Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus

Flavia Indrio 1, Axel Enninger 2, Wajeeh Aldekhail 3, Ghanem Al-Ghanem 4, Abdulrahman Al-Hussaini 5, Bakr Al-Hussaini 6, Fawaz Al-Refaee 7, Khoula Al-Said 8, Bassam Eid 9, Wafaa Faysal 10, Ruwaida Hijazeen 11, Hasan M A Isa 12, Dinesh Onkarappa 13, Mohammad Rawashdeh 14, Pejman Rohani 15, Maroun Sokhn 16

Affiliations

01 July 2021

-

doi: 10.5223/pghn.2021.24.4.325

Abstract

The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs. This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.

Keywords: Colic; Constipation; Gastrointestinal diseases; Infant; Laryngopharyngeal reflux; Middle East; Probiotics.

Conflict of interest statement

Conflict of Interest: Flavia Indrio serves as a Speaker for BioGaia, Nestlé Nutrition Institute and Danone. Axel Enninger serves as a speaker, member of advisory board Nestlé Nutrition Institute, Speaker, member of advisory board Milupa/Danone, Speaker: infectopharm, abbvie, Nutricia and Author: Thieme, infectopharm. None of the other authors have a conflict of interest.

Similar articles

The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals.

Beser OF, Cullu Cokugras F, Dogan G, Akgun O, Elevli M, Yilmazbas P, Ocal M, Bayrak NA, Sezer Yamanel RG, Bozaykut A, Celtik C, Polat E, Gerenli N, Bozlak S, Ayyildiz Civan H, Ozkul Saglam N, Hatipoglu SS, Özgürhan G, Sunnetci Silistre E, Solmaz B, Kutluk G, Genc HS, Onal H, Usta AM, Urganci N, Sahin A, Cam S, Yildirim S, Yildirim A, Vandenplas Y.Eur J Pediatr. 2021 Aug;180(8):2443-2452. doi: 10.1007/s00431-021-04059-2. Epub 2021 Apr 3.PMID: 33811535

A population-based study on prevalence and predisposing risk factors of infant functional gastrointestinal disorders in a single center in Southern Fujian.

Huang H, Wang C, Lin W, Zeng Y, Wu B.Front Pediatr. 2022 Sep 29;10:993032. doi: 10.3389/fped.2022.993032. eCollection 2022.PMID: 36245733 Free PMC article.

Prevalence and Risk Factors of Functional Gastrointestinal Disorders in Infants in Indonesia.

Lestari LA, Rizal AN, Damayanti W, Wibowo Y, Ming C, Vandenplas Y.Pediatr Gastroenterol Hepatol Nutr. 2023 Jan;26(1):58-69. doi: 10.5223/pghn.2023.26.1.58. Epub 2023 Jan 10.PMID: 36816434 Free PMC article.

A Narrative Review on the Update in the Prevalence of Infantile Colic, Regurgitation, and Constipation in Young Children: Implications of the ROME IV Criteria.

Muhardi L, Aw MM, Hasosah M, Ng RT, Chong SY, Hegar B, Toro-Monjaraz E, Darma A, Cetinkaya M, Chow CM, Kudla U, Vandenplas Y.Front Pediatr. 2022 Jan 5;9:778747. doi: 10.3389/fped.2021.778747. eCollection 2021.PMID: 35071132 Free PMC article. Review.

Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants.

Salvatore S, Abkari A, Cai W, Catto-Smith A, Cruchet S, Gottrand F, Hegar B, Lifschitz C, Ludwig T, Shah N, Staiano A, Szajewska H, Treepongkaruna S, Vandenplas Y.Acta Paediatr. 2018 Apr 30;107(9):1512-20. doi: 10.1111/apa.14378. Online ahead of print.PMID: 29710375 Free PMC article. Review.

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. Benninga MA, Nurko S, Faure C, Hyman PE, St James Roberts I, Schechter NL. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2016;150:1443–55.e2.
  2.  
    1. Thompson WG. The road to Rome. Gastroenterology. 2006;130:1552–1556. - PubMed
  3.  
    1. Iacono G, Merolla R, D'Amico D, Bonci E, Cavataio F, Di Prima L, et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis. 2005;37:432–438. - PubMed
  4.  
    1. Vandenplas Y, Abkari A, Bellaiche M, Benninga M, Chouraqui JP, Çokura F, et al. Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr. 2015;61:531–537. - PMC - PubMed
  5.  
    1. Zwiener R, Robin S, Keller C, Hyman PE, Nurko S, Saps M, et al. Prevalence of functional gastrointestinal disorders in infants and toddlers according to the Rome IV criteria. Gastroenterology. 2017;152:S649.
  6.  
    1. Robin SG, Keller C, Zwiener R, Hyman PE, Nurko S, Saps M, et al. Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV criteria. J Pediatr. 2018;195:134–139. - PubMed
  7.  
    1. van Tilburg MA, Hyman PE, Walker L, Rouster A, Palsson OS, Kim SM, et al. Prevalence of functional gastrointestinal disorders in infants and toddlers. J Pediatr. 2015;166:684–689. - PubMed
  8.  
    1. Bellaiche M, Oozeer R, Gerardi-Temporel G, Faure C, Vandenplas Y. Multiple functional gastrointestinal disorders are frequent in formula-fed infants and decrease their quality of life. Acta Paediatr. 2018;107:1276–1282. - PMC - PubMed
  9.  
    1. Indrio F, Miqdady M, Al Aql F, Haddad J, Karima B, Khatami K, et al. Knowledge, attitudes, and practices of pediatricians on infantile colic in the Middle East and North Africa region. BMC Pediatr. 2017;17:187. - PMC - PubMed
  10.  
    1. AlFaleh K, AlLuwaimi E, AlJefri S, AlOsaimi A, Behaisi M. Infant formula in Saudi Arabia: a cross sectional survey. Kuwait Med J. 2014;46:328–332.
  11.  
    1. Hegar B, Boediarso A, Firmansyah A, Vandenplas Y. Investigation of regurgitation and other symptoms of gastroesophageal reflux in Indonesian infants. World J Gastroenterol. 2004;10:1795–1797. - PMC - PubMed
  12.  
    1. Martin AJ, Pratt N, Kennedy JD, Ryan P, Ruffin RE, Miles H, et al. Natural history and familial relationships of infant spilling to 9 years of age. Pediatrics. 2002;109:1061–1067. - PubMed
  13.  
    1. Savino F, Castagno E, Bretto R, Brondello C, Palumeri E, Oggero R. A prospective 10-year study on children who had severe infantile colic. Acta Paediatr Suppl. 2005;94:129–132. - PubMed
  14.  
    1. Romanello S, Spiri D, Marcuzzi E, Zanin A, Boizeau P, Riviere S, et al. Association between childhood migraine and history of infantile colic. JAMA. 2013;309:1607–1612. - PubMed
  15.  
    1. Radesky JS, Zuckerman B, Silverstein M, Rivara FP, Barr M, Taylor JA, et al. Inconsolable infant crying and maternal postpartum depressive symptoms. Pediatrics. 2013;131:e1857–64. - PubMed
  16.  
    1. Botha E, Joronen K, Kaunonen M. The consequences of having an excessively crying infant in the family: an integrative literature review. Scand J Caring Sci. 2019;33:779–790. - PubMed
  17.  
    1. Akman I, Kuşçu K, Ozdemir N, Yurdakul Z, Solakoglu M, Orhan L, et al. Mothers' postpartum psychological adjustment and infantile colic. Arch Dis Child. 2006;91:417–419. - PMC - PubMed
  18.  
    1. Räihä H, Lehtonen L, Huhtala V, Saleva K, Korvenranta H. Excessively crying infant in the family: mother-infant, father-infant and mother-father interaction. Child Care Health Dev. 2002;28:419–429. - PubMed
  19.  
    1. Chogle A, Velasco-Benitez CA, Koppen IJ, Moreno JE, Ramírez Hernández CR, Saps M. A population-based study on the epidemiology of functional gastrointestinal disorders in young children. J Pediatr. 2016;179:139–43.e1. - PubMed
  20.  
    1. Salvatore S, Baldassarre ME, Di Mauro A, Laforgia N, Tafuri S, Bianchi FP, et al. Neonatal antibiotics and prematurity are associated with an increased risk of functional gastrointestinal disorders in the first year of life. J Pediatr. 2019;212:44–51. - PubMed
  21.  
    1. Walter AW, Hovenkamp A, Devanarayana NM, Solanga R, Rajindrajith S, Benninga MA. Functional constipation in infancy and early childhood: epidemiology, risk factors, and healthcare consultation. BMC Pediatr. 2019;19:285. - PMC - PubMed
  22.  
    1. Chitkara DK, Rawat DJ, Talley NJ. The epidemiology of childhood recurrent abdominal pain in Western countries: a systematic review. Am J Gastroenterol. 2005;100:1868–1875. - PubMed
  23.  
    1. Koppen IJ, Nurko S, Saps M, Di Lorenzo C, Benninga MA. The pediatric Rome IV criteria: what's new? Expert Rev Gastroenterol Hepatol. 2017;11:193–201. - PubMed
  24.  
    1. Bellù R, Condò M. Functional gastrointestinal disorders in newborns: nutritional perspectives. Pediatr Med Chir. 2018;40:10–13. - PubMed
  25.  
    1. Vandenplas Y, Hauser B, Salvatore S. Functional gastrointestinal disorders in infancy: impact on the health of the infant and family. Pediatr Gastroenterol Hepatol Nutr. 2019;22:207–216. - PMC - PubMed
  26.  
    1. Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66:516–554. - PMC - PubMed
  27.  
    1. Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58:258–274. - PubMed
  28.  
    1. CDC Evaluation Research Team. Gaining consensus among stakeholders through the nominal group technique [Internet] Atlanta (GA): CDC; 2018. [cited 2019 Mar 13]. Available from: https://www.cdc.gov/healthyyouth/evaluation/pdf/brief7.pdf.
  29.  
    1. Moore DM, Rizzolo D. Sandifer syndrome. JAAPA. 2018;31:18–22. - PubMed
  30.  
    1. Indrio F, Riezzo G, Raimondi F, Bisceglia M, Cavallo L, Francavilla R. The effects of probiotics on feeding tolerance, bowel habits, and gastrointestinal motility in preterm newborns. J Pediatr. 2008;152:801–806. - PubMed
  31.  
    1. Indrio F, Riezzo G, Raimondi F, Bisceglia M, Filannino A, Cavallo L, et al. Lactobacillus reuteri accelerates gastric emptying and improves regurgitation in infants. Eur J Clin Invest. 2011;41:417–422. - PubMed
  32.  
    1. Anabrees J, Indrio F, Paes B, AlFaleh K. Probiotics for infantile colic: a systematic review. BMC Pediatr. 2013;13:186. - PMC - PubMed
  33.  
    1. Urbańska M, Szajewska H. The efficacy of Lactobacillus reuteri DSM 17938 in infants and children: a review of the current evidence. Eur J Pediatr. 2014;173:1327–1337. - PMC - PubMed
  34.  
    1. Xu M, Wang J, Wang N, Sun F, Wang L, Liu XH. 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. - PMC - PubMed
  35.  
    1. Dryl R, Szajewska H. Probiotics for management of infantile colic: a systematic review of randomized controlled trials. Arch Med Sci. 2018;14:1137–1143. - PMC - PubMed
  36.  
    1. 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. - PubMed
  37.  
    1. Olgaç MAB, Sezer OB, Özçay F. Çocuk Sağlığı Hastalık Derg. 2013;56:1–7. [Comparison of probiotic and lactulose treatments in children with functional constipation and determination of the effects of constipation treatment on quality of life] Turkish.
  38.  
    1. Kubota M, Ito K, Tomimoto K, Kanazaki M, Tsukiyama K, Kubota A, et al. Lactobacillus reuteri DSM 17938 and magnesium oxide in children with functional chronic constipation: a double-blind and randomized clinical trial. Nutrients. 2020;12:225. - PMC - PubMed
  39.  
    1. Orenstein SR, Hassall E, Furmaga-Jablonska W, Atkinson S, Raanan M. Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatr. 2009;154:514–20.e4. - PubMed
  40.  
    1. Metcalf TJ, Irons TG, Sher LD, Young PC. Simethicone in the treatment of infant colic: a randomized, placebo-controlled, multicenter trial. Pediatrics. 1994;94:29–34. - PubMed
  41.  
    1. Orenstein SR. Prone positioning in infant gastroesophageal reflux: is elevation of the head worth the trouble? J Pediatr. 1990;117(2 Pt 1):184–187. - PubMed
  42.  
    1. Orenstein SR, Whitington PF, Orenstein DM. The infant seat as treatment for gastroesophageal reflux. N Engl J Med. 1983;309:760–763. - PubMed
  43.  
    1. 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. - PubMed
  44.  
    1. Tobin JM, McCloud P, Cameron DJ. Posture and gastro-oesophageal reflux: a case for left lateral positioning. Arch Dis Child. 1997;76:254–258. - PMC - PubMed
  45.  
    1. Loots C, Kritas S, van Wijk M, McCall L, Peeters L, Lewindon P, et al. Body positioning and medical therapy for infantile gastroesophageal reflux symptoms. J Pediatr Gastroenterol Nutr. 2014;59:237–243. - PubMed
  46.  
    1. Eichenwald EC COMMITTEE ON FETUS AND NEWBORN. Diagnosis and management of gastroesophageal reflux in preterm infants. Pediatrics. 2018;142:e20181061. - PubMed
  47.  
    1. Moon RY TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138:e20162940. - PubMed
  48.  
    1. Salvatore S, Savino F, Singendonk M, Tabbers M, Benninga MA, Staiano A, et al. Thickened infant formula: what to know. Nutrition. 2018;49:51–56. - PubMed
  49.  
    1. Bosscher D, Van Caillie-Bertrand M, Van Dyck K, Robberecht H, Van Cauwenbergh R, Deelstra H. Thickening infant formula with digestible and indigestible carbohydrate: availability of calcium, iron, and zinc in vitro. J Pediatr Gastroenterol Nutr. 2000;30:373–378. - PubMed
  50.  
    1. Pensabene L, Salvatore S, D'Auria E, Parisi F, Concolino D, Borrelli O, et al. Cow's milk protein allergy in infancy: a risk factor for functional gastrointestinal disorders in children? Nutrients. 2018;10:1716. - PMC - PubMed
  51.  
    1. Jakobsson I, Lindberg T. Cow's milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatrics. 1983;71:268–271. - PubMed
  52.  
    1. Sopo SM, Arena R, Scala G. Functional constipation and cow's-milk allergy. J Pediatr Gastroenterol Nutr. 2014;59:e34 - PubMed

Page Navigation