: relation to mucosal inflammation and psychological functioning. J Pediatr Gastroenterol Nutr. 2010;51:298–303.
Friesen C, Singh M, Singh V, et al. An observational study of headaches in children and adolescents with functional abdominal pain: Relationship to mucosal inflammation and gastrointestinal and somatic symptoms. Medicine (Baltimore). 2018;97:e11395.
Kovacic K, Kapavarapu PK, Sood MR, et al. Nausea exacerbates symptom burden, quality of life, and functioning in adolescents with functional abdominal pain disorders. Neurogastroenterol Motil. 2019;31:e13595.
Le Gal J, Michel JF, Rinaldi VE, et al. Association between functional gastrointestinal disorders and migraine in children and adolescents: a case-control study. Lancet Gastroenterol Hepatol. 2016;1:114–21.
Horst S, Shelby G, Anderson J, et al. Predicting persistence of functional abdominal pain from childhood into young adulthood. Clin Gastroenterol Hepatol. 2014;12:2026–32.
Schurman JV, Danda CE, Friesen CA, et al. Variations in psychological profile among children with recurrent abdominal pain. J Clin Psychol Med Settings. 2008;15:241–51.
Zuo XL, Li YQ, Li WJ, et al. Alterations of food antigen-specific serum immunoglobulins G and E antibodies in patients with irritable bowel syndrome and functional dyspepsia. Clin Exp Allergy. 2007;37:823–30.
Zhao B, Zhao J, Cheng WF, et al. Efficacy of Helicobacter pylori eradication therapy on functional dyspepsia: a meta-analysis of randomized controlled studies with 12-month follow-up. J Clin Gastroenterol. 2014;48:241–7.
Lan L, Yu J, Chen YL, et al. Symptom-based tendencies of Helicobacter pylori eradication in patients with functional dyspepsia. World J Gastroenterol. 2011;17:3242–7.
Spee LA, Madderom MB, Pijpers M, et al. Association between helicobacter pylori and gastrointestinal symptoms in children. Pediatrics. 2010;125:e651-669.
Jones NL, Koletzko S, Goodman K, et al. Joint ESPGHAN/NASPGHAN guidelines for the management of Helicobacter pylori in children and adolescents (update 2016). J Pediatr Gastroenterol Nutr. 2017;64:991–1003.
Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional disorders: children and adolescents. Gastroenterology. 2016. https://doi.org/10.1053/j.gastro.2016.02.015.
Ozaki RK, Soares AC, Speridiao Pda G, et al. Water load test in childhood functional abdominal pain: no relation to food intake and nutritional status. J Pediatr Gastroenterol Nutr. 2015;61:330–3.
Gururatsakul M, Holloway RH, Bellon M, et al. Complicated and uncomplicated peptic ulcer disease: altered symptom response to a nutrient challenge linked to gastric motor dysfunction. Digestion. 2014;89:239–46.
Rodriguez-Ayllon M, Cadenas-Sanchez C, Estevez-Lopez F, et al. Role of physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: a systematic review and meta-analysis. Sports Med. 2019;49:1383–410.
Koloski NA, Jones M, Walker MM, et al. Functional dyspepsia is associated with lower exercise levels: a population-based study. United Eur Gastroenterol J. 2020;8:577–83.
Yeh AM, Golianu B. Integrative treatment of reflux and functional dyspepsia in children. Children (Basel). 2014;1:119–33.
Zybach K, Friesen CA, Schurman JV. Therapeutic effect of melatonin on pediatric functional dyspepsia: a pilot study. World J Gastrointest Pharmacol Ther. 2016;7:156–61.
Reed-Knight B, Claar RL, Schurman JV, et al. Implementing psychological therapies for functional GI disorders in children and adults. Expert Rev Gastroenterol Hepatol. 2016;10:981–4.
van Tilburg MA, Chitkara DK, Palsson OS, et al. Audio-recorded guided imagery treatment reduces functional abdominal pain in children: a pilot study. Pediatrics. 2009;124:e890–7.
Pinto-Sanchez MI, Yuan Y, Bercik P, et al. Proton pump inhibitors for functional dyspepsia. Cochrane Database Syst Rev. 2017;3:CD011194.
Talley NJ, American GA. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology. 2005;129:1753–5.
Suzuki H, Kusunoki H, Kamiya T, et al. Effect of lansoprazole on the epigastric symptoms of functional dyspepsia (ELF study): a multicentre, prospective, randomized, double-blind, placebo-controlled clinical trial. United Eur Gastroenterol J. 2013;1:445–52.
Moayyedi P, Soo S, Deeks J, et al. Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2006;4:CD001960.
Browne PD, Nagelkerke SCJ, van Etten-Jamaludin FS, et al. Pharmacological treatments for functional nausea and functional dyspepsia in children: a systematic review. Expert Rev Clin Pharmacol. 2018;11:1195–208.
Mearin F, Rodrigo L, Perez-Mota A, et al. Levosulpiride and cisapride in the treatment of dysmotility-like functional dyspepsia: a randomized, double-masked trial. Clin Gastroenterol Hepatol. 2004;2:301–8.
Holtmann G, Talley NJ, Liebregts T, et al. A placebo-controlled trial of itopride in functional dyspepsia. N Engl J Med. 2006;354:832–40.
Ueda M, Iwasaki E, Suzuki H. Profile of acotiamide in the treatment of functional dyspepsia. Clin Exp Gastroenterol. 2016;9:83–8.
Madani S, Cortes O, Thomas R. Cyproheptadine use in children with functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2016;62:409–13.
Rodriguez L, Diaz J, Nurko S. Safety and efficacy of cyproheptadine for treating dyspeptic symptoms in children. J Pediatr. 2013;163:261–7.
Tack J, Janssen P, Masaoka T, et al. Efficacy of buspirone, a fundus-relaxing drug, in patients with functional dyspepsia. Clin Gastroenterol Hepatol. 2012;10:1239–45.
Badihian N, Yaghini O, Badihian S, et al. Comparison of the efficacy of buspirone and placebo in childhood functional abdominal pain: a randomized clinical trial. Am J Gastroenterol. 2020;115:756–65.
Talley NJ, Locke GR, Saito YA, et al. Effect of amitriptyline and escitalopram on functional dyspepsia: a multicenter randomized controlled study. Gastroenterology. 2015;149:340-349.e342.
Talley NJ. Functional dyspepsia: advances in diagnosis and therapy. Gut Liver. 2017;11:349–57.
Tack J, Ly HG, Carbone F, et al. Efficacy of mirtazapine in patients with functional dyspepsia and weight loss. Clin Gastroenterol Hepatol. 2016;14:385-392.e384.
Suzuki H, Matsuzaki J, Fukushima Y, et al. Randomized clinical trial: rikkunshito in the treatment of functional dyspepsia–a multicenter, double-blind, randomized, placebo-controlled study. Neurogastroenterol Motil. 2014;26:950–61.
Oikawa T, Ito G, Hoshino T, et al. Hangekobokuto (Banxia-houpo-tang), a kampo medicine that treats functional dyspepsia. Evid Based Complement Alternat Med. 2009;6:375–8.
Raveendra KR, Jayachandra, Srinivasa V, et al. An extract of glycyrrhiza glabra (gutgard) alleviates symptoms of functional dyspepsia: a randomized, double-blind, placebo-controlled study. Evid Based Complement Alternat Med. 2012;2012:216970.
Lewis ML, Palsson OS, Whitehead WE, et al. Prevalence of functional gastrointestinal disorders in children and adolescents. J Pediatr. 2016;177:39-43.e33.
Varni JW, Bendo CB, Nurko S, et al. Health-related quality of life in pediatric patients with functional and organic gastrointestinal diseases. J Pediatr. 2015;166:85–90.
Ford AC, Forman D, Bailey AG, et al. Effect of dyspepsia on survival: a longitudinal 10-year follow-up study. Am J Gastroenterol. 2012;107:912–21.
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Waseem, S., Rubin, L. A comprehensive review of functional dyspepsia in pediatrics. Clin J Gastroenterol 15, 30–40 (2022). https://doi.org/10.1007/s12328-021-01561-w
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DOI: https://doi.org/10.1007/s12328-021-01561-w