PedsQL gastrointestinal symptoms module: feasibility, reliability, and validity.

OBJECTIVE: The objective of this study was to report on the measurement properties of the Pediatric Quality of Life Inventory (PedsQL) Gastrointestinal Symptoms Module for patients with functional gastrointestinal (GI) disorders (FGIDs) and organic GI diseases, hereafter referred to as "GI disorders," for patient self-report ages between 5 and 18 and parent proxy-report for ages between 2 and 18 years. METHODS: The 74-item PedsQL GI Module and 23-item PedsQL Generic Core Scales were completed in a 9-site study by 584 patients and 682 parents. Patients had physician-diagnosed GI disorders (such as chronic constipation, functional abdominal pain, irritable bowel syndrome, functional dyspepsia, Crohn disease, ulcerative colitis, gastroesophageal reflux disease). RESULTS: Fourteen unidimensional scales were derived measuring stomach pain, stomach discomfort when eating, food and drink limits, trouble swallowing, heartburn and reflux, nausea and vomiting, gas and bloating, constipation, blood, diarrhea, worry, medicines, and communication. The PedsQL GI Module Scales evidenced excellent feasibility, excellent reliability for the Total Scale Scores (patient self-report α = 0.97, parent proxy-report α = 0.97), and good-to-excellent reliability for the 14 individual scales (patient self-report α = 0.67-0.94, parent proxy-report α = 0.77-0.95). Intercorrelations with the Generic Core Scales supported construct validity. Individual Symptoms Scales known-groups validity across 7 GI disorders was generally supported. Factor analysis supported the unidimensionality of the individual scales. CONCLUSIONS: The PedsQL GI Module Scales demonstrated acceptable-to-excellent measurement properties and may be used as common metrics to compare GI-specific symptoms in clinical research and practice both within and across patient groups for FGIDs and organic GI diseases.

Chronic childhood constipation is associated with impaired quality of life: a case-controlled study.

OBJECTIVE: The objective of this study was to investigate the effect of chronic constipation on children's quality of life. METHODS: From October 2002 to November 2003, 224 children (140 male, 84 female, aged 10.6 +/- 2.9 years) and 224 parents were evaluated by a health related quality of life tool during initial outpatient consultation. Children with constipation (n = 80) were compared with controls with inflammatory bowel disease (n = 42), controls with gastroesophageal reflux disease (n = 56), and with healthy children (n = 46). RESULTS: Children with constipation had lower quality of life scores than did those with inflammatory bowel disease (70 versus 84; P < 0.05), gastroesophageal reflux disease (70 versus 80; P < 0.05), and healthy children (70 versus 88; P < 0.05). Children with constipation reported lower physical scores than did inflammatory bowel disease patients (75 versus 85; P < 0.02), gastroesophageal reflux disease patients (75 versus 85; P < 0.05), or healthy children (75 versus 87; P < 0.05). Parents of children with constipation reported lower scores than did their children (61 versus 70; P < 0.05). Children with constipation had longer duration of symptoms than did the controls with inflammatory bowel disease and gastroesophageal reflux disease (43.8 months versus 14.2 months; P < 0.001). Prolonged duration of symptoms for children with constipation correlated with lower parent-reported scores (P < 0.002). CONCLUSIONS: At initial evaluation, children with constipation have a lower quality of life than do children with inflammatory bowel disease or gastroesophageal reflux disease. Self-reported lower scores may be a reflection of impaired physical ability. Parental perceptions of low quality of life are probably impacted by the duration of their child's symptoms and by family members with similar complaints. Practitioners should be aware of the high level of parental concern and the relatively low self-reported and parent-reported quality of life in children with chronic constipation as they plan therapy.

Treatment of functional abdominal pain in childhood with cognitive behavioral strategies.

OBJECTIVE: The aim of this study was to assess the efficacy of a cognitive-behavioral approach to the treatment of recurrent abdominal pain caused by childhood functional gastrointestinal disorders (FGIDs). METHODS: From September 2001 to December 2002, 18 patients (12 male; mean age, 12.1 +/- 4.9 years) with chronic abdominal pain (mean duration, 11.8 +/- 13.3 months) caused by FGIDs were referred to our facility's mind-body institute (MBI). Treatment included guided imagery and progressive relaxation techniques. The mean number of sessions per patient was 4.3 +/- 3.4. Outcomes included change in abdominal pain and quality of life, evaluated by the Pediatric Quality of Life Scale (PedsQL). Follow-up was 10.6 +/- 2.3 months after the last MBI session. RESULTS: Abdominal pain improved in 89% of patients; weekly pain episodes decreased from 5.5 +/- 0.9 to 2.0 +/- 2.7 (P < 0.05); pain intensity (0 to 3 scale) decreased from 2.7 +/- 0.6 to 0.6 +/- 0.7 (P < 0.04); missed school days/month decreased from 4.6 +/- 1.7 to 1.4 +/- 3.2 (P < 0.05); social activities/week increased from 0.3 +/- 0.6 to 1.3 +/- 0.6 (P < 0.05); physician office contacts/year decreased from 24 +/- 10.2 to 8.7 +/- 13.1 (P = 0.07). PedsQL scores (0 to 100 scale) improved from 55.3 +/- 11.9 to 80.0 +/- 10.7 (P < 0.03). CONCLUSIONS: Guided imagery and progressive relaxation can safely and effectively reduce chronic abdominal pain in children with FGIDs. This treatment also improved social functioning and school attendance.