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Introduction

Pediatric patients with recurrent functional abdominal pain (RAP) may associate small intestinal bacterial overgrowth (SIBO). Also, children with known atopy may present RAP more frequently.

Aims & Methods

The objective of this research was to establish a potential conection between intestinal dysbiosis and alimentary or respiratory allergic diseases in children diagnosed with functional RAP. The authors conducted a randomized placebo controled prospective study. All consecutive pediatric patients diagnosed with RAP between January 2022 and January 2023 were enrroled in this study. All children undergone complet work up protocol to rule out organic causes for RAP. Glucose hydrogen breath test (GHBT) was performed to asses the presence of SIBO in every case. Also, all subjects were tested for allergies by assessing specific serum IgE level or by performing skin prick tests. The control lot included sex and aged matched healthy children that undergone GHBT. The study lots were statistically compared according to the distribution of SIBO and the presence of atopy.

Results

258 patients with RAP were enrolled (148 females and 110 males). GHBT was positive in 136 patients (52,71%). From 230 control subjects, only 15 (6,52%) tested positive for SIBO (p=0.001 compared to RAP group). All controls were negative for atopy assessment. 78% of children with SIBO and RAP tested positive to allergy assessment compared to only 23% of patients without SIBO and presence of RAP (p=0.001). The odds ratio for developing an allergy in children with SIBO was 4.42 (95% CI, 1.85-14.24; p = 0.001).

Conclusion

There is a statistic correlation between alergic disorders (cow's milk protein allergy, atopic dermatitis, allergic rhinitis) and SIBO in children with RAP. Therefore, in pediatric patients with RAP and atopy, SIBO should be investigated and treated accordingly to alleviate symptoms.

Disclosure

There is no conflict of interest.

THE RELATIONSHIP BETWEEN DYSBIOSIS AND ATOPY AMONG CHILDREN WITH RECURRENT ABDOMINAL PAIN

Oana Belei 1, Laura Olariu 2, Iulius Juganaru 2, Otilia Marginean 2

1 Victor Babes University Of Medicine And Pharmacy, Timisoara, Romania

2 Victor Babes University of Medicine and Pharmacy, Timisoara, Romania

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 03 Small intestinal (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Presentation

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PHENOTYPIC-GENOTYPIC ASSOCIATIONS OF ABDOMINAL PAIN IN CHILDREN

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Introduction

Abdominal pain is the most common symptom among children, but its pathophysiology is heterogeneous and its mechanisms are incompletely understood. To date, various risk factors for abdominal pain have been reported ^1–3 but reports of genetic associations for abdominal pain in children are scarce. To understand the determinants of abdominal pain in children, phenotypic-genotypic associations using robust stratification in a large sample are necessary.

Aims & Methods

To stratify children with abdominal pain according to common characteristics by machine learning (ML) algorithms and to identify phenotype-genotype associations.
The Born in Bradford birth cohort has 13,858 children registered between 2007 and 2011 whose primary care medical records are available. In 1,274 children who developed abdominal pain from the whole cohort　(average age: 8.4 ± 1.1 years old, male/female: 615/659), we investigated the frequencies of comorbidities associated with abdominal pain and then clustered them using the unsupervised ML algorithm. Genome-wide association studies (GWAS) were used to seek significant variants of single nucleotide polymorphisms (SNPs) responsible for the differences among clusters, using 6,488 (male/female = 3,375/3,113) children without abdominal pain as the control. Gene annotations for each SNP were obtained to identify gene sets for each cluster, and these were used in enrichment analysis.

Results

Children with abdominal pain were classified into 3 unique clusters: 137 children in cluster 1 (10.8 %), 677 children in cluster 2 (53.1 %), and 340 children in cluster 3 (26.7 %). Significant results of comparison of clinical characteristics among 3 clusters are shown in the table. Children in cluster 1 were characterized by allergic diseases (99.3 %), and all mothers had allergic diseases (100 %). In cluster 2, mothers' comorbidities, e.g., abdominal pain (70.0 %), allergic diseases (40.0 %), and migraine (34.0 %), were the highest compared to the other 2 clusters. In cluster 3, the frequencies of comorbidities, including allergic diseases and mother's comorbidities, were very low. GWAS showed that there were 2, 1, and 4 SNPs with genome-wide significance (p < 5.0×10^-8) in clusters 1, 2, and 3, respectively. Enrichment analysis revealed that ARPC5 and CLDN genes associated with Tight junction might account for abdominal pain in cluster 1. Genes associated with bile acid biosynthesis might also be associated with abdominal pain in clusters 1 and 2; there no significant findings in cluster 3.

Cluster No	Cluster 1 (n = 137)	Cluster 2 (n = 677)	Cluster 3 (n = 340)	P value (Cluster 1 vs. 2)	P value (Cluster 1 vs. 3)	P value (Cluster 2 vs. 3)
Allergic disease, n (%)	136 (99.3 %)	465 (68.7 %)	0 (0.0 %)	<0.01	<0.01	<0.01
Mother’s abdominal pain, n (%)	0 (0.0 %)	474 (70.0 %)	157 (46.2 %)	<0.01	<0.01	<0.01
Mother’s allergic disease, n (%)	137 (100.0 %)	271 (40.0 %)	81 (23.8 %)	<0.01	<0.01	<0.01
Mother’s arthritis, n (%)	10 (7.3 %)	77 (11.4 %)	14 (4.1 %)	0.53	0.50	<0.01
Mother’s depressive disorder, bipolar disorder, n (%)	28 (20.4 %)	252 (37.2 %)	0 (0.0 %)	<0.01	<0.01	<0.01
Mother’s FD, n (%)	1 (0.7 %)	27 (4.0 %)	4 (1.2 %)	0.21	1.00	0.04
Mother’s GORD, n (%)	14 (10.2 %)	128 (18.9 %)	14 (4.1 %)	0.04	0.05	<0.01
Mother’s IBS, n (%)	12 (8.8 %)	86 (12.7 %)	24 (7.1 %)	0.75	1.00	0.02
Mother’s migraine, n (%)	15 (10.9 %)	230 (34.0 %)	20 (5.9 %)	<0.01	0.24	<0.01

Conclusion

We detected 3 distinct phenotypes of abdominal pain in children. Each phenotype may need a tailor-made therapeutic approach according to its etiology and pathophysiology. Furthermore, genetic findings can be a target for future studies to investigate the mechanisms of abdominal pain. In particular, the link between allergy and intestinal barrier may be of mechanistic and therapeutic importance.

References

1. Korterink, J., Devanarayana, N. M., Rajindrajith, S., Vlieger, A. & Benninga, M. A. Childhood functional abdominal pain: Mechanisms and management. Nat. Rev. Gastroenterol. Hepatol. 12, 159–171 (2015).
2. Sjölund, J. et al. Allergy-related diseases in childhood and risk for abdominal pain-related functional gastrointestinal disorders at 16 years—a birth cohort study. BMC Med. 19, 1–11 (2021).
3. Levy, R. L. et al. Increased somatic complaints and health-care utilization in children: Effects of parent IBS status and parent response to gastrointestinal symptoms. Am. J. Gastroenterol. 99, 2442–2451 (2004).

PHENOTYPIC-GENOTYPIC ASSOCIATIONS OF ABDOMINAL PAIN IN CHILDREN

Kazuya Takahashi 1, Huma Shehwana 2, James Ruffle 3, John A. Williams 4, Animesh Acharjee 4, Shuji Terai 5, Georgios V. Gkoutos 4, Humayoon Satti 2, Qasim Aziz 6

1 Queen Mary University of London, London, United Kingdom

2 National University of Medical Sciences, Rawalpindi, Pakistan

3 Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of L, London, United Kingdom

4 College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom

5 Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

6 Wingate Institute for Neurogastroenterology - Centre for Neuroscience and Trauma, London, United Kingdom

Event

UEG Week Copenhagen 2023

Topics

IBD Neurogastroenterology & Motility Paediatrics Small Intestine & Nutrition Colorectal

Submission format

Abstract

Session

Disorders of gut-brain interactions: New tricks for old dogs

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Nutrition is one of the important risk factors for the occurrence of functional gastrointestinal disorders in children. These disorders, including functional dyspepsia (FD) and irritable bowel syndrome (IBS), are increasingly prevalent in the pediatric population. Understanding dietary patterns in affected children is crucial for developing preventive and therapeutic strategies.

Aims & Methods

The aim is to study eating behavior disorders in children with functional gastrointestinal disorders and to analyze the diet of children with combined functional gastrointestinal pathology.
Materials and methods: 110 children aged 6 to 18 with functional gastrointestinal disorders were examined. Patients were divided into two groups: 44 with a combination of symptoms of functional dyspepsia and irritable bowel syndrome and 66 with functional dyspepsia. The control group consisted of 30 practically healthy children. The diagnosis of functional dyspepsia and irritable bowel syndrome was established on the basis of clinical symptoms according to the Rome IV criteria (2016). In order to detect a violation of the nutritional regime, children were interviewed according to a questionnaire developed by us. They also studied the food preferences of schoolchildren using the Youth Adolescent Food Frequency Questionnaire, adapted to the model of children's nutrition in Ukraine.

Results

The frequency of eating disorders (absence of breakfast or full lunch at school, reduced number of meals) in children with functional disorders is higher than in healthy children. In children with overlap syndrome, these disorders were detected statistically significantly more often than in children with isolated functional dyspepsia. In children with functional disorders, the frequency of consumption of vegetables, cereals and cereal products is lower than in healthy children, and the consumption of meat, sausages and confectionery, fast food, chips, nuts, seeds, energy and sweet carbonated drinks, and fruit juices is higher. In children with a combination of functional dyspepsia and irritable bowel syndrome, the frequency of consumption of vegetables, cereals, and grain products is lower, and the consumption of confectionery, fast food, energy and sweet carbonated drinks is higher than in children with functional dyspepsia.
We conducted an analysis of nutrition in children with a combined pathology of functional dyspepsia (FD) and irritable bowel syndrome (IBS) (see table below).

Indicator Eating less than 3 times a day	Combined FD and IBS, n = 44, N 14	% ± m 31.8 ± 7.3*	Functional Dyspepsia n = 66, N 8	% ± m 12.2 ± 4.4	Control Group n = 30, N 3	% ± m 10 ± 5.5
Skip breakfast	17	38.6 ± 7.3*	5	7.6 ± 3.9	4	13.3 ± 6.2***
Eat sandwiches for breakfast	14	31.8 ± 6.7	27	40.9 ± 7.4**	4	13.3 ± 6.2
Eat hot meals for breakfast	13	29.7 ± 6.6*	34	51.6 ± 7.5	22	73.3 ± 8.1***
Do not eat lunch at school	2	4.54 ± 1.51	5	7.57 ± 3.98	0	-
Eat lunch in school cafeteria	19	43.2 ± 7.5	42	63.2 ± 7.3	20	66.7 ± 8.6
Buy food in school snack bar	21	47.7 ± 7.53*	15	22.7 ± 6.3**	2	6.7 ± 4.5*
Bring food from home	2	4.5 ± 1.5	4	6.1 ± 3.7**	8	26.6 ± 8.1*
Have an afternoon snack	23	52.3 ± 7.6*	55	83.0 ± 5.6	27	90.0 ± 5.5*
Eat dinner	43	92.7 ± 3.9	61	92.4 ± 3.9	30	100

Legend:
* – statistically significant difference (p < 0.05) between groups I and II;
** – statistically significant difference (p < 0.05) between group II and the control group;
*** – statistically significant difference (p < 0.05) between group I and the control group.

Conclusion

Violation of the regime and quality of nutrition is a risk factor for the formation of functional gastrointestinal disorders in children, which must be taken into account in treatment.

References

Chouliaras G, Kondyli C, Bouzios I, Spyropoulos N, Chrousos GP, Roma-Giannikou E. Dietary Habits and Abdominal Pain-related Functional Gastrointestinal Disorders: A School-based, Cross-sectional Analysis in Greek Children and Adolescents. J Neurogastroenterol Motil 2019; 25:113-122. https://doi.org/10.5056/jnm17113
Alatas, F. S., Salsabila, K., Amalia, N., & Hanafi, G. (2022). Functional gastrointestinal disorders and nutritional status in junior high school students. Paediatrica Indonesiana, 62(4), 243-8. https://doi.org/10.14238/pi62.4.2022.243-8
Katsagoni CN, Karagianni V-M, Papadopoulou A. Efficacy of Different Dietary Patterns in the Treatment of Functional Gastrointestinal Disorders in Children and Adolescents: A Systematic Review of Intervention Studies. Nutrients. 2023; 15(12):2708. https://doi.org/10.3390/nu15122708

THE DEVELOPMENT OF FUNCTIONAL GASTROINTESTINAL DISORDERS IN SCHOOL-AGE CHILDREN: THE INFLUENCE OF MALNUTRITION AND EATING DISORDERS

Olga Bielousova 1

1 Vilnius University, Vilnius, Lithuania

Conference

UEG Week Berlin 2025

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

NUTRITION (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Abdominal pain, anaemia, unremarkable upper and lower GI endoscopy

Shankar Kumar 1

1 UCL, London, United Kingdom

Event

UEG Postgraduate Teaching Programme 2023

Topics

Digestive Oncology Endoscopy Radiology & Imaging Small Intestine & Nutrition

Session

Diagnosis and management of small bowel tumours: Looking for a needle in a haystack?

Published

2023

UEG Standards and Guidelines

Position Paper

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Abstract

Chronic liver disease places patients at increased risk of malnutrition that can be challenging to identify clinically and treat. Nutrition support is a key aspect of the management of these patients as it has an impact on their quality of life, morbidity, and mortality. There are significant gaps in the literature regarding the optimal nutrition support for patients with different types of liver diseases and the impact of these interventions on long-term outcomes. This Position Paper summarizes the available literature on the nutritional aspects of the care of patients with chronic liver diseases. Specifically, the challenges associated with the nutritional assessment of these subjects are discussed, and recently investigated approaches to determining the patients’ nutritional status are reviewed. Furthermore, the pathophysiology of the malnutrition seen in the context of chronic liver disease is summarized and monitoring, as well as treatment, recommendations are provided. Lastly, suggestions for future research studies are described.

Nutrition Support of Children With Chronic Liver Diseases

Marialena Mouzaki

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

Hepatobiliary Paediatrics Small Intestine & Nutrition

Citation

Journal of Pediatric Gastroenterology and Nutrition, 69: 498-511

Published

2019

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Malnutrition in children: Relevance, diagnostic workup, therapy

Ilse Broekaert 1

1 University Childrens Hospital Cologne, Cologne, Germany

Event

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition Paediatrics Primary Care Standards & Guidelines

Session

From guidelines to clinical practice: Malnutrition

Published

2023

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Peutz-Jeghers syndrome (PJS) is a well-described inherited syndrome, characterized by the development of gastrointestinal polyps, and characteristic mucocutaneous freckling. Development of small bowel intestinal polyps may lead to intussusception in children may require emergency laparotomy with potential loss of bowel. Gastrointestinal polyps may lead to bleeding and anemia. This European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper provides a guide for diagnosis, assessment, and management of PJS in children and adolescents and guidance on avoiding complications from PJS or from the endoscopic procedures performed on these patients. This is the first position paper regarding PJS published by European Society for Paediatric Gastroenterology Hepatology and Nutrition. Literature from PubMed, Medline, and Embase was reviewed and in the absence of evidence, recommendations reflect the opinion of pediatric and adult experts involved in the care of polyposis syndromes. Because many of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, some of the recommendations are based on expert opinion. This position paper will be helpful in the appropriate management and timing of procedures in children and adolescents with PJS.

Keywords: adolescent; child; colonoscopy; colorectal cancer; Peutz-Jeghers syndrome; polyposis

Management of Peutz-Jeghers Syndrome in Children and Adolescents: A Position Paper From the ESPGHAN Polyposis Working Group

Andrew Latchford, Shlomi Cohen, Marcus Auth, Michele Scaillon, Jérome Viala, Richard Daniels, Cecile Talbotec, Thomas Attard, Carol Durno, Warren Hyer

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology Endoscopy Paediatrics Primary Care Small Intestine & Nutrition

Citation

JPGN 2019;68: 442–452

Published

2019

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