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      Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age

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          ABSTRACT

          Objectives:

          The aim of the study was to review published evidence and the opinion of practising clinicians on the prevalence and long-term health consequences of functional gastrointestinal symptoms in infants younger than 12 months.

          Methods:

          PubMed was searched from inception to November 2014 to find articles reporting the prevalence and long-term health outcomes of infantile colic, regurgitation, functional constipation, functional diarrhoea, and dyschezia in infants younger than <12 months. A questionnaire was sent to practising clinicians worldwide, and a group of 15 international experts met to discuss the likely frequency and longer-term consequences of these symptoms.

          Results:

          The literature search identified 30 studies reporting the prevalence of infantile colic (2%–73%), 13 that of regurgitation (3%–87%), 8 that of functional constipation (0.05%–39.3%), 2 that of functional diarrhoea (2%–4.1%), and 3 that of dyschezia (0.9%–5.6%). The studies varied in design, populations investigated, and definition of the symptoms. Questionnaires were received from 369 respondents. The experts agreed that the likely prevalences for colic, regurgitation, and functional constipation were 20%, 30%, and 15%, respectively. The limited data in the literature for functional diarrhoea and dyschezia suggest prevalences <10%. Infantile colic may be associated with future health problems in a subset of infants.

          Conclusions:

          Functional gastrointestinal symptoms appear to occur in a significant proportion of infants younger than 12 months and may have an impact on future health outcomes. Prospective collection of data according to agreed criteria is needed to obtain more accurate estimates of the prevalence and consequences of these symptoms.

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          Most cited references71

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          Gastrointestinal flora and gastrointestinal status in children with autism -- comparisons to typical children and correlation with autism severity

          Background Children with autism have often been reported to have gastrointestinal problems that are more frequent and more severe than in children from the general population. Methods Gastrointestinal flora and gastrointestinal status were assessed from stool samples of 58 children with Autism Spectrum Disorders (ASD) and 39 healthy typical children of similar ages. Stool testing included bacterial and yeast culture tests, lysozyme, lactoferrin, secretory IgA, elastase, digestion markers, short chain fatty acids (SCFA's), pH, and blood presence. Gastrointestinal symptoms were assessed with a modified six-item GI Severity Index (6-GSI) questionnaire, and autistic symptoms were assessed with the Autism Treatment Evaluation Checklist (ATEC). Results Gastrointestinal symptoms (assessed by the 6-GSI) were strongly correlated with the severity of autism (assessed by the ATEC), (r = 0.59, p < 0.001). Children with 6-GSI scores above 3 had much higher ATEC Total scores than those with 6-GSI-scores of 3 or lower (81.5 +/- 28 vs. 49.0 +/- 21, p = 0.00002). Children with autism had much lower levels of total short chain fatty acids (-27%, p = 0.00002), including lower levels of acetate, proprionate, and valerate; this difference was greater in the children with autism taking probiotics, but also significant in those not taking probiotics. Children with autism had lower levels of species of Bifidobacter (-43%, p = 0.002) and higher levels of species of Lactobacillus (+100%, p = 0.00002), but similar levels of other bacteria and yeast using standard culture growth-based techniques. Lysozyme was somewhat lower in children with autism (-27%, p = 0.04), possibly associated with probiotic usage. Other markers of digestive function were similar in both groups. Conclusions The strong correlation of gastrointestinal symptoms with autism severity indicates that children with more severe autism are likely to have more severe gastrointestinal symptoms and vice versa. It is possible that autism symptoms are exacerbated or even partially due to the underlying gastrointestinal problems. The low level of SCFA's was partly associated with increased probiotic use, and probably partly due to either lower production (less sacchrolytic fermentation by beneficial bacteria and/or lower intake of soluble fiber) and/or greater absorption into the body (due to longer transit time and/or increased gut permeability).
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            Rome III: New standard for functional gastrointestinal disorders.

            The publication in the April, 2006 issue of Gastroenterology of Rome III has made available to the scientific world an enhanced and updated version of the Rome criteria and related information on the functional GI disorders. It is expected that the criteria will be adopted and used by physicians, pharmaceuticals and regulatory agencies worldwide, just as the previous Rome II became the standard for clinical practice and research. In this issue of J Gastrointestin Liver Dis, these Guidelines, the Rome III, are presented. Also included are some of the differences between Rome II and Rome III criteria as well as the rationale for publishing this new version.
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              Frequency of gastrointestinal symptoms in children with autistic spectrum disorders and association with family history of autoimmune disease.

              This is a cross-sectional study that compares lifetime prevalence of gastrointestinal (GI) symptoms in children with autistic spectrum disorders (ASDs) and children with typical development and with other developmental disabilities (DDs) and examines the association of GI symptoms with a family history of autoimmune disease. A structured interview was performed in 50 children with ASD and 2 control groups matched for age, sex, and ethnicity-50 with typical development and 50 with other DDs. Seventy-four percent were boys with a mean age of 7.6 years (SD, +/-3.6). A history of GI symptoms was elicited in 70% of children with ASD compared with 28% of children with typical development (p <.001) and 42% of children with DD (p =.03). Abnormal stool pattern was more common in children with ASD (18%) than controls (typical development: 4%, p =.039; DD: 2%, p =.021). Food selectivity was also higher in children with ASD (60%) compared with those with typical development (22%, p =.001) and DD (36%, p =.023). Family history of autoimmune disease was reported in 38% of the ASD group and 34% of controls and was not associated with a differential rate of GI symptoms. In the multivariate analysis, autism (adjusted odds ratio (OR), 3.8; 95% confidence interval (CI), 1.7-11.2) and food selectivity (adjusted OR, 4.1; 95% CI, 1.8-9.1) were associated with GI symptoms. Children with ASD have a higher rate of GI symptoms than children with either typical development or other DDs. In this study, there was no association between a family history of autoimmune disease and GI symptoms in children with ASD.
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                Author and article information

                Journal
                J Pediatr Gastroenterol Nutr
                J. Pediatr. Gastroenterol. Nutr
                JPGA
                Journal of Pediatric Gastroenterology and Nutrition
                Lippincott Williams & Wilkins
                0277-2116
                1536-4801
                November 2015
                29 October 2015
                : 61
                : 5
                : 531-537
                Affiliations
                []UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
                []Unit of Pediatric Gastroenterology, University Hospital Ibn Rochd, Faculty of Medicine, University Hassan 2, Casablanca, Morocco
                []GI Unit, Robert Debre Hospital, Paris, France
                [§ ]Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
                [|| ]Gastroentérologie, Hépatologie et Nutrition, Clinique Universitaire de Pédiatrie, Grenoble Cedex 9, France
                []Pediatric Gastroenterology Hepatology and Nutrition, Cerrahpaşa Medical Faculty, University of Istanbul, Istanbul, Turkey
                [# ]Children's Nutrition Research Centre, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia
                [∗∗ ]Department of Child Health University of Indonesia, Jakarta, Indonesia
                [†† ]Department of Pediatrics, Section of Gastroenterology, Hepatology, and Transplantation, Hospital Italiano, Buenos Aires, Argentina
                [‡‡ ]Nutricia Research, Utrecht, The Netherlands
                [§§ ]Pediatric GI, Hepatology, and Nutrition, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
                [|||| ]Division of Pediatric Gastroenterology, Paulista School of Medicine, Federal University of São Paulo, Brazil
                [¶¶ ]Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
                [## ]Clinica Pediatrica, Università dell’Insubria, Varese, Italy
                [∗∗∗ ]Schneider Children's Medical Centre of Israel, Tel-Aviv University, Israel
                [††† ]Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
                [‡‡‡ ]Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
                [§§§ ]Gastroenterology Unit, Great Ormond Street Hospital and UCL Institute of Child Health, London, UK.
                Author notes
                Address correspondence and reprint requests to Yvan Vandenplas, MD, PhD, Department of Pediatrics, UZ Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium (e-mail: yvan.vandenplas@ 123456uzbrussel.be).
                Article
                00003
                10.1097/MPG.0000000000000949
                4631121
                26308317
                99e10512-954d-49f6-a2f0-224480596bfb
                Copyright 2015 by ESPGHAN and NASPGHAN. Unauthorized reproduction of this article is prohibited.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 27 March 2015
                : 14 August 2015
                Categories
                Invited Review
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                constipation,dyschezia,functional diarrhoea,functional gastrointestinal disorder,infant,infantile colic,regurgitation

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