Functional defecation disorders in children: PACCT criteria versus Rome II criteria.
OBJECTIVE
To evaluate the clinical validity and applicability of the Paris Consensus on Childhood Constipation Terminology (PACCT) versus the Rome II criteria for pediatric functional defecation disorders (FDDs).


METHODS
Children from infancy to 17 years who had been referred to a tertiary center for chronic constipation were recruited for the study. A prospective longitudinal design was used. The Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) for parents of children age 0 to 4 and 4 to 17 years and for children age 10 to 17 years was used for diagnosis of FDDs.


RESULTS
Children (n = 128; mean age, 67.2 months; 62 males) were screened consecutively. FDDs were diagnosed significantly more often by PACCT than by the Rome II criteria (112 [88.9%] vs 60 [47.6%]; P = .001). The agreement Cohen's kappa test showed kappa = .173. A statistically significant difference was reported between Rome II and PACCT in the 4- to 17-year-old group (P = .001). Scybalous, pebble-like stools and defecation with straining were the main symptoms reported (80%), followed by painful defecation (66%).


CONCLUSIONS
The PACCT criteria show greater applicability than the Rome II criteria for FDDs. The poor agreement implies that they do not identify the same types of patients. Because such a high percentage of constipated children reported the symptoms of defecation with straining, scybalous pebble-like stools, and painful defecation, including these symptoms in any revised criteria should be taken into consideration.
Boccia
Gabriella
G
Department of Pediatrics, University of Federico II, Naples, Italy.
Manguso
Francesco
F
Coccorullo
Paola
P
Masi
Paola
P
Pensabene
Licia
L
Staiano
Annamaria
A
D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D009626:Terminology as Topic