Psychiatric, somatic, gastrointestinal disorders and helicobacter pylori infection among children with recurrent abdominal pain

Yoshiko Nakayama ¹, Akira Horiuchi ¹, Toshiko Kumagai ², Seiko Kubota ², Yoshiki Taki ¹, Sawako Oishi ¹ and Hoda M. Malaty ^3*

¹ Departments of Pediatrics and Gastroenterology, Showa Inan General Hospital, Komagane, Japan
² Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
³ Baylor Collage of Medicine, Houston, Texas, United States

^* To whom correspondence should be addressed. E-mail: hmalaty{at}bcm.tmc.edu.

Accepted 7 April 2006

Abstract

Background: Recurrent abdominal pain (RAP) is a common health problem in children and adolescents. Evaluation of children with RAP continues to challenge investigators. The Rome II criteria were developed to standardize the classification of functional gastrointestinal disorders; including RAP using a symptom-based approach both in adults and children.

Aims: to examine the utility of the Rome II criteria among children with recurrent abdominal pain and compare them to those who met Apley's criteria and those who met neither criteria. We compared several parameters between the three groups including demographic, psychiatric, somatic, and other gastrointestinal disorders. Additionally, all children were tested for H. pylori infection.

Methods: A prospective study was conducted in general pediatric clinics in Komagane, Japan. Children were qualified if they were identified by their physician as having any type of abdominal pain. Children with AP were classified into 3 groups; a group met Rome II criteria, a second group met Apley's criteria, and a third group did qualify for neither Apley's nor Rome II criteria. Psychiatric disease and somatic symptoms were reported as well as family history for peptic ulcer disease. H. pylori infection was diagnosed among all participating children by urea breath test, stool antigen test and ELISA assay.

Results: 182 children with RAP participated (51% girls); 45 children met Rome II criteria, 55 met Apley's criteria, and 82 met neither criterion. Children who met Rome II had significantly higher prevalence of psychiatric and somatic disorders compared to the group who did not meet either criteria (36% vs. 6%, OR=8.5 (2.9.-25.3), p=0.001), (22% vs. 10%, OR= 2.6 (1.1.-7.2), p=0.05), respectively. The overall prevalence of H. pylori was 7% and the prevalence increased with age from 3% at age <10 to 10% for children >10 years (OR=3.9, 95% CI=0.9-18.2, p=0.06). Children who met Rome II criteria have significantly higher prevalence of H. pylori infection than the reference group (18% vs. 4%, OR= 5.7 (1.4.-22.7.2), p=0.002). In a logistic regression model, we included all the study variables in the model specifying first the Rome II criteria group as the independent variable; psychiatric disorders, Helicobacter pylori infection, older age group were found to be independent risk factors with odds ratios (95% CI) of 4.5(2.0.-15), 3.7 (1.1-12.7), and 3.6 (2.0- 8.4)), respectively.

Conclusions: more than half the children suffering from recurrent abdominal pain did meet neither Apley's nor Rome II criteria. Children who meet Rome II criteria should be evaluated for psychiatric disorders and should be tested for Helicobacter pylori infection. Despite the overall trend for a fall in the prevalence of H. pylori infection among children in Japan, there are subpopulations of sick children where the prevalence of the infection is relatively high

Keywords: Apley's criteria, Rome II criteria, children, h. pylori infection, recurrent abdominal pain

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Atoms

Howard Bauchner
Arch. Dis. Child. 2006 91: 627. [Extract] [Full Text] [PDF]