Effectivity of treatment for children with functional dyspepsia.

Functional dyspepsia is very common in children of all ages and has a significant impact on the patient's family and quality of life. Since the revision of the Rome IV criteria with the introduction of two subtypes, the prevalence of functional dyspepsia has increased, but currently no guidelines for the treatment are available. The aim of this study was to characterize patients, who have been diagnosed with functional dyspepsia and analyze the outcome of different treatments they received. This is a retrospective study of pediatric patients, diagnosed with functional dyspepsia between March 2017 and September 2020. All patients aged between 0 and18 years, who complained about gastric symptoms, have had a normal full blood count, a normal thyroid function, a negative coeliac screening, and most importantly normal macro- and microscopic findings on esophago-gastro-duodenoscopy were included in the study. Patient's data were extracted from the medical record and three months after the performance of the endoscopy, parents were interviewed about the effect of the treatment. A total of 154 patients (66.2% female, 33.8% male) between the age of 4 and 18 years were included. In 113 (73.4%) the leading symptom was epigastric pain, followed by nausea (22; 14.3%) and a fifth of the patients (females: 18.6%; males: 21.2%) self-reported a current stressor in clinic. After receiving the diagnosis of a functional nature, families chose following treatments: 50 STW5 (32.3%, overall, 10.4% added dietary changes, alternative treatment, and psychology support), psychological support (22.7%), alternative treatments (e.g., hypnotherapy, meditation; 19.5%), dietary changes (12.9%), lifestyle changes (9.7%), no treatment (11%) and in 10.4% no treatment was needed as symptoms resolved after endoscopy had been performed. Only lifestyle changes (p = 0.03) in females, dietary changes (p = 0.035 for girls, p = 0.06 for boys) and STW5 in males (p = 0.043) showed a statistically relevant correlation regarding duration of symptoms. There was no correlation between location of symptoms and effectiveness of treatment. It is recommended to treat patients from both subgroups of functional dyspepsia differently, in accordance with the currently available explanatory models of underlying pathophysiological processes. In this cohort of patients this could not be verified. As all patients did benefit from any treatment, it is likely that the treatment itself was not accountable for the relief of symptoms, but that most patients benefit from education on the diagnosis, reassurance and a recommendation of a healthy lifestyle. Some patients might benefit from medications, small changes in the diet, psychological support or alternative treatment, but success depends on individual, unpredictable factor.

Coeliac disease: Evaluation of diagnosis in children and teenagers.

BACKGROUND: Coeliac disease is no longer a rare disease, but has a rising prevalence, especially in children, with a shift from malabsorption syndrome to a more subtle presentation. Therefore, European guidelines regarding the diagnosis of coeliac disease were changed in 2012. If laboratory tests are positive, children can now be diagnosed without performing an endoscopy. The aim of this study was to characterize the Swiss patients, who have been diagnosed with coeliac disease. METHODS: This is a retrospective study of Swiss paediatric patients who have been diagnosed with coeliac disease according to European guidelines between 01/2011 and 11/2020. The data needed was extracted from medical records. RESULTS: A total of 369 children were included in the study. The main complain was abdominal pain (118; 32%), followed by failure to thrive/gain weight (92; 24.9%). 10% (37/367) of all patients had no symptoms at all. In 72.6% (268/369) of all patients, an endoscopy was performed due to lower antibodies. Mean values for ferritin, vitamins D and B12 as well as folic acid were within normal range. CONCLUSION: In our cohort of patients, females were clearly more often affected and also showed a small deviation in height and weight. Our finding of 10% of all patients having no symptoms at all is in line with other studies observing a decline in symptoms. A complicating factor for the clinician is the fact that overall no vitamin deficiencies were detected. As the incidence continues to rise but the clinical presentation of coeliac disease is changing from a malabsorption syndrome to a silent disease, further observational studies are needed to monitor this trend.