title: Assessment of abdominal pain through global outcomes and recent FDA recommendations in children: are we ready for change?
abstract: OBJECTIVE
  Irritable bowel syndrome is a multisymptom construct, with abdominal pain (AP) acting as the driving symptom of patient-reported severity. The Food and Drug Administration considers a >30% decrease in AP as satisfactory improvement, but this has not been validated in children. We investigated the correspondence of 2 measures for AP assessment, ≥30% improvement in AP and global assessment of improvement.
  
  
  METHODS
  Secondary analysis of data from 72 children who completed a randomized clinical trial for abdominal pain-associated functional gastrointestinal disorders. Children completed daily assessment of AP intensity, functional disability inventory (FDI), question regarding pain's interference with activities, and 2 global assessment questions. We measured the extent to which ≥30% improvement of AP and global assessment questions correlated with each other and with disability.
  
  
  RESULTS
  The global questions correlated with each other (r=0.74; P<0.0001) and with a ≥30% improvement in AP (P<0.01). Global outcomes were satisfaction with treatment was inversely related to the child's report of interference with activities (P<0.01) and symptom relief was positively associated with ≥30% improvement in FDI scores (P<0.009). A 30% change in FDI scores was associated with global questions of symptom relief (P=0.009) but not with satisfaction with treatment (P=0.07). The association of AP improvement with interference with activities (P=0.14) or change in FDI scores (P=0.27) did not reach significance.
  
  
  CONCLUSIONS
  Currently used global assessments are significantly associated with decreased pain intensity, decreased interference with daily activities, and a ≥30% change in FDI scores, whereas recommended 30% improvement in pain intensity is not as comprehensive.
authors.affiliation: *Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, IL †Division of Gastroenterology, Nationwide Children's Hospital, Columbus, OH ‡Digestive Healthcare Center, Hillsborough, NJ §Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI ||Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, MA ¶Division of Pediatric Gastroenterology, Children's Hospital of New Orleans, New Orleans, LA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Mohammad
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: Nader N
authors.initials: NN
authors.lastname: Youssef
authors.forename: Adrian
authors.initials: A
authors.lastname: Miranda
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
authors.forename: Paul
authors.initials: P
authors.lastname: Hyman
authors.forename: Miguel
authors.initials: M
authors.lastname: Saps
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy* / Q000209:etiology; D000203:Activities of Daily Living; D000293:Adolescent; D000639:Amitriptyline / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D002648:Child; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D017063:Outcome Assessment, Health Care / Q000592:standards*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D018712:Analgesics, Non-Narcotic; D000639:Amitriptyline