Early Life Events: Infants with Pyloric Stenosis Have a Higher Risk of Developing Chronic Abdominal Pain in Childhood
Early Life Events: Infants with Pyloric Stenosis Have a Higher Risk of Developing Chronic Abdominal Pain in Childhood
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DOI：
10.1016/j.jpeds.2011.03.018
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发表时间：
2011-10-01
影响因子：
5.1
通讯作者：
Bonilla, Silvana
中科院分区：
文献类型：
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作者：
Saps, Miquel;Bonilla, Silvana
目的我们假设幽门狭窄的儿童发生慢性腹痛的风险更大，因为这一队列结合了各种危险因素：早期应激事件、胃手术和围手术期放置鼻胃管。研究设计这是一项病例对照研究，研究对象是2000年1月1日至2005年6月31日在芝加哥儿童纪念医院被诊断为幽门狭窄的所有儿童。由于他们相似的遗传和社会经济背景，没有幽门狭窄病史的4到20岁的兄弟姐妹被选为对照组。有症状儿童的父母完成了儿科GI症状罗马III版问卷的父母表格，用于病例和对照。根据罗马III标准，主要结果是慢性腹痛的患病率，次要结果是疼痛相关性功能性胃肠疾病(FGID)的存在，符合罗马III标准。结果病例组(n=100；平均年龄7.49±1.43岁；29名女孩)和对照组(n=91；平均年龄9.20±4.19岁；29名女孩)参与了研究。平均随访时间为7.2+/-1.6年。慢性腹痛在病例组明显多于对照组(20/80[25%]比5/91[5.8%]；OR，4.3；95%CI，1.5-12；P=0.0045)。20例受试者中有7例(35%)符合罗马III诊断疼痛相关性FGID的标准(3例肠易激综合征，2例功能性消化不良，2例功能性腹痛)，对照组1例(肠易激综合征)符合这些标准(OR，6.8；95%CI，0.82-56；P=.043)。我们的研究结果表明，婴儿期幽门狭窄的存在及其围手术期护理因素是长期随访时儿童慢性腹痛发生的危险因素。这项研究为支持疼痛相关的FGID的多因素理论构建提供了重要的数据，并强调了早期生活事件在儿童慢性腹痛发展中的重要性。(《儿科杂志》2011；159：551-4)。
Objective We hypothesize that children who had pyloric stenosis are at greater risk for developing chronic abdominal pain because this cohort combines various risk factors: an early stressful event, gastric surgery, and perioperative nasogastric tube placement in most cases.Study design This was a case control study of all children diagnosed with pyloric stenosis during infancy (cases) between January 1, 2000, and June 31, 2005, at Children's Memorial Hospital, Chicago. Because of their similar genetic and socioeconomic backgrounds, siblings aged 4 to 20 years without a history of pyloric stenosis were selected as controls. Parents of children with symptoms completed the parental form of the Pediatric GI Symptoms Rome III version questionnaire for both cases and controls. The primary outcome was the prevalence of chronic abdominal pain, and the secondary outcome was the presence of pain-associated functional gastrointestinal disorder (FGID), in accordance with Rome III criteria.Results Cases (n = 100; mean age, 7.49 +/- 1.43 years; 29 girls) and controls (n = 91; mean age, 9.20 +/- 4.19 years; 29 girls) participated in the study. Mean time to follow-up was 7.2 +/- 1.6 years. Chronic abdominal pain was significantly more common in cases, than in controls (20/80 [25%] vs 5/91 [5.8%]; OR, 4.3; 95% CI, 1.5-12; P = .0045). Seven out of 20 subjects (35%) met the Rome III criteria for diagnosis of a pain-associated FGID (3 with irritable bowel syndrome, 2 with functional dyspepsia, and 2 with functional abdominal pain), and 1 patient in the control group (with irritable bowel syndrome) met these criteria (OR, 6.8; 95% CI, 0.82-56; P = .043).Conclusion We have described a new model to study early life events in infants. Our findings suggest that the presence of pyloric stenosis in infancy and factors involved in its perioperative care represent risk factors in the development of chronic abdominal pain in children at long-term follow-up. This study provides important data to sustain the multifactorial theoretical construct of pain-associated FGID and underscores the importance of early life events in the development of chronic abdominal pain in children. (J Pediatr 2011;159:551-4).