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247 FUNCTIONAL GASTROINTESTINAL DISORDERS: IS VISCERAL HYPERALGESIA CORRELATED WITH SYMPTOM SEVERITY? J Castilloux, A Noble, C Faure INTRODUCTION: Abdominal pain related to functional gastrointestinal disorders (FGID) is frequent in children and can be of variable severity. Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are associated with rectal hypersensitivity. Our aim was to test the hypothesis that, in children with IBS or FAP, the rectal sensory threshold for pain (RSTP) is correlated with symptom severity.
Division of Pediatric Gastroenterology, Hôpital Sainte-Justine, Montréal, Université de Montréal, Montreal, Quebec
METHODS: 52 patients (37 girls, mean age 13.7 years, range 8.5 to 17.6 y) with IBS (n=30) and FAP (n=22), according to Rome II criteria, underwent a series of rectal isobaric balloon distensions using an electronic barostat to determine their RSTP. Pain was evaluated with a visual analog scale. The patients completed the Questionnaire on Pediatric Gastrointestinal Symptoms, which includes questions regarding pain frequency and duration, missed days of school and missed activities with friends, in addition to the STAIC and CDI for symptoms of anxiety and depression respectively.
RESULTS: The mean RSTP of IBS patients (19 mmHg ±10) was not significantly different from that of the FAP patients (23 mmHg ±11; p=0.2). 85% of the patients had a RSTP <= 30 mmHg which represents the 5th percentile of our control population and were considered hypersensitive. 81% reported abdominal pain for more than one year and 91% once a week or more. 52% and 37% respectively reported missing school and social activities at least once a week. Increased frequency of pain, missed days of school and missed social activities were not predictive of an abnormal RSTP value in either the IBS or FAP group. No correlation was found between RSTP values and CDI or STAIC scores. Analysis of the subset of hypersensitive children (RSTP <= 30 mmHg) did not reveal any significant association with frequency of pain, missed days of school, missed social activities, CDI and STAIC scores.
CONCLUSION: In our population, rectal hypersensitivity, as measured by RSTP, was not proportional to the gravity of symptoms in children with IBS and FAP, suggesting that symptom severity in FGID is not only dependent on visceral hypersensitivity but is also influenced by other factors.