Diagnostic algorithm of centrally mediated abdominal pain syndrome — does it need changes? According to the materials of Rome IV Criteria

The article discusses the algorithm for diagnosing of centrally mediated abdominal pain syndrome (CAPS), formerly called functional abdominal pain syndrome, contained in the Rome Criteria of the IV revision (2016). Recommendations for the diagnosis of CAPS, mainly based on the compliance of the signs available in patients with the developed diagnostic criteria with a minimum of additional laboratory tests, are criticized, since such an approach is fraught with possible errors. The author considers the diagnosis of CAPS as a “diagnosis of exclusion”, which can be made only after a thorough examination of patients using laboratory and instrumental research methods (including ultrasound and endoscopic), confi rming the absence of organic diseases in patients.

A Narrative Review on the Update in the Prevalence of Infantile Colic, Regurgitation, and Constipation in Young Children: Implications of the ROME IV Criteria

Regurgitation, colic, and constipation are frequently reported Functional Gastrointestinal Disorders (FGIDs) in the first few years of life. In 2016, the diagnostic criteria for FGIDs were changed from ROME III to ROME IV. This review assesses the prevalence of the most frequent FGIDs (colic, regurgitation and constipation) among children aged 0–5 years after the introduction of the later criteria. Articles published from January 1, 2016 to May 1, 2021 were retrieved from PubMed and Google Scholar using relevant keywords. A total of 12 articles were further analyzed based on the inclusion and exclusion criteria. This review consists of two studies (17%) from the Middle East, three (25%) from Asia, two (17%) from the USA, three (25%) from Europe, and one (8%) from Africa. Three studies (25%) were based on data obtained from healthcare professionals, while the rest were parent or caregiver reports. About half of the retrieved studies used the ROME IV criteria. Among infants aged 0–6 months, the reported prevalence of colic ranged between 10–15%, whilst that of regurgitation was 33.9%, and constipation was 1.5%. Among infants aged 0–12 months, the reported prevalence of regurgitation and constipation were 3.4–25.9% and 1.3–17.7%, respectively. The reported prevalence of constipation was 1.3–26% among children aged 13–48 months and 13% among children aged 4–18 years. Despite the large variations due to differences in diagnostic criteria, study respondents and age group, the prevalence of infantile colic was higher, while that for infantile regurgitation and constipation were similar using the ROME IV or III criteria.

Evaluation of QOL in Patients with Dyspeptic Symptoms Who Meet or Do Not Meet Rome IV Criteria

Health related quality of life (HR-QOL) of functional dyspepsia (FD) patients is impaired. However, the QOL of such patients has not been fully examined. Accordingly, we examined the QOL of Rome IV defined FD, endoscopic negative dyspeptic patients who do not meet the criteria, (non-FD patients) and healthy subjects, and investigated the factors that influence HR-QOL. This was a multicenter, prospective, observational study. Two hundred thirty-five patients (126 FD, 87 non-FD) and 111 healthy subjects were investigated, and non-FD patients were subdivided into three groups: 17 patients failing to meet only the disease duration criterion (Group A), 53 patients failing to meet only disease frequency criterion (Group B) and 17 patients failing to meet both the disease duration and frequency criteria (Group C). They completed a questionnaire survey regarding gastrointestinal symptoms (GSRS), QOL and psychological factors, which were compared among three groups. The total GSRS score was significantly higher in FD patients than non-FD patients (p = 0.012), which was higher than the healthy subjects (p < 0.0001). Furthermore, the total GSRS score of FD patients was comparable to that of Group A (p = 0.885), which was significantly higher than that of the Group B and C (p = 0.028, p = 0.014, respectively). HR-QOL is more impaired in FD patients than non-FD patients, which was significantly lower than the healthy subjects. That GSRS score in FD and Group A was comparable suggesting that an increased frequency of symptoms may have impact on the impairment of patient’s QOL.

Uninvestigated Dyspepsia and Heartburn Overlap Syndrome at Industrial Hub of Eastern Siberia

Aim. A study of the overlap syndrome of uninvestigated dyspepsia and heartburn at an industrial hub city of Eastern Siberia.Materials and methods. A total of 1,382 subjects (684 men and 698 women, mean age 40.6 years) were randomly selected and examined for the central district of Krasnoyarsk. The clinical check-up and interviewing results were registered with a standard questionnaire. Heartburn was diagnosed as per the Montreal Consensus. Since no endoscopic patient examination had been performed, dyspepsia was assumed uninvestigated. Dyspepsia was diagnosed as per the Rome IV criteria. The study conduction complied with ethical standards. Each participant signed an informed examination consent, in accordance to the regulations by the World Medical Association’s Declaration of Helsinki. The survey data were analysed with common statistical methods.Results. Heartburn, uninvestigated dyspepsia and their overlap syndrome had prevalence of 12.4, 21.1 and 5% in study population, respectively. Uninvestigated dyspepsia was registered in 40.4% patients with and 18.4% — without heartburn (p < 0.001). The risk factors of overlap syndrome were age >40 years (p = 0.002), obesity (p = 0.002), nonsteroidal anti-inflammatory drug and/or aspirin intake (p = 0.004) and tobacco smoking (p = 0.007). Among total patients with the heartburn/uninvestigated dyspepsia overlap syndrome, only 33.3% systemically had proton pump inhibitors, and only 17.4% had a prokinetic therapy.Conclusion. The heartburn/uninvestigated dyspepsia overlap syndrome is an actual issue in the Krasnoyarsk population. Attention is warranted to this problem to optimise treatment and prevention measures.

Neuromodulators in the Brain-Gut Axis: their Role in the Therapy of the Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a clinically well-defined chronic condition that is now understood as a disorder of gut-brain regulation, as established in the work of the Rome IV committees coordinated by Drossman, 2016. People with IBS often report high disability levels and poor health-related quality of life. Drug therapy focuses on reducing main symptoms and disability and improving health-related quality of life. Central neuromodulators reduce IBS symptoms by targeting dysregulated pain and motility related to gut-brain dysregulation. It can also treat associated mental health symptoms. Based on their multiple effects on central and peripheral mechanisms, neuromodulators have been used to treat IBS patients. This review presents the rationale supporting medication treatments for specific IBS symptoms, discusses evidence-based management of IBS with central neuromodulators, and reviews the progress in the research for new neuromodulators.

Irritable Bowel Syndrome Prevalence among Participants of Woodstock Rock Festival in Poland Based on Rome IV Criteria Questionnaire

Background: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder (FGID), in which etiology and pathogenesis are not fully explored. There is an ongoing need for more population studies adhering to new ROME IV criteria. In the current study, which follows our previous investigation among participants of the Woodstock Rock Festival in Poland, we aimed to evaluate the prevalence of IBS and its relation to age, gender, education, and IBS type. Methods: Rome IV criteria questionnaire was used to assess abdominal complaints of 386 participants of the Woodstock Rock festival 2018. Results: Analyzed data revealed that Rome IV criteria were met by 42 participants (11.41%), 11 men and 31 women (p = 0.0028), with following types of IBS: IBS-M (mixed form) 55%, IBS-D (with diarrhea) 33%, IBS-U (unclassified) 10%, IBS-C (with constipation) 2%. No statistically significant correlation between IBS prevalence and age, gender, or education (p > 0.05) was found. Conclusions: The prevalence of IBS among major rock festival participants in Poland was high. Women met the criteria more often than men, which is consistent with global epidemiology for many years. Among participants of the Woodstock Rock Festival, the most frequent subtype was IBS-M, the rarest—IBS-C. There is a need of conducting cohort studies in bigger groups in our population.

Hiệu quả của hai phác đồ sử dụng polyethylene glycol 3350 và lactulose trong điều trị táo bón mạn tính chức năng ở trẻ em dưới 6 tuổi

Táo bón là một bệnh lý tiêu hóa thường gặp ở trẻ em. Nghiên cứu nhằm đánh giá hiệu quả của hai phác đồ có sử dụng polyethylene glycol 3350 và lactulose trong điều trị táo bón mạn tính chức năng ở trẻ em dưới 6 tuổi. Thực hiện thử nghiệm lâm sàng mở, ngẫu nhiên có đối chứng trên trẻ từ 12 tháng đến 72 tháng tuổi được chẩn đoán táo bón mạn tính theo tiêu chuẩn ROME IV. 156 trẻ được ngẫu nhiên chia vào hai nhóm điều trị bằng lactulose (1,5ml/kg/ngày) hoặc polyethylene glycol 3350 (0,5g/kg/ngày) trong 3 tháng. Nghiên cứu thu được kết quả số lần đại tiện trung bình trong tuần và tỷ lệ đại tiện phân mềm của cả hai nhóm tăng rõ rệt tại các thời điểm 1, 2 và 3 tháng sau điều trị (p < 0,001). Tỷ lệ trẻ cải thiện số lần đại tiện trung bình trong tuần, phân mềm và không có máu, đau hậu môn, gắng sức khi đại tiện và tư thế giữ phân ở nhóm sử dụng polyethylene glycol 3350 cao hơn nhóm sử dung lactulose ở các thời điểm đánh giá (p < 0,05). Các tác dụng không mong muốn ở nhóm polyethylene glycol 3350 ít hơn nhóm lactulose, p < 0,05. Hiệu quả điều trị của nhóm trẻ sử dụng phác đồ có polyethylene glycol 3350 cao hơn so với phác đồ có lactulose tại các thời điểm đánh giá, p < 0,05. Phác đồ sử dụng polyethylene glycol 3350 có hiệu quả điều trị cao hơn và tác dụng không mong muốn thấp hơn so với phác đồ sử dụng lactulose.