Prospective study of the effect of auricular percutaneous electrical nerve field stimulation on quality of life in children with pain related disorders of gut-brain interaction.

Background: Disorders of the Gut-Brain Interaction (DGBIs) account for 50% of pediatric gastrointestinal (GI) consultations. Children with DGBIs have worse quality of life (QoL) than those with organic GI disorders such as inflammatory bowel disease and gastroesophageal reflux disease. Pediatric DGBIs patients, especially those with chronic abdominal pain (AP), have impaired QoL and increased psychological distress in the form of anxiety and depression. Percutaneous Electrical Nerve Field Stimulation (PENFS) therapy has been shown to be effective in improving symptoms and functioning in children with DGBIs. The treatment's impact on these patients' QoL is unknown. Methods: This prospective study evaluated changes in QoL, gastrointestinal symptoms, functional disability, somatization, global health, anxiety, and depression in patients aged 11-18 years who received PENFS therapy (IB-stim, NeurAxis, Versailles, IN) for treatment of pain related DGBIs, once a week for four consecutive weeks. Results: This study included 31 patients with an average age of 15.7 years (SD = 2); 80.6% were female. After PENFS therapy, patients reported significant reductions in abdominal pain, nausea severity, functional disability, somatization, and anxiety from baseline to week 4 (p < 0.05). Parents reported significant improvement in their child's QoL regarding physical function, psychosocial function, and generic core scale scores (p < 0.05). Parents also noted reduced abdominal pain, functional disability, and somatization. Average scores on the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scale significantly improved based on both patient and parent reports (p < 0.05). Our patients' QoL was significantly lower than healthy controls at baseline and after treatment (p < 0.05). Conclusion: Our research demonstrates that PENFS significantly enhances the QoL of children suffering from pain-related DGBIs, in addition to improvement in GI symptoms, daily functioning, somatization, global health, and psychological comorbidities. These findings demonstrate the effectiveness of PENFS and its potential to alleviate the suffering of countless children.

Upper Gastrointestinal Endoscopy with biopsy in paediatric feeding disorders.

AIM: Our aim was to evaluate upper GI pathology found endoscopically among children seen in a GI feeding clinic for persistent feeding problems compared with controls. METHODS: Esophagogastroduodenoscopy biopsy results were examined among two cohorts of children. The first group included 86 children evaluated in a gastroenterology feeding clinic for paediatric feeding disorders. A comparison was made with an age-matched control group of 86 children referred for endoscopy for conditions other than disordered feeding. RESULTS: In the feeding cohort, 57% had abnormal endoscopy biopsies. These included 30% with microscopic esophagitis and 15.1% with eosinophilic esophagitis (EoE). Among the controls, 53% had abnormal biopsies, which included 26% with microscopic esophagitis and 8% with eosinophilic esophagitis. The statistical comparison between groups included p = 0.98 for microscopic esophagitis and p = 0.15 for eosinophilic esophagitis. CONCLUSION: Results demonstrated similar prevalence of abnormal endoscopy biopsies and microscopic esophagitis in both groups. The incidence of eosinophilic esophagitis in the feeding group triples that of previous reports and nearly doubles controls. Our findings suggest paediatric feeding disorders which do not resolve may warrant investigation by upper endoscopy.

Long-term Outcomes of Children With Pediatric Feeding Disorders Treated in an Inpatient Multidisciplinary Program.

ABSTRACT: The purpose of this longitudinal observational study was to evaluate the effectiveness of a multidisciplinary inpatient treatment model for feeding disorders by analyzing long-term nutritional and health outcomes 12 months following discharge. Fifty patients completed the study. Average caloric intake by mouth as a percentage of goal for gastrostomy tube (GT)-dependent patients (n = 31) increased from pre-admit, week 1, and week 2 of the inpatient program (30%, 70%, and 84%, respectively), and was sustained from week 3 to 12-month follow-up (85% and 86%, respectively). Eighty-one percentage were discharged without GT support and 65% remained off GT support at 12 months. Oral supplement dependence for non-GT patients (n = 19) decreased from pre-admit, discharge, and 12-month follow-up (51%, 31%, and 19% of caloric intake, respectively). BMI z-scores improved during and after treatment. The present study demonstrated an effective approach for treatment of pediatric feeding disorders, including decreased reliance on oral supplementation and GT dependence.