Alleviating Gasto-Intestinal Discomfort in Infants: Quest for Effective Interventions
Main Article Content
Abstract
Functional gastrointestinal disorders (FGIDs) are common among infants, yet precise diagnosis and optimal management strategies remain a challenge. Understanding the prevalence and impact of these conditions is essential for improving infant health. We present a comprehensive review of the evolution of treatment strategies for FGIDs tracing the identification of the first case to the recent advancements in disease management. The article explores the journey of the Rome criteria, which is the most widely used diagnostic parameter for FGIDs, as it transformed from consensus-based recommendations culminating in the present-day evidence-based guidelines, setting the stage for the upcoming Rome V criteria. FGIDs were initially hypothesized solely as a GI entity; however, thorough etio-pathologic research has elucidated the complex bio-psychosocial basis of FGIDs. In infants, these conditions can be particularly challenging to identify and manage due to their limited ability to communicate discomfort and distress. The article briefly refers to pathophysiology and diagnostic challenges as an exploratory background for effective management. An overview of existing research can shed light on the various treatment approaches for FGIDs in infants. We examined pharmacotherapy in FGID management in terms of its indications and limitations, which would allow its judicious use in clinical practice. The article underscores the efficacy and safety of a dietary approach in FGID management in infants, especially in the absence of red flags. We highlight key research details that led to newer advancements in nutritional interventions such as probiotics. L reuteri DSM 17938 is the most extensively studied probiotic with proven benefits and manifold indications. We highly recommend large prospective studies to identify the ideal therapeutic agent that can provide a potential opportunity to prevent FGIDs.
Keywords:
Functional gastrointestinal disorders (FGIDs), Rome criteria, infant nutrition, probiotics, L reuteri DSM 17938
Article Details
How to Cite
KESAVELU, Dhanasekhar.
Alleviating Gasto-Intestinal Discomfort in Infants: Quest for Effective Interventions.
Medical Research Archives, [S.l.], v. 11, n. 9, sep. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4459>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i9.4459.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Rasquin-Weber A, Hyman PE, Cucchiara S, et al. Childhood functional gastrointestinal disorders. Gut. 1999;45(Supplement 2):ii60-ii68. doi:10.1136/gut.45.2008.ii60
4. Mahon J, Lifschitz C, Ludwig T, et al. The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England. BMJ Open. 2017;7(11):e015594. doi:10.1136/bmjopen-2016-015594
5. Muhardi L, Aw MM, Hasosah M, et al. A Narrative Review on the Update in the Prevalence of Infantile Colic, Regurgitation, and Constipation in Young Children: Implications of the ROME IV Criteria. Front Pediatr. 2022;9. Accessed May 14, 2023. https://www.frontiersin.org/articles/10.3389/fped.2021.778747
6. Benninga MA, Nurko S, Faure C, Hyman PE, Roberts ISJ, Schechter NL. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016;150(6):1443-1455.e2. doi:10.1053/j.gastro.2016.02.016
7. Curien-Chotard M, Jantchou P. Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort. BMC Pediatr. 2020;20:152. doi:10.1186/s12887-020-02047-3
8. Vernon-Roberts A, Alexander I, Day AS. Systematic Review of Pediatric Functional Gastrointestinal Disorders (Rome IV Criteria). J Clin Med. 2021;10(21):5087. doi:10.3390/jcm10215087
9. Rogovik AL, Goldman RD. Treating infants’ colic. Can Fam Physician. 2005;51(9):1209-1211.
10. Huang Y, Tan SY, Parikh P, Buthmanaban V, Rajindrajith S, Benninga MA. Prevalence of functional gastrointestinal disorders in infants and young children in China. BMC Pediatr. 2021;21:131. doi:10.1186/s12887-021-02610-6
11. Chia LW, Nguyen TVH, Phan VN, et al. Prevalence and risk factors of functional gastrointestinal disorders in Vietnamese infants and young children. BMC Pediatr. 2022;22(1):1-7. doi:10.1186/s12887-022-03378-z
12. Raucci U, Borrelli O, Di Nardo G, et al. Cyclic Vomiting Syndrome in Children. Front Neurol. 2020;11:583425. doi:10.3389/fneur.2020.583425
13. Sunku B. Cyclic Vomiting Syndrome. Gastroenterol Hepatol. 2009;5(7):507-515.
14. Franco K, Campbell N, Tamburrino M, Evans C. Rumination: The Eating disorder of infancy. Child Psychiatry Hum Dev. 1993;24(2):91-97. doi:10.1007/BF02367262
15. 15. Hertz AF. Congenital Dyschezia. Proc R Soc Med. 1912;5(Sect Study Dis Child):169-174.
16. Clayden GS, Lawson JO. Investigation and management of long-standing chronic constipation in childhood. Arch Dis Child. 1976;51(12):918-923. doi:10.1136/adc.51.12.918
17. Illingworth RS. Infantile colic revisited. Arch Dis Child. 1985;60(10):981-985.
18. WESSEL MA, COBB JC, JACKSON EB, HARRIS GS JR, DETWILER AC. PAROXYSMAL FUSSING IN INFANCY, SOMETIMES CALLED “COLIC.” Pediatrics. 1954;14(5):421-435. doi:10.1542/peds.14.5.421
19. Pärtty A, Kalliomäki M. Infant colic is still a mysterious disorder of the microbiota–gut–brain axis. Acta Paediatr. 2017;106(4):528-529. doi:10.1111/apa.13754
20. Lloyd-Still JD. Chronic diarrhea of childhood and the misuse of elimination diets. J Pediatr. 1979;95(1):10-13. doi:10.1016/s0022-3476(79)80074-8
21. Koppen IJN, Nurko S, Saps M, Di Lorenzo C, Benninga MA. The pediatric Rome IV criteria: what’s new? Expert Rev Gastroenterol Hepatol. 2017;11(3):193-201. doi:10.1080/17474124.2017.1282820
22. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology. 2016;150(6):1262-1279.e2. doi:10.1053/j.gastro.2016.02.032
23. Rome Pediatrics. Rome Foundation. Accessed May 14, 2023. https://theromefoundation.org/rome-pediatrics/
24. Banks JB, Rouster AS, Chee J. Colic. In: StatPearls. StatPearls Publishing; 2023. Accessed May 14, 2023. http://www.ncbi.nlm.nih.gov/books/NBK518962/
25. Baaleman DF, Di Lorenzo C, Benninga MA, Saps M. The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice. Curr Gastroenterol Rep. 2020;22(5):21. doi:10.1007/s11894-020-00760-8
26. novalac-symposium-2019-pr-salvatore-presentation.pdf. Accessed May 17, 2023. https://novamil.com/sites/default/files/2020-06/novalac-symposium-2019-pr-salvatore-presentation.pdf
27. Salvatore S, Abkari A, Cai W, et al. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta Paediatr. 2018;107(9):1512-1520. doi:10.1111/apa.14378
28. Jakobsson I, Lindberg T. Cow’s milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatrics. 1983;71(2):268-271.
29. Sood R, Ford AC. Rome IV criteria for FGIDs — an improvement or more of the same? Nat Rev Gastroenterol Hepatol. 2016;13(9):501-502. doi:10.1038/nrgastro.2016.110
30. Trivić I, Hojsak I. Initial Diagnosis of Functional Gastrointestinal Disorders in Children Increases a Chance for Resolution of Symptoms. Pediatr Gastroenterol Hepatol Nutr. 2018;21(4):264-270. doi:10.5223/pghn.2018.21.4.264
31. Beser O, Cokugras F, Doğan G, et al. The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals. Eur J Pediatr. 2021;180. doi:10.1007/s00431-021-04059-2
32. Campeotto F, Barbaza MO, Hospital V. Functional Gastrointestinal Disorders in Outpatients Aged up to 12 Months: A French Non-Interventional Study. Int J Environ Res Public Health. 2020;17(11):4031. doi:10.3390/ijerph17114031
33. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, Van Tilburg M. Childhood Functional Gastrointestinal Disorders: Child/Adolescent. Gastroenterology. 2016;150(6):1456-1468.e2. doi:10.1053/j.gastro.2016.02.015
34. García Marqués S, Chillón Martínez R, González Zapata S, Rebollo Salas M, Jiménez Rejano JJ. Tools assessment and diagnosis to infant colic: a systematic review. Child Care Health Dev. 2017;43(4):481-488. doi:10.1111/cch.12454
35. Indrio F, Enninger A, Aldekhail W, et al. Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus. Pediatr Gastroenterol Hepatol Nutr. 2021;24(4):325-336. doi:10.5223/pghn.2021.24.4.325
36. Salvatore S, Barberi S, Borrelli O, et al. Pharmacological interventions on early functional gastrointestinal disorders. Ital J Pediatr. 2016;42:68. doi:10.1186/s13052-016-0272-5
37. Illingworth RS. Three month’s colic; treatment by methylscopolamine nitrate (skopyl). Acta Paediatr. 1955;44(3):203-208. doi:10.1111/j.1651-2227.1955.tb04133.x
38. O’Donovan JC, Bradstock AS Jr. The Failure of Conventional Drug Therapy in the Management of Infantile Colic. Am J Dis Child. 1979;133(10):999-1001. doi:10.1001/archpedi.1979.02130100023003
39. Blumenthal I. The gripe water story. J R Soc Med. 2000;93(4):172-174. doi:10.1177/014107680009300404
40. Jain K, Gunasekaran D, Venkatesh C, Soundararajan P. Gripe Water Administration in Infants 1-6 months of Age-A Cross-sectional Study. J Clin Diagn Res JCDR. 2015;9(11):SC06-SC08. doi:10.7860/JCDR/2015/13727.6738
41. Sarasu JM, Narang M, Shah D. Infantile Colic: An Update. Indian Pediatr. 2018;55(11):979-987. doi:10.1007/s13312-018-1423-0
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