Clinical utility of Rome criteria managing functional gastrointestinal disorders in pediatric primary care.
OBJECTIVE
Our goals were to demonstrate that functional gastrointestinal disorders (FGIDs) can be diagnosed in a positive fashion and managed by family pediatricians (FPs); to assess the compliance of FPs with a predefined diagnostic/therapeutic protocol for managing FGIDs to evaluate efficacy of continuing medical education; and to evaluate the success of reassurance by using a biopsychosocial model in comparison to drug treatment in an open-label, nonrandomized study.


METHODS
A total of 9291 patients, aged birth to 14 years, were prospectively enrolled during a 3-month period by 21 FPs. Follow-up was performed at 1-, 3-, and 12-month intervals. To assess compliance, after diagnosis, FPs that participated in the study were asked to comply with the diagnostic/therapeutic protocol and record investigations and treatment prescribed.


RESULTS
Two hundred sixty-one patients (2.8%) met Rome II criteria and were included in the study. In all cases but 4, diagnosis of FGIDs was confirmed at the end of follow-up (98.4%). Average compliance of FPs was >80%. Among 56 patients treated only with the explanation of symptom and reassurance, 52 (92.8%) have reported success, in comparison with 26 of 35 patients (74.3%) treated with drugs (odds ratio: 4.5 [95% confidence interval: 1.3-16]).


CONCLUSIONS
FGIDs can be diagnosed and managed in primary care. Prospective studies in primary care allow assessment of compliance of pediatricians and implementation of what is learned in courses developed in continuing medical education. Informed reassurance and availability of FPs are more useful than over-the-counter drugs, which are often used for FGIDs.
Primavera
Giuseppe
G
National Health System, Azienda Sanitaria Locale 6, Associazione Culturale Pediatri Trinacria, Palermo, Italy. giuseppe.magazzu@unime.it
Amoroso
Biagio
B
Barresi
Alba
A
Belvedere
Letizia
L
D'Andrea
Cristina
C
Ferrara
Dante
D
Cascio
Antonina Lo
AL
Rizzari
Sara
S
Sanfilippo
Elisa
E
Spataro
Angelo
A
Zangara
Daniela
D
Magazzù
Giuseppe
G
D000293:Adolescent; D000367:Age Factors; D001774:Blood Chemical Analysis; D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy / Q000379:methods; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000188:drug therapy; D007558:Italy; D008297:Male; D016017:Odds Ratio; D010372:Pediatrics / Q000379:methods*; D010808:Physical Examination; D011320:Primary Health Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D005765:Gastrointestinal Agents