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Childhood Functional Gastrointestinal Disorders Gut: First Published As 10.1136/Gut.45.2008.Ii60 on 1 September 1999

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Childhood Functional Gastrointestinal Disorders Gut: First Published As 10.1136/Gut.45.2008.Ii60 on 1 September 1999 II60 Gut 1999;45(Suppl II):II60–II68 Childhood functional gastrointestinal disorders Gut: first published as 10.1136/gut.45.2008.ii60 on 1 September 1999. Downloaded from A Rasquin-Weber, P E Hyman, S Cucchiara, D R Fleisher, J S Hyams, P J Milla, A Staiano Abstract provided clinicians with a method for standard- Co-Chair, Committee on Childhood This is the first attempt at defining izing their manner of defining clinical disor- Functional criteria for functional gastrointestinal dis- ders, and have allowed researchers from Gastrointestinal orders (FGIDs) in infancy, childhood, and various fields to study the physiology and treat- Disorders, adolescence. The decision-making proc- ment of the same disorders from diVerent Multinational Working ess was as for adults and consisted of points of view. Publication of the Rome Teams to Develop diagnostic criteria resulted in an explosion of Criteria for Functional arriving at consensus, based on clinical Disorders (Rome II), experience. This paper is intended to be a clinical research, contributed to an improved Professor of quick reference. The classification system understanding of FGIDs, and provided clini- Pediatrics, selected diVers from the one used in the cians with a positive approach to treating 3 University of adult population in that it is organized patients. Montreal, according to main complaints instead of It was perceived as a privilege by our working Montreal, Canada team to be oVered the challenge of defining A Rasquin-Weber being organ-targeted. Because the child is still developing, some disorders such as diagnostic criteria according to the Rome Chair, Committee on toddler’s diarrhea (or functional di- criteria for the pediatric population. We Childhood Functional arrhea) are linked to certain physiologic believed that a collaboration with our adult Gastrointestinal stages; others may result from behavioral gastroenterology colleagues would increase our Disorders, responses to sphincter function acquisi- understanding of FGIDs and provide a basis Multinational Working for longitudinal studies on the origins and evo- Teams to Develop tion such as fecal retention; others will Criteria for Functional only be recognizable after the child is cog- lution of these disorders. Disorders (Rome II), nitively mature enough to report the Childhood FGIDs include a variable combi- Associate Clinical symptoms (e.g., dyspepsia). Infant regur- nation of often age-dependent, chronic, or Professor of gitation, rumination, and cyclic vomiting recurrent symptoms not explained by struc- Pediatrics, tural or biochemical abnormalities. As the child University of constitute the vomiting disorders. Ab- dominal pain disorders are classified as: is programmed to develop, it is not surprising California at Los that some functional disorders which occur Angeles, functional dyspepsia, irritable bowel syn- during childhood accompany normal develop- Orange County, CA, drome (IBS), functional abdominal pain, ment (e.g., infant regurgitation or toddler’s USA abdominal migraine, and aerophagia. P E Hyman diarrhea), or may be triggered by age appropri- Disorders of defecation include: infant ate but maladaptive behavioral responses to dyschezia, functional constipation, func- http://gut.bmj.com/ Associate Professor of internal or external stimuli (e.g., functional tional fecal retention, and functional non- Pediatrics, fecal retention often results from painful University Frederico II, retentive fecal soiling. Some disorders, defecation and/or coercive toilet training). The Naples, Italy such as IBS and dyspepsia and functional diagnosis of some childhood FGIDs depends S Cucchiara abdominal pain, are exact replications of on the child’s ability to report symptoms. Thus the adult criteria because there are Associate Professor of some disorders, such as irritable bowel syn- Child Health, enough data to confirm that they repre- drome (IBS), are not described in children University of Missouri, sent specific and similar disorders in below a certain age. This does not preclude its on September 27, 2021 by guest. Protected copyright. Columbia, MO, USA pediatrics. Other disorders not included D R Fleisher existence in younger children; rather, preschool in the pediatric classification, such as children are unable to report the necessary functional biliary disorders, do occur in Professor and Vice details for a diagnosis. Therefore, instead of Chair of Pediatrics, children; however, existing data are insuf- classifying disorders according to target organs University of ficient to warrant including them at the (as in the adult population), we divided pediat- Connecticut School of present time. For these disorders, it is Medicine, ric disorders according to main complaints suggested that, for the time being, clini- reported by children or their parents. For Hartford, CT, USA cians refer to the criteria established for JSHyams example, aerophagia was classified within the adult population. pediatric disorders as presenting as abdominal Reader in Pediatric (Gut 1999;45(Suppl II):II60–II68) pain, whereas in adults, the disorder was classi- Gastroenterology, fied as belonging to the esophagus-related University of London, Keywords: infant vomiting; cyclic vomiting syndrome; London, UK functional dyspepsia in children; irritable bowel group of symptoms. P J Milla syndrome in children; functional abdominal pain in The working team agreed that some infants children; functional diarrhea in children; functional inherit a temperament characterized in part by Associate Professor of constipation in children; Rome II gastrointestinal reactivity to stress, which Pediatrics, constitutes a genetic susceptibility to FGIDs. University Frederico Indeed, temperament-sensitive reactivity in II, School of Medicine, The pediatric working team met for the first infants has already been suggested in associ- Naples, Italy time in Rome in September 1997, seven years A Staiano ation with three other biological systems after the first paper classifying diagnostic crite- (cardiovascular, neuroendocrine, and Correspondence to: ria for functional gastrointestinal disorders immunologic).4 Conversely, our committee Andree Rasquin-Weber, MD, (FGIDs) in the adult population was Gastrointestinal Division, published.1 These disorders were further de- Hopital Ste Justine, 3175 St Abbreviations used in this paper: FGID, functional Catherine Road, Montreal, fined in a document, now referred to as the gastrointestinal disorder; IBS, irritable bowel Quebec H3T 1C5, Canada. Rome criteria for FGIDs.2 These criteria have syndrome; RAP, recurrent abdominal pain. Childhood functional gastrointestinal disorders II61 Table 1 Functional gastrointestinal disorders functional chest pain, functional heartburn, functional dysphagia, and proctalgia fugax. Gut: first published as 10.1136/gut.45.2008.ii60 on 1 September 1999. Downloaded from A. Esophageal disorders Functional biliary disorders were not described A1. Globus A2. Rumination syndrome because documentation and experience with A3. Functional chest pain of presumed esophageal origin gall bladder and sphincter of Oddi dysfunction A4. Functional heartburn A5. Functional dysphagia in children are insuYcient. Eventually, it was A6. Unspecified functional esophageal disorder agreed that the co-occurrence of FGIDs and B. Gastroduodenal disorders organic disease in the same child often goes B1. Functional dyspepsia B1a. Ulcer-like dyspepsia unrecognized. Thus, for example, the presence B1b. Dysmotility-like dyspepsia of IBS often leads to overtreatment in adoles- B1c. Unspecified (non-specific) dyspepsia cents with inflammatory bowel disease. B2. Aerophagia B3. Functional vomiting C. Bowel disorders C1. Irritable bowel syndrome G1. Vomiting C2. Functional abdominal bloating G1a. Infant regurgitation C3. Functional constipation C4. Functional diarrhea Regurgitation is the involuntary return of pre- C5. Unspecified functional bowel disorder viously swallowed food or secretions into or out D. Functional abdominal pain of the mouth. Regurgitation is distinguished D1. Functional abdominal pain syndrome D2. Unspecified functional abdominal pain from vomiting, which is defined by a central E. Biliary disorders nervous system reflex involving both auto- E1. Gall bladder dysfunction nomic and skeletal muscles in which gastric E2. Sphincter of Oddi dysfunction F. Anorectal disorders contents are forcefully expelled through the F1. Functional fecal incontinence mouth because of coordinated movements of F2. Functional anorectal pain the small bowel, stomach, esophagus, and dia- F2a. Levator ani syndrome F2b. Proctalgia fugax phragm. Regurgitation, vomiting, and rumina- F3. Pelvic floor dyssynergia tion are examples of gastroesophageal reflux. G. Functional pediatric disorders When the latter causes or contributes to tissue G1. Vomiting G1a. Infant regurgitation damage or inflammation (e.g. esophagitis, G1b. Infant rumination syndrome obstructive apnea, reactive airway disease, pul- G1c. Cyclic vomiting syndrome G2. Abdominal pain monary aspiration, or failure to thrive), it is G2a. Functional dyspepsia called gastroesophageal reflux disease. G2b. Irritable bowel syndrome G2c. Functional abdominal pain G2d. Abdominal migraine DIAGNOSTIC CRITERIA G2e. Aerophagia G3. Functional diarrhea (1) Regurgitation two or more times per G4. Disorders of defecation day for three or more weeks; G4a. Infant dyschezia G4b. Functional constipation (2) There is no retching, hematemesis, G4c. Functional fecal retention aspiration, apnea, failure to thrive, or G4d. Non-retentive
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