Introduction

Functional abdominal pain disorders (FAPDs), linked to brain-gut interaction disturbances, are common in childhood, with a prevalence of 3-16%. They are classified based on the Rome IV criteria, involving persistent gastrointestinal symptoms due to abnormal enteric system functioning without organic issues. Childhood stress and anxiety are linked to FAPDs. Psychotherapy aims to educate patients and families about pain triggers and uses cognitive-behavioral therapy extensively.

Aims & Methods

To discuss different characteristics of patients with FAPDs and identify triggering factors for stress/anxiety. Moreover, to analyze the role of various treatment options, including mind-targeted therapies as a treatment.
This prospective cohort study included all patients who were referred to the Pediatric Gastroenterology and Hepatology Outdoor Department at Children's Hospital Lahore due to chronic abdominal pain and subsequently diagnosed with FAPDs based on Rome IV criteria after excluding organic causes over a period of 18 months. Patients were screened for stress by the clinical psychologist using perceived stress scores after excluding organic causes. The role of various treatment options, including mind-targeted therapies, was studied in patients with different FAPDs. They were reassessed for symptom improvement or resolution at a 4-week follow-up by both gastroenterologists and clinical psychologists.

Results

This study included 300 patients aged 4-16 years, of any gender and economic background, using consecutive non-probability sampling. The overall mean age was 9.848 ± 2.6879 years, with 171 female (57%) & 129 male (43%) patients. 245 patients (81.7%) were diagnosed with an organic cause for chronic abdominal pain based on various clinical and biochemical parameters. Commonest cause was gastritis 83 (27.7%) followed by celiac 59 (19.7%), chronic pancreatitis 32 (10.7%), Abdominal TB 22 (7.3%), UTI 17( 5.7%), IBD 16 (5.3%), Choledochal cyst 9 (3%), Cholelithiasis 5 (1.7%), Hydatid cyst 2 (0.7%). In total 55 (18.3%) were diagnosed with functional GI disorders based on Rome IV criteria. Among them, Functional Abdominal Pain, not otherwise specified accounted for 21 cases (38.18%), followed by functional dyspepsia 19 (34.54%), irritable bowel syndrome 10 (18.18%), and abdominal migraine with 5 cases (9.09%).The age range of patients diagnosed with FAPDs spanned from 7.5 to 15 years, with a median age of 12 years. There were 34 females (61.8%) compared to 21 males (38.2%). 60% of them were from urban areas. Various triggers for stress were identified: financial issues (69.1%), followed by family conflict (58.2%), family member illness (18.2%), single parents/broken families (16.4%), exam failure (16.4%), abuse/bullying (12.7%), family member death (9.1%), frequent punishment at home (5.5%), sibling rivalry (3.6%), and frequent punishment at school (1.8%). The perceived stress scores were categorized as low (0-13) for 7 (12.7%), moderate (14-26) for 45 (81.8%), and high (27-40) for 3 (5.5%) patients before treatment. Among them, 43.3% received psychotherapy, followed by 25.5% receiving psychotherapy along with symptomatic treatment, 16.4% symptomatic treatment, 9.1% psychotherapy along with antidepressant, and 5.5% receiving only antidepressant. Patients with a moderate stress score were given psychotherapy alone in 48.9% of cases. Post-treatment perceived stress scores improved to low in 40 patients (72.7%) (p<0.001).

Conclusion

Functional GI disorders, with stress or masked depression, need assessment for better child welfare, as healthy psyche fosters resilience.

References

1. Robin SG, et al. Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV criteria. J Pediatr. 2018;195:134-139.
2. Hyams JS, et al. Functional disorders: children and adolescents. Gastroenterology. 2016. https://doi.org/10.1053/j.gastro.2016.02.015.
3. Newton E, Schosheim A, Patel S, Chitkara DK, van Tilburg MAL. The role of psychological factors in pediatric functional abdominal pain disorders. Neurogastroenterol Motil. 2019;31:e13538.

Introduction

Obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) have been linked to gut dysbiosis.

Aims & Methods

This study aimed to investigate the relationship between gut microbiota composition, hepatic fat content and stiffness, and body mass index (BMI) status. This cross-sectional study enrolled adolescents aged 12 to 18. Transient elastography with controlled attenuation parameter (CAP) was employed to diagnose hepatic fibrosis and steatosis. Fecal samples were analyzed by 16S rRNA sequencing. Relative abundance, as well as alpha- and beta-diversity of the microbiota, were compared across participants with different nutrition statuses and the presence of hepatic steatosis and fibrosis.

Results

A total of 76 participants (51 males) were recruited for this study, including 43 with normal weight, 19 overweight, and 14 obese. The clinical characteristics of the participants are presented in Table 1. Hepatic steatosis was present in 8 out of 14 obese participants (57.2%) and 2 out of 19 overweight (10.5%) participants. Hepatic fibrosis was detected in 4 out of 14 obese participants (28.6%) but none in the normal weight or overweight groups. There were no significant differences in alpha- or beta-diversity between the normal weight, overweight, and obese groups. The Firmicutes to Bacteroidetes (F/B) ratio was 1.2 across all three groups. Several genera, including Eubacterium_halli_group and Ruminococcus_gauvreauii_group were present in higher abundances in the gut microbiome of the obese group compared to the normal-weight group, with p values of 0.025 and 0.036, respectively. In contrast, Bifidobacterium was more abundant in the normal-weight participants (p=0.012). Obese individuals with hepatic fibrosis exhibited a significantly higher F/B ratio compared to those without hepatic fibrosis (p=0.04). There were significant differences in the relative abundance of specific genera between the fibrosis and non-fibrosis groups: Phascolarctobacterium (p=0.020), Dorea (p=0.040), and Ruminococcus_gauvreauii_group (p=0.045) were present in higher abundances in the fibrosis group, whereas Senegalimassilia was more abundant in the non-fibrosis group (p=0.037).

Conclusion

Hepatic steatosis and fibrosis are common among obese adolescents. The gut microbiota abundance in obese individuals with hepatic fibrosis differ from those without it. Further studies are crucial to explore the role of gut microbiota modification in the progression of hepatic steatosis and fibrosis.

Introduction

Coeliac disease (CD) is a chronic small intestinal immune-mediated enteropathy which occurs in genetically predisposed individuals by exposure to ingested gluten, globally about 1% of the world’s population. CD mainly affects the gastrointestinal tract but may also affect other organs. CD may therefore present with a wide range of symptoms and signs. Diagnosing CD involves assessment of symptoms, clinical findings, serology, and endoscopy with duodenal biopsies. In children and adolescents, endoscopy with biopsies can be omitted if serology is conclusive, but this is controversial in adults. Endoscopy can have an additional yield by diagnosing other non-CD related findings, including premalignant and malignant lesions of the upper gastrointestinal tract.

Aims & Methods

The aim of this study was to assess the additional non-CD related findings at the diagnostic endoscopy for CD in an adult population screened for CD. The study was based on the fourth Trøndelag Health Study (HUNT4), a population-based study of adults above 20 years of age in Norway (1). Serum samples of 54,505 participants were analysed using a dual anti-transglutaminase 2 immunoglobulin A and G assay, and the 1107 seropositive individuals were invited to upper gastrointestinal endoscopy with duodenal biopsies. CD was confirmed if histological findings corresponding to Marsh grade 3 were found. At the diagnostic investigation performed by specialists in gastroenterology, additional endoscopic findings were recorded systematically. Multivariable logistic regression analysis was used to estimate the risk of additional findings at the diagnostic endoscopy for CD. The risk was adjusted for sex, age, and use of medications (non-steroid anti-inflammatory drugs/acetylsalicylic acid and proton pump inhibitors/histamine-2 receptor antagonists).

Results

In the present study, 476 individuals with confirmed CD were included. Median age was 55 years and 54.6% were women. The proportion of additional non-CD related endoscopic findings increased with increasing age, especially above 50 years of age. Seven Barrett’s oesophagus and one duodenal adenoma with low grade dysplasia were found, all among participants above 50 years of age. No malignant lesions were found. The risk of additional endoscopic findings increased with advancing age and was higher among men and those using proton pump inhibitors or histamine-2 receptor antagonists.

Conclusion

This study suggests that diagnosing CD without endoscopy will not result in missing clinically significant additional findings in the younger adult population below 50 years of age. However, with advancing age above 50 years, the risk of non-CD related premalignant lesions increases. These lesions can be detected at the diagnostic endoscopy for CD and treated or included in surveillance programs to prevent sinister outcomes.

References

1. Lukina P, Andersen IL, Eggen PT, Mjones PG, Ronne E, Bolstad N, et al. Coeliac disease in the Trondelag Health Study (HUNT), Norway, a population-based cohort of coeliac disease patients. BMJ Open. 2024;14(1):e077131.

Introduction

In patients with Helicobacter pylori (HP) infection, superficial gastritis proceeds to atrophic gastritis in about half of the patients. Although, it usualy involves the antrum, it can also proceed to the corpus with sometimes neuroendocrine cell hyperlasia and chromogranin A antibody positivity, like in classic autoimmune gastritis.

Aims & Methods

The aim of our study was to determine the frequence of HP infection in autoimmune atrophic gastritis and its characteristics
A retrospective study was conducted over patients with autoimmune atrophic gastritis diagnosed in the gastroenterology department in Mohamed taher maamouri hospital between January 2019 and December 2021. Clinical, biological, endoscopic and pathology features were abstracted from medical records.

Results

A total of 31 patients were included in this study. The sex ratio M/F was 0.8 and the mean age was 56 years [28- 82 years]. The average haemoglobin level was 9,9 g/dl and the average mean corpuscular volume was 95,6 fL. Serum markers were available in 13 patients. Intrinsic factor antibodies were positive in five patient and anti-parietal cell antibodies in 11 patients. Pathology findings of fundal biopsies showed mild atrophy in 16,1% patients, moderate in 48,4% and severe in 35,5% with presence of intestinal metaplasia in 90,3%. The antrum was atrophic in one patient and antral intestinal metaplasia was detected in 11 patients (35,5%). HP infection was diagnosed in 23 patients (74,2%). The presence of HP infection was correlated with the severity of anaemia (p= 0.048). No correlation was found between HP infection and the degree of atrophy or the presence of intestinal metaplasia (p= 0.35 et 0.38 respectively).

Conclusion

Our study showed the presence of HP in 74.2% of patients with autoimmune atrophic gastritis , which may support the inplication of HP infection in the development of autoimmune gastritis. The presence of HP infection was correlated with the severity of anaemia, hence the importance of HP eradication treatment.