• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.1
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• pp.1-13
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• 2017

Functional gastrointestinal disorders (FGIDs) are common worldwide and cover a wide range of disorders attributable to the gastrointestinal tract that cannot be explained by structural or biochemical abnormalities. The diagnosis of these disorders relies on the symptom-based Rome criteria. In 2016 the Rome criteria were revised for infants/toddlers and for children and adolescents. In this review, we discuss the novel Rome IV criteria for infants and toddlers. The criteria for infant colic were drastically changed, whereas only minor changes were made for regurgitation, cyclic vomiting syndrome, functional diarrhea, infant dyschezia and functional constipation. In addition to this, the new Rome IV discusses underlying mechanisms of pain in infants and toddlers, including the neurodevelopment of nociceptive and pain pathways, the various factors that are involved in pain experience, and methods of pain assessment in infants and toddlers is essential for the clinician who encounters functional pain in this age group. Overall, the Rome IV criteria have become more distinctive for all disorders in order to improve the process of diagnosing pediatric FGIDs.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.27 no.2
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• pp.125-135
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• 2024

Purpose: The updated ROME IV criteria for functional constipation (FC) in children were published in 2016. However, information on the use of these criteria is scarce. This study aimed to report the frequency of the use of the ROME IV criteria by Indonesian pediatricians and general practitioners (GPs) in FC management in infants and toddlers. Methods: An anonymous cross-sectional online survey was conducted between November 2021 and March 2022. Results: A total of 248 respondents (183 pediatricians and 65 GPs) from 24 Indonesian provinces completed the survey. Most respondents reported an estimated prevalence of FC to be less than 5% both in infants and toddlers. On average, only 64.6% of respondents frequently used the ROME IV criteria. Pediatricians used the ROME IV criteria more often than GPs did (p<0.001). The most frequently used criteria were painful or hard bowel movements (75.0%) and ≤2 defecations/week (71.4%). Lactulose as a laxative was the preferred treatment choice, followed by changing the standard formula to a specific nutritional formula. Most of the respondents carried out parenteral reassurance and education. Normal growth, as a marker of good digestion and absorption function, and normal stool consistency and frequency were the most reported indicators of gut health. Conclusion: The ROME IV criteria for functional constipation are not extensively used by pediatricians and GPs in Indonesia. Laxatives and specific nutritional formulas were the most used management approaches in infants and toddlers. Medical education, especially for general practitioners, should be updated.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.5
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• pp.376-386
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• 2022

Functional gastrointestinal disorders (FGIDs) are classified as a combination of persistent gastrointestinal symptoms. The Rome IV criteria can elucidate several factors in the pathogenesis of FGIDs. The frequency of FGIDs can differ between clinical and nonclinical settings and between geographic regions. To determine the global prevalence of FGIDs in neonates and toddlers according to the Rome IV criteria. We included cohort and descriptive observational studies reporting the prevalence of FGIDs according to the Rome IV criteria in children aged 0-48 months. We searched the Medline, Embase, Lilacs, and CENTRAL databases from May 2016 to the present day. Furthermore, unpublished literature was searched to supplement this information. The Strengthening the Reporting of Observational Studies in Epidemiology statement was used to evaluate the risk of bias. A meta-analysis of the proportions was performed using MetaProp in R. The results are reported in forest plots. We identified and analyzed 15 studies comprising 48,325 participants. Six studies were conducted in Europe, three in Latin America, two in North America, and four in Asia. Most participants were 12-48 months old (61.0%) and were recruited from the community. The global prevalence of FGIDs was 22.0% (95% confidence interval, 15-31%). The most common disorder was functional constipation (9.0%), followed by infant regurgitation syndrome (8.0%). Its prevalence was higher in the Americas (28.0%). FGIDs, as defined by the Rome IV criteria, are present in 22% of children, and the most common primary disorder is functional constipation. A higher prevalence of FGIDs has been reported in America.

• The Journal of Pediatrics of Korean Medicine
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• v.31 no.3
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• pp.1-13
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• 2017

Objectives The purpose of this study is to investigate how irritable bowel syndrome (IBS) affects fatigue scales and eating habits in children and adolescents using Rome IV criteria. Methods Questionnaires and The $PedsQL^{TM}$ Multidimensional Fatigue Scale (MFS) have been given to 211 children and adolescents aged 8 to 18 years old who were admitted to ${\bigcirc}{\bigcirc}$ university Korean medicine hospital pediatric departments, from 29th, July, 2016 to 12th, August, 2016 to evaluate their eating habits and fatigue. Additionally, PASW statistics 18.0 were used to analyze influence of irritable bowel syndrome on eating habits and fatigue in children and adolescents by using chi-square test, independent t-test and linear regression. Results In total of 211 subjects, 29 (13.7%) were diagnosed with IBS according to the Rome IV criteria. 1. There was a statistically significant difference (p<0.05) between IBS group and non-IBS group on a specific question in the eating habit questionnaire: the amount of sugar intake and the prevalence of IBS. 2. There was a statistically significant difference in general fatigue and cognitive fatigue categories when comparing the MFS subscores according to the prevalence of IBS. Conclusions Considering patients eating habits and fatigue is a necessary process for the successful treatment of irritable bowel syndrome. Korean medicine that maximizes quality of life while minimizing the potential risks to the patients of gastrointestinal disease should also include administrative interventions that may be helpful in the daily life of IBS patients.

• Korean Journal of Clinical Pharmacy
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• v.29 no.3
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• pp.156-165
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• 2019

Objective: The purpose of this study was to provide a database for making better decisions of the treatment of the irritable bowel syndrome (IBS) patient, and for improving the recognition of IBS in the Korean society. Methods: The survey was conducted on 174 female college students in Korea from January 2017 to January 2018. Out of the total students surveyed, 160 questionnaires were analyzed after excluding 14 uncompleted questionnaires. Results: Based on the survey, the prevalence of IBS among female college students in Korea was found to be 13.8%. Statistically, the results proved that there were significant differences in the stress levels between the students with IBS and non-IBS diagnosed by ROME IV criteria. Students with IBS had higher stress levels than students without the ailment. Conclusions: Based on this study, stress management related treatment should be actively considered. Furthermore, it is necessary to develop more efficient and updated guidelines for the treatment of IBS and new patient care programs.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.2
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• pp.116-126
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• 2023

Purpose: This study aimed to evaluate the prevalence and risk factors of infant dyschezia as well as pediatrician awareness regarding this disease in Indonesia. Methods: This is a two-part cross-sectional study, which was divided into study A and B. Study A: Parents whose infants were under 9 months old and attended well-baby clinics were recruited at two randomly selected primary health centers. Parents also provided information on the infant's previous medical history, and socio-demographic and family details. The Rome IV criteria was translated and validated to be used for diagnosis of infant dyschezia. Study B: Randomly selected pediatricians were surveyed by using a questionnaire to evaluate their knowledge regarding infant dyschezia. Results: The prevalence of infant dyschezia based on the result of this study was 11.8%. Three risk factors had a significant relationship with infant dyschezia i.e., the number of children in the family (odds ratio [OR], 5.619; 95% confidence interval [CI], 2.194-14.390; p<0.001), complementary food diet (OR, 4.238; 95% CI, 1.902-9.443; p<0.001), and social-emotional disturbance (OR, 5.670; 95% CI, 2.550-12.609; p<0.001). The percentage of pediatricians correctly diagnosed infant dyschezia was 71.5%. Most pediatricians agreed that they did not perform any diagnostic testing (79.7%) and only provided education in cases of infant dyschezia (58.5%). Conclusion: The prevalence of infant dyschezia identified in our study was higher than that in other neighboring Asian countries, with the highest prevalence observed in infants 7-9 months old. Being an only child, receiving complementary food diet, and sociao-emotional disturbances were significant risk factors of infant dyschezia.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.27 no.3
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• pp.186-195
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• 2024

Purpose: Infantile colic diagnostic criteria were established by Rome IV. A universally accepted management remains to be established. We aimed to evaluate diagnostic criteria, management strategies, and perceived regional prevalence of infantile colic in Pakistan, as well as its effect on physicians and parents. Methods: A questionnaire was distributed amongst 1,256 physicians. Results: We received 800 replies. Wessel and Rome IV criteria were used by most physicians for diagnosis; however, the response "any infant who cries a lot" was selected by older physicians (48% of those over 60 years), physicians in rural areas (32%), physicians practicing in private clinics (27%), and general physicians (30%). Estimated prevalence of infantile colic ranges from 21-40%. Reassurance was the most widely recommended management strategy followed by herbal teas (51%), switching to a different formula (49%), probiotics (28%) and antibiotics (26%), discontinuation of breastfeeding (14%), elimination of dairy products from the breastfeeding mothers' diet (6%), and the administration of colic drops (1%). Most physicians considered the negative impact of colic on their personal lives and the parents as mild-to-moderate. Notably, 38% of percent of physicians routinely screened for maternal depression, and 45% of physicians were aware of the association between infantile colic and shaken baby syndrome. Conclusion: Most physicians in Pakistan diagnose and manage infantile colic according to the established guidelines. However, the guidelines pertaining to treatment planning are not followed. Educational efforts directed toward general physicians and doctors practicing in rural areas and clinics must be implemented to avoid unnecessary testing and treatment burden.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.7
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• pp.487-495
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• 2020

This study examined the effects of auricular acupressure on female college students with functional constipation to propose auricular acupressure as an effective and evidence-based nursing intervention. This is an experimental study designed with randomization and single-blind in a Sham-control approach. The subjects included 44 female college students with functional constipation whose symptoms met the Rome IV criteria. In this study, five different acupressure sites were applied to each group; the experimental group (n=23) received auricular acupressure on rectum, large intestine, lung, san jiao, and shenmen, whereas the Sham control group (n=21) received acupressure on ankle, helix, tooth, jaw, and external ear. The intervention was implemented once a week for a total of six weeks. After six weeks, the severity of constipation, stool form, and quality of life regarding constipation in the experimental group significantly improved compared to that of the Sham control group (p<.001). Consequently, the study showed that auricular acupressure can be used as an effective nursing intervention to alleviate constipation in female college students.

• Journal of Korean Biological Nursing Science
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• v.22 no.2
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• pp.90-101
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• 2020

Purpose: The purpose of this study was to build and verify a structural model that could predict the severity of irritable bowel syndrome in university students. Methods: Participants were 205 students enrolled in college with irritable bowel syndrome using the irritable bowel syndrome module of the ROME IV Adult Questionnaire. The data were collected using online questionnaires in AprilMay 2019. The data were analyzed using the SPSS WIN 25.0 and AMOS 20.0 programs. Results: 1) The symptom severity that participants experienced were mild (14.6%), moderate (45.4%), and severe (40%). 2) Fit indices of the model were x²= 79.66 (df = 52, p= .009), CFI= .94, TLI= .96, RMSEA= .05, RMR= 1.59, GFI= .94, and TLI= .96.3). The severity of irritable bowel syndrome was influenced directly by anxiety and sleep, and indirectly by family history, perfectionism, social support, coping, and stress. The severity of irritable bowel syndrome was indirectly affected by the following: family history through anxiety; perfectionism through stress, anxiety, and sleep; social support through coping, stress, anxiety, and sleep; coping through stress and anxiety; and stress through anxiety and sleep. Conclusion: Based on the results of this study, a nursing intervention is needed to reduce the anxiety and stress and improve the quality of sleep to improve the health of the college students and manage the symptoms of patients with irritable bowel syndrome.

• Journal of the Korean Society of School Health
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• v.32 no.1
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• pp.1-9
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• 2019

Purpose: The purpose of this study was to identify the prevalence, subtypes and risk factors of Irritable Bowel Syndrome (IBS) among male adolescents. Methods: The survey was conducted on male adolescents (n=441) attending a high school. Rome IV criteria was used to diagnose IBS. Data on health promoting behaviors, psychological distress, sleep hygiene practices were collected using self-administered structured questionnaires. Results: The prevalence of IBS was 11.1% and the subtypes were mixed (77.5%), unclassified (10.2%), diarrhea-predominant (8.2%), and constipation-predominant (4.1%). Risk factors influencing IBS were sleeping time (Odds Ratio [OR]=1.00, 95% Confidence Interval [CI]: 0.99~1.00), anxiety, a subfactor under psychological distress (OR=1.12, 95% CI: 1.02~1.22), and arousal-related behaviors, a subfactor under sleep hygiene practices (OR=1.10, 95% CI: 1.03~1.17). Conclusion: Our findings indicated that IBS is a common problem in male adolescents. It is necessary to develop school-based intervention strategies addressing sleeping time, anxiety and arousal-related behaviors in order to prevent and improve IBS in male adolescents.