(Press-News.org)
Children who frequently miss school because of abdominal complaints are far more likely to be suffering from disorders of the gut-brain axis such as irritable bowel syndrome than diseases that can be detected with medical tests, new UVA Health Children’s research has found. The discovery could improve care for children with these common GI disorders and might spare them from a barrage of unproductive tests.
UVA’s Stephen M. Borowitz, MD, and fourth-year medical student Seth M. Tersteeg looked at school absenteeism as reported by parents who brought their children to UVA Health Children’s Pediatric Gastroenterology Clinic. Children who had missed more than three days of school in the prior month were nearly five times more likely to be suffering from what are called “functional gastrointestinal disorders” – conditions that range from irritable bowel to heightened digestive sensitivity – than to be suffering an illness with a specific underlying cause that doctors could pinpoint with a lab test.
Further, children who had been homebound for the entire month were nearly eight times more likely to be suffering from a functional GI disorder, the researchers found.
“We suspect that one of the biggest reasons children with functional gastrointestinal disorders are more likely to miss lots of school is because of what is often a long delay in making a definitive diagnosis,” said Borowitz, a pediatric gastroenterologist with UVA Health Children’s Department of Pediatrics. “The longer the child goes without an explanation of why they are having symptoms and what can be done to lessen those symptoms, the more anxious, fearful and frustrated the child and the family become. In general, the quicker we can identify what is going on and begin treatment, the better the outcome.”
Gastrointestinal Problems in Children
As every parent knows, stomach and digestive problems are common among school-age children. This can be from a short-term illness, such as a stomach virus, but in the vast majority of persistent cases, the cause is something else. These chronic cases of abdominal pain and constipation account for up to 38% of pediatrician visits, and 95% of those cases are not the result of a gastrointestinal disease and are due to a functional GI disorder.
These ambiguous diagnoses can be worrisome for both parent and child and can contribute to school absenteeism, Borowitz and Tersteeg note in a paper in the medical journal Frontiers in Pediatrics. Further, delays in getting these children a specific diagnosis can reduce the effectiveness of treatment for their conditions.
Despite how common GI problems are among children, Borowitz and Tersteeg could find no studies evaluating whether there was a link to school absenteeism. “Over the years, it seemed like the majority of children we were seeing in our practice with chronic gastrointestinal complaints and were missing lots of school were suffering from functional gastrointestinal disorders – disorders of the gut-brain axis – rather than gastrointestinal diseases,” Tersteeg said. “So we performed this study to see if this impression was correct.”
School Absenteeism Patterns
To shed light on the matter, the researchers asked about school absenteeism when talking with parents of children with chronic GI complaints, ages 5 to 19, who visited UVA’s Pediatric Gastroenterology Clinic between September 2016 and June 2017. This included 674 visits of school-age children.
Ultimately, the researchers found that 82% of children who had missed more than three days of school in the prior month went on to be diagnosed with a functional GI disorder.
Of the 408 children found to have functional disorders, the most common diagnoses were functional constipation (36%), functional abdominal pain (35%), and irritable bowel (31%). More than 220 of the children were found to have more than one disorder, but their absenteeism rates were no higher than children who had only one disorder.
The researchers say their findings suggest doctors may find it useful to ask about school absenteeism to help them more quickly identify children who may be suffering from functional GI disorders. This could help speed a diagnosis and begin treatment more quickly, improving the children’s outcomes.
To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog at http://makingofmedicine.virginia.edu.
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Media Contacts
American College of Gastroenterology
Becky Abel mediaonly@gi.org (301) 263-9000
American Gastroenterological Association
Annie Mehl communications@gastro.org (301) 272-0013
American Society for Gastrointestinal Endoscopy
Andrea Lee alee@asge.org (630) 570-5601
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