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The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals

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Abstract

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1–12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).

Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID.

What is Known:

• The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants.

• In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment.

What is New:

• This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation.

• The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs.

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Abbreviations

FGID:

Functional gastrointestinal disorders

FODMAP:

Fermentable, oligo-, di-, and mono-saccharides and polyols

LFA:

Length-for-age

WFL/H:

Weight-for-length/height

WHO:

World Health Organization

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Authors and Affiliations

  1. Cerrahpasa Medical Faculty, Paediatric Gastroenterology, Hepatology and Nutrition, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Omer Faruk Beser & Fugen Cullu Cokugras

  2. Haseki Education and Training Hospital, Department of Paediatric, University of Health Sciences, Istanbul, Turkey

    Guzide Dogan, Ozlem Akgun & Murat Elevli

  3. Okmeydani Education and Training Hospital, Department of Paediatric, University of Health Sciences, Istanbul, Turkey

    Pinar Yilmazbas & Meric Ocal

  4. Zeynep Kamil Education and Training Hospital, Department of Paediatric, University of Health Sciences, Istanbul, Turkey

    Nevzat Aykut Bayrak, Rabia Gonul Sezer Yamanel & Abdulkadir Bozaykut

  5. Umraniye Education and Training Hospital, Paediatric Gastroenterology, Hepatology and Nutrition, University of Health Sciences, Istanbul, Turkey

    Coşkun Celtik, Esra Polat & Nelgin Gerenli

  6. Umraniye Education and Training Hospital, Department of Paediatric, University of Health Sciences, Istanbul, Turkey

    Serdar Bozlak

  7. Bakirkoy Dr. Sadi Konuk Education and Training Hospital, Department of Paediatric, University of Health Sciences, Istanbul, Turkey

    Hasret Ayyildiz Civan, Neslihan Ozkul Saglam & Sadik Sami Hatipoglu

  8. Istanbul Education and Training Hospital, Department of Paediatric, University of Health Sciences, Istanbul, Turkey

    Gamze Özgürhan, Eda Sunnetci Silistre & Burcu Solmaz

  9. Kanuni Sultan Suleyman Education and Training Hospital, Paediatric Gastroenterology, Hepatology and Nutrition, University of Health Sciences, Istanbul, Turkey

    Gunsel Kutluk

  10. Kanuni Sultan Suleyman Education and Training Hospital, Department of Paediatric, University of Health Sciences, Istanbul, Turkey

    Hamide Sevinc Genc

  11. Kanuni Sultan Suleyman Education and Training Hospital, Pediatric Metabolic Disease, University of Health Sciences, Istanbul, Turkey

    Hasan Onal

  12. Sisli Hamidiye Etfal Education and Training Hospital, Paediatric Gastroenterology, Hepatology and Nutrition, University of Health Sciences, Istanbul, Turkey

    Ayse Merve Usta & Nafiye Urganci

  13. Sisli Hamidiye Etfal Education and Training Hospital, Department of Paediatric, University of Health Sciences, Istanbul, Turkey

    Ayse Sahin

  14. Goztepe Education and Training Hospital, Paediatric Gastroenterology, Hepatology and Nutrition, Medeniyet University, Istanbul, Turkey

    Sebahat Cam

  15. Goztepe Education and Training Hospital, Department of Paediatric, Medeniyet University, Istanbul, Turkey

    Sema Yildirim & Asilay Yildirim

  16. Kidz Health Castle, Paediatric Gastroenterology, Hepatology and Nutrition, Universitair Ziekenhuis Brussel, Brussel, Belgium

    Yvan Vandenplas

Authors
  1. Omer Faruk Beser
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  2. Fugen Cullu Cokugras
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  3. Guzide Dogan
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  4. Ozlem Akgun
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  7. Meric Ocal
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  8. Nevzat Aykut Bayrak
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  9. Rabia Gonul Sezer Yamanel
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  10. Abdulkadir Bozaykut
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  11. Coşkun Celtik
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  12. Esra Polat
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  13. Nelgin Gerenli
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  14. Serdar Bozlak
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  15. Hasret Ayyildiz Civan
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  16. Neslihan Ozkul Saglam
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  17. Sadik Sami Hatipoglu
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  18. Gamze Özgürhan
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  19. Eda Sunnetci Silistre
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  20. Burcu Solmaz
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  21. Gunsel Kutluk
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  22. Hamide Sevinc Genc
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  23. Hasan Onal
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  24. Ayse Merve Usta
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  25. Nafiye Urganci
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  26. Ayse Sahin
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  27. Sebahat Cam
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  28. Sema Yildirim
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  29. Asilay Yildirim
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  30. Yvan Vandenplas
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Contributions

Omer Faruk Beser had primary responsibility for protocol development, enrollment, outcome assessment, preliminary data analysis, and writing the manuscript. Fugen Cullu Cokugras had primary responsibility for protocol development, outcome assessment, and supervised the design and execution of the study. Guzide Dogan, Ozlem Akgun, Murat Elevli, Pinar Yilmazbas, Meric Ocal, Nevzat Aykut Bayrak, Rabia Gonul Sezer, Abdulkadir Bozaykut, Coşkun Celtik, Esra Polat, Nelgin Gerenli, Serdar Bozlak, Hasret Ayyildiz Civan, Neslihan Ozkul Saglam, Sadik Sami Hatipoglu, Gamze Özgürhan, Eda Sunnetci Silistre, Burcu Solmaz, Gunsel Kutluk, Hamide Sevinc Genc, Hasan Onal, Ayse Merve Usta, Nafiye Urganci, Ayse Sahin, Sebahat Cam, Sema Yildirim, and Asilay Yildirim participated in analytical framework for the study and contributed to the patient screening. Yvan Vandenplas supervised the design and execution of the study, performed the final data analyses, and contributed to the writing of the manuscript.

Corresponding author

Correspondence to Omer Faruk Beser.

Ethics declarations

Ethical approval

The study protocol was approved by the University of Health Sciences, Okmeydanı Education and Training Hospital Ethics Committee, and all the parents provided written informed consent. Data were collected in an anonymous way and analyzed and reported only in aggregate form. Given the purely descriptive and retrospective nature of the study, informed consent was waived.

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All the parents provided written informed consent.

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Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

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Beser, O.F., Cullu Cokugras, F., Dogan, G. et al. The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals. Eur J Pediatr 180, 2443–2452 (2021). https://doi.org/10.1007/s00431-021-04059-2

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