Quality of Life of Infants with Functional Gastrointestinal Disorders: A Large Prospective Observational Study
Keywords:functional gastrointestinal disorder, infant, quality of life, QUALIN, nutrition
Background: Functional gastrointestinal disorders (FGID) are very common during infancy, leading to frequent medical consultations. The aim of this large, prospective study was to assess the quality of life (QoL) and clinical management of infants with FGID.
Methods: Completely or partially bottle-fed infants under 5 months old, presenting one or more FGID (regurgitation, constipation, diarrhea, crying/fussing), were enrolled during initial consultation by 111 pediatricians in private practice throughout France and reassessed at one month. Parents were asked to complete the QUALIN QoL questionnaire at inclusion and at Day 15.
Results: A total of 815 infants (mean age 2.1Â±1.2 months) were evaluable. Mean QoL score improved from +27.2Â±15.1 at inclusion to +38.0Â±12.9 at day 15 (p<0.0001) irrespective of FGID symptoms. Multivariate analysis indicated that younger age, dietary advice, and partial breastfeeding were associated with better QoL outcome. Gastrointestinal symptoms showed significant regression at Day 30. The number of bottle feeds followed by external reflux episodes decreased from 80.0Â±27.4% to 36.1Â±31.4% at Day 30 (p<0.0001), the weekly number of stools increasing from 3.9Â±4.0 to 8.0Â±3.7 (p<0.0001).
Conclusion: Medical management based on information, reassurance, lifestyle advice and dietary intervention improved QoL in infants with FGID and led to a reduction in FGID symptoms.
 Vandenplas Y, Abkari A, Bellaiche M, et al. Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr 2015; 61: 531-7.
 Aro P, Talley NJ, Agréus L, et al. Functional dyspepsia impairs quality of life in the adult population. Aliment Pharmacol Ther 2011; 33: 1215-24.
 Kaji M, Fujiwara Y, Shiba M, et al. Prevalence of overlaps between GERD, FD and IBS and impact on health-related quality of life. J Gastroenterol Hepatol 2010; 25: 1151-6.
 Youssef NN, Murphy TG, Langseder AL, Rosh JR. Quality of life for children with functional abdominal pain: a comparison study of patients' and parents' perceptions. Pediatrics 2006; 117: 54-9.
 Van Tilburg MA, Hyman PE, Walker L, et al. Prevalence of functional gastrointestinal disorders in infants and toddlers. J Pediatr 2015; 166: 684-9.
 Manificat S, Dazord A, Langue J, et al. Evaluation of the quality of life of infants and very young children: validation of a questionnaire. Multicenter European study. Arch Pediatr 2000; 7: 605-14. French.
 André E, Hodgkinson I, Bérard C, des Portes V. Quality of life of very disabled children: a questionnaire about the role of health status and tube feeding. Arch Pediatr 2007; 14: 1076-83. French.
 Holenweg-Gross C, Newman CJ, Faouzi M, Poirot-Hodgkinson I, Bérard C, Roulet-Perez E. Under nutrition in children with profound intellectual and multiple disabilities (PIMD): its prevalence and influence on quality of life. Child Care Health Dev 2014; 40: 525-32.
 Méndez Rubio I, Lázaro de Mercado P, Carbonell Estrany X, Figueras Aloy J, Grupo IRIS. Quality of life of preterm infants and admissions due to respiratory infections. An Pediatr (Barc) 2010; 73: 121-31. Spanish.
 Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. North American Society for Pediatric Gastroenterology Hepatology and Nutrition, European Society for Pediatric Gastroenterology Hepatology and Nutrition. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009; 49: 498-547.
 Bagucka B, De Schepper J, Peelman M, Van de Maele K, Vandenplas Y. Acid gastro-esophageal reflux in the 10 degrees-reversed-Trendelenburg-position in supine sleeping infants. Acta Paediatr Taiwan 1999; 40: 298-301.
 Horvath A, Dziechciarz P, Szajewska H. The effect of thickened-feed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials. Pediatrics 2008; 122: e1268-77.
 Vandenplas Y, Belli D, Benhamou P, et al. A critical appraisal of current management practices for infant regurgitation recommendations of a working party. Eur J Pediatr 1997; 156: 343-57.
 Vandenplas Y, Leluyer B, Cazaubiel M, Housez B, Bocquet A. Double-blind comparative trial with two antiregurgitation formulae. J Pediatr Gastroenterol Nutr 2013; 57: 389-93.
 Tolia V, Lin C-H, Kuhns LR. Gastric emptying using three different formulas in infants with gastroesophageal reflux. J Pediatr Gastroenterol Nutr 1992; 15: 297-301.
 Billeaud C, Guillet J, Sandler B. Gastric emptying in infants with or without gastro-oesophageal reflux according to the type of milk. Eur J Clin Nutr 1990; 44: 577-83.
 Vandenplas Y, Cruchet S, Faure C, et al. When should we use partially hydrolysed formulae for frequent gastrointestinal symptoms and allergy prevention? Acta Paediatr 2014; 103: 689-95.
 Higginbotham TW. Effectiveness and safety of proton pump inhibitors in infantile gastroesophageal reflux disease. Ann Pharmacother 2010; 44: 572-6.
 Van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA. Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics 2011; 127: 925-35.
 ANSES. Saisine n° 2001-SA-0257. Rapport du comité d'experts spécialisé ""eaux"" concernant les critères de qualité des eaux minérales naturelles et des eaux de source embouteillées permettant une consommation sans risque sanitaire pour les nourrissons et les enfants en bas âge. [Report of a committee of experts specialized in ""waters"" concerning the quality criteria for bottled natural mineral waters and spring waters permitting their consumption with no risk to health by infants and young children]. 9 September 2003. www.anses.fr/fr/system/files/EAUX2001sa0257Ra.pdf. Accessed 15 March 2017.
 Scholtens PA, Goossens DA, Staiano A. Stool characteristics of infants receiving short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides: a review. World J Gastroenterol 2014; 20: 13446-52.
 Coccorullo P, Strisciuglio C, Martinelli M, Miele E, Greco L, Staiano A. Lactobacillus reuteri (DSM 17938) in infants with functional chronic constipation: a double-blind, randomized, placebo-controlled study. J Pediatr 2010; 157: 598-602.
 Tabbers MM, DiLorenzo C, Berger MY, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58: 258-74.
 Wessel MA, Cobb JC, Jackson EB, Harris GS, Detwiller AC. Paroxysmal fussing in infancy sometimes called “colic”. Pediatrics 1954; 14: 421-35.
 Miller AR, Barr RG. Infantile colic. Is it a gut issue? Pediatr Clin North Amer 1991; 38: 1407-23.
 Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 2006; 130: 1519-26.
 Rhoads JM, Fatheree NY, Norori J, et al. Altered fecal microflora and increased fecal calprotectin in infants with colic. J Pediatr 2009; 155: 823-8.
 Chau K, Lau E, Greenberg S, et al. Probiotics for infantile colic: a randomized, double-blind, placebo-controlled trial investigating Lactobacillus reuteri DSM 17938. J Pediatr 2015; 166: 74-8.
 Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics 2010; 126: e526-33.
 Szajewska H, Gyrczuk E, Horvath A. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr 2013; 162: 257-62.
 Xu M, Wang J, Wang N, Sun F, Wang L, Liu X-H. The efficacy and safety of the probiotic bacterium Lactobacillus reuteri DSM 17938 for infantile colic: A meta-analysis of randomized controlled trials. PLoS One 2015; 10: e0141445.
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