Symptoms and subtypes in pediatric functional dyspepsia: relation to mucosal inflammation and psychological functioning.
OBJECTIVE
The aim of the present study was to explore relations between antral or duodenal inflammatory cells and aspects of psychological functioning with clinical symptom presentation in children with functional dyspepsia (FD), as well as to determine whether histologic inflammation and/or psychopathology are differentially associated with FD subtypes as defined by the Rome II and Rome III criteria.


METHODS
One hundred pediatric patients with dyspepsia completed a standardized history and physical examination at initial evaluation. Patients and parents also completed a measure of psychological functioning. Subsequently, 63 of these patients underwent upper endoscopy with biopsy (4 patients excluded from analysis because of mucosal disease). Inflammatory cells in the mucosa of stomach and duodenum were enumerated. Associations between specific symptoms and FD subtypes with inflammatory cell densities and anxiety, depression, and somatization scores were examined.


RESULTS
Rome III subtypes were more robustly related to differences in mast cell densities and scores on psychologic subscales than was true for Rome II subtypes. At the individual symptom level, having pain wake the patient from sleep was associated with higher duodenal mast cell density. Bloating was associated with lower levels of general antral inflammation, as well as higher self-reported levels of anxiety and somatization. Early satiety and bothersome postprandial fullness also were associated with higher levels of self-reported anxiety and depression.


CONCLUSIONS
The present study provides preliminary evidence for a relation between clinical presentation, specific types of inflammatory cell infiltrates, and aspects of psychological functioning in children with FD. Rome III subtyping, adopted for adult dyspepsia, may be relevant to the pediatric population.
Schurman
Jennifer V
JV
The Children's Mercy Hospital, Kansas City, MO, USA. jschurman@cmh.edu
Singh
Meenal
M
Singh
Vivekanand
V
Neilan
Nancy
N
Friesen
Craig A
CA
D015746:Abdominal Pain / Q000150:complications; D000293:Adolescent; D001007:Anxiety / Q000209:etiology*; D002648:Child; D003863:Depression / Q000209:etiology*; D004415:Dyspepsia / Q000145:classification / Q000150:complications / Q000276:immunology / Q000523:psychology; D005260:Female; D005753:Gastric Mucosa / Q000276:immunology; D005767:Gastrointestinal Diseases / Q000276:immunology / Q000523:psychology; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000523:psychology; D007413:Intestinal Mucosa / Q000276:immunology; D008297:Male; D008407:Mast Cells; D052016:Mucositis / Q000276:immunology / Q000523:psychology; D019518:Postprandial Period; D012527:Satiation; D057566:Self Report; D012893:Sleep Wake Disorders / Q000209:etiology; D013001:Somatoform Disorders / Q000209:etiology