Emerging evidence on new ways to provide these techniques in a cost-effective and accessible manner including telephone-delivered CBT and exposure-based Internet-CBT are promising. However, these interventions involve significant amount of time and require qualified professionals, consequently not realistic in most settings in our current environment. 10– 12 When available, these are excellent tools that constitute the first line of treatment of pediatric patients with AP-FGIDs. Nonpharmacologic strategies such as cognitive-behavioral therapy (CBT) and hypnotherapy have consistently demonstrated superior efficacy in improving pain in children with AP-FGIDs. 9 These disorders are considered problems of the brain–gut interaction, and usually require multidisciplinary treatments. 7, 8 Higher rates of AP-FGIDs have also been reported in adolescents with anxiety or depressive symptoms. 6 Anxiety and depressive symptoms are more prevalent in patients with AP-FGIDs. 5 Accordingly, the association between pediatric recurrent abdominal pain (RAP), anxiety, and depression is well established. There is significant evidence of the role of predisposing factors including genetic makeup, stressful events during childhood, and pathophysiologic mechanisms such as visceral hypersensitivity, altered gastrointestinal motility, intestinal dysbiosis, and altered central nervous system processing. The pathophysiology of FGIDs is thought to be multifactorial. 4 This group of disorders are costly and have a significant impact in the child daily activities and quality of life (QoL). A recent cross-sectional study based on the Rome IV criteria in US children aged 0–18 years found that 24.7% of infants and toddlers aged 0–3 years and 25.0% of children and adolescents aged 4–18 years fulfilled symptom-based criteria for a functional gastrointestinal disorder (FGID). 2, 3 AP-FGIDs are a global problem with a pooled prevalence of 13.5%. These criteria have been recently revised and are currently in its fourth iteration. The diagnosis relies mainly on clinical evaluation and the use of symptom-based criteria known as Rome criteria. AP-FGIDs are a group of disorders characterized by the presence of chronic abdominal pain without evidence of biochemical or structural abnormalities that may account for the symptoms. 1 A significant percentage of pediatric chronic abdominal pain cases meet criteria for abdominal pain-functional gastrointestinal disorders (AP-FGIDs). Careful consideration must be given to adverse effects, particularly increased suicidal ideation.Ĭhronic abdominal pain is a common problem encountered in childhood. There is an urgent need for well-designed randomized clinical trials using age-appropriate validated outcome measures. Evidence of the efficacy of antidepressants in the management of pediatric AP-FGIDs is not consistent. Data available in pediatric population have significant limitations including nonuniform methodology with different study designs and primary endpoints. Antidepressants are one type of neuromodulators, and one of the most studied drugs for the management of AP-FGIDs in adult and pediatric population. Therefore, attention has been directed to the use of neuromodulators as potential interventions for AP-FGIDs. Anxiety and depressive symptoms are more prevalent in patients with AP-FGIDs. The diagnosis is made on clinical grounds using symptom-based criteria (Rome criteria). They are considered disorders of the brain–gut interaction. Pathophysiologic mechanisms include early stressful events, visceral hypersensitivity, dysmotility, changes in intestinal microbiota, and altered central nervous system processing. These disorders are costly and, in some cases, lead to impairment of daily functioning and overall quality of life. A large proportion of cases meet Rome criteria for abdominal pain-functional gastrointestinal disorders (AP-FGIDs). Chronic abdominal pain is frequently encountered in pediatric practice.
0 kommentar(er)
