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Objective The aim of this study was to implement clinical hypnosis (CH) as an adjunctive therapy for adolescents with Crohn's disease (CD) and to assess the impact of CH on quality of life (QoL), abdominal pain, psychosocial measures, and disease activity compared with standard care. Methods Forty adolescents with CD were randomized to a hypnosis intervention (HI) or waitlist control (WC) group. The intervention consisted of 1 in-person CH session, self-hypnosis education, and recordings for home practice. Data was collected at baseline, after the 8-week intervention, and at week 16. The primary outcome was patient- and parent-reported QoL; secondary outcomes were patient-reported abdominal pain, depression, anxiety, and sleep; school absences; and disease activity by Pediatric Crohn's Disease Activity Index. Paired and independent t-tests were used to compare differences from baseline to postintervention within and between groups. Results Forty patients (50% girls, mean 15.8 years) were enrolled from February to May 2019. Seventy-eight percent had inactive disease, and 55% had abdominal pain. Post intervention, significant improvements were noted in HI parent-reported QoL compared with WC in total score (P = 0.05), social functioning (P = 0.01), and school functioning (P = 0.04) but patient-reported QoL was unchanged. Abdominal pain severity significantly improved in HI compared with WC (P = 0.03). School absences decreased in significantly more intervention than control patients (P = 0.01). Patients who practiced self-hypnosis consistently showed a trend toward greater QoL improvement than those who did not (P = 0.1). Conclusions CH is an acceptable and feasible adjunct in CD and may improve psychosocial QoL and abdominal pain. Further research is warranted.

Inflammatory bowel disease (IBD) and abdominal pain of functional origin (AP) are common gastrointestinal disorders in children, which are associated with increased risk for depression and disability. Both symptom severity and coping with symptoms may contribute to these outcomes. We hypothesized that children with AP use different coping strategies compared with those with IBD for a number of reasons, including the fact that fewer treatment options are available to them. We also examined whether coping was related to depression and functional disability beyond the contributions of symptom severity.The study method included secondary data analysis of 2 existing data sets including 200 children with AP (73% girls, mean age 11.2 years) and 189 children with IBD (49% girls, mean age 13.8 years).Compared with patients with IBD, patients with AP reported more use of coping strategies of self-isolation, behavioral disengagement, and catastrophizing, as well as problem solving and seeking social support. Multivariate analyses revealed that, in both samples, ≥1 coping strategies were associated with depression and functional disability, independent of symptom severity, and controlling for age and sex. In IBD, symptoms were not a significant predictor of depression but coping was. Catastrophizing predicted depression and disability in both samples.Patients with AP report more frequent use of several of the coping strategies we measured compared with patients with IBD. Certain types of coping, particularly catastrophizing, were associated with greater depression and functional disability in both groups. Clinicians should be aware of maladaptive coping, which may be a risk factor for poor psychosocial and functional outcomes in both patient groups.

OBJECTIVES The aim of the study was to test the hypothesis that caregiver-reported difficulties in infant behavior and caregivers' distress will significantly improve on lactose-free (LF) milk-based or LF soy-based formulas compared with a milk-based, lactose-containing formula. METHODS In this double-blind randomized controlled trial, infants (mean age: 4.97 weeks) with caregiver-reported feeding problems on a milk-based lactose-containing formula were randomized to receive either LF milk-based (n = 96), LF soy-based (n = 97), or milk-based, lactose-containing (n = 103) formula. Study formula was infants' sole item of diet for 14 days. Infants' caregivers completed measures of infant behavior and caregivers' distress for the week preceding baseline and again for the week preceding the 14-day follow-up. RESULTS Infants who received LF milk or LF soy-based formulas did not significantly differ from those who received milk-based, lactose-containing formula on follow-up caregiver-reported measures of infant difficultness from the Infant Characteristics Questionnaire, F(2, 277) = 0.83, nor on measures of caregivers' distress, assessed with measures of caregivers' mental health and parenting efficacy, F(2, 285) = 0.73-1.07. Across the 3 formula groups, scores on outcome measures significantly improved from baseline to follow-up (P

Chronic or recurrent abdominal pain affects 8% to 25% of healthy school-age children (1–3) and is characterized by continuous or episodic abdominal pain. In most cases, the pain is functional—it cannot be adequately explained by structural or biochemical abnormalities (4). Pediatric functional abdominal pain (Ped-FAP) persists throughout development in a significant proportion of children (1,5–8) and has been linked to functional gastrointestinal disorders (FGIDs) such as irritable bowel syndrome in adulthood (7,9,10). Despite evidence that Ped-FAP may persist for years, the field has not yet identified factors that reliably predict which pediatric patients will have FGIDs in adolescence and adulthood. One promising factor is the expression of nongastrointestinal (non-GI) somatic symptoms. Non-GI somatic symptoms have been linked to higher levels of disability (11) and emotional distress (12) in patients with Ped-FAP. Moreover, a prospective cohort study identified a subgroup of patients with Ped-FAP characterized by consistently high levels of somatic symptoms at each assessment during a 5-year period following their initial medical evaluation (13). These findings suggest that non-GI somatic symptoms may be a useful marker of increased risk for poor long-term outcomes in patients with Ped-FAP. The present study is based on data from a cohort of patients with Ped-FAP and well controls studied prospectively for 4 to 15 years. The study aimed to determine whether non-GI somatic symptoms reported by patients with Ped-FAP at their initial medical evaluation were relevant to predicting which patients with Ped-FAP would subsequently meet criteria for FGIDs as adolescents and young adults. We assessed non-GI somatic symptoms in well controls and in patients with Ped-FAP at the time of their evaluation at a pediatric gastroenterology clinic. At follow-up, we assessed the Rome III symptom criteria for abdominal pain–predominant FGIDs. We hypothesized that patients with Ped-FAP with higher baseline levels of non-GI somatic symptoms would have a greater risk of FGIDs at follow-up.

The association between clinical symptoms and laboratory visceral sensitivity remains poorly defined and controversial. It has even been suggested that laboratory observations of visceral sensitivity are irrelevant to the clinical presentation of chronic visceral pain. To better understand this association, gastrointestinal and psychological features of pediatric patients' clinical presentation were examined in relation to a laboratory-based measure of visceral sensitivity.At the time of their medical evaluation, 101 patients with medically unexplained abdominal pain (ages 8-15 years) completed validated questionnaires assessing recent depressive symptoms, functional disability, pain efficacy beliefs, gastrointestinal (GI), and non-GI symptoms. These clinical features were examined in relation to visceral sensitivity assessed 2 months later in the laboratory. The measure of visceral sensitivity was based on increases in GI complaints in response to the water load symptom provocation task.More severe GI symptoms and functional disability in the weeks before patients' clinical evaluation were associated with significantly greater increases in GI symptoms in the laboratory in response to the water load symptom provocation task (all P0.04). Patients believing that they had the ability to alleviate their pain (high problem-focused pain efficacy) had significantly lower laboratory visceral sensitivity (P0.01). Clinical depressive symptoms and non-GI symptoms were not associated with laboratory visceral sensitivity.Clinical presentations of more severe GI symptoms and disability as well as low perceived pain efficacy are significant predictors of laboratory visceral sensitivity in children with functional abdominal pain. Depression does not account for the association between clinical presentation of GI symptoms and a laboratory measure of visceral sensitivity.

Standardized symptom-based criteria for pediatric functional gastrointestinal disorders (FGIDs) were introduced in 1999 with the publication of the Rome II criteria for FGIDs in children (1). Since their publication, the Rome II criteria have been used to assess the prevalence of FGIDs in community settings (2,3) and have served as selection criteria in laboratory studies of pediatric FGIDs (4). Several empirical studies have used the Rome II criteria to estimate the rates of various FGIDs among children with primary symptoms of abdominal pain (5–7). In addition, psychosocial characteristics of children who meet criteria for FGIDs defined by the Rome II criteria have been identified (8,9). Thus, the Rome II criteria for pediatric FGIDs have considerably advanced research in this area. Research using the Rome II criteria provided the foundation for the updated Rome III criteria (10,11). Changes from the Rome II to the Rome III criteria for pediatric FGIDs include a reduction in the required duration of symptoms, the addition of new FGID categories (eg, Functional Abdominal Pain Syndrome), changes to specific criteria for several FGIDs, and separate criteria defining FGIDs among infants versus children and adolescents. The rationale for these changes is described in detail alongside the published Rome III criteria (11). However, the implications of these changes for patient classification are so far unknown, to our knowledge. The purpose of this study was to compare the results of Rome II versus Rome III criteria in the classification of gastrointestinal symptoms described by children undergoing medical evaluation for chronic abdominal pain. Specifically, the study compared classification results using Rome II versus Rome III criteria for 5 FGIDs associated with abdominal pain: Irritable Bowel Syndrome (IBS), Abdominal Migraine, Functional Dyspepsia, Functional Abdominal Pain, and Functional Abdominal Pain Syndrome.

Objectives:Toidentifysymptomsand psychosocialfactorsthat predicted referral for esophagogastroduodenoscopy (EGD) and discriminated between patients with positive versus negative biopsy findings. Patients and Methods: Children age 8 to 16 years old and parents completed validated questionnaires assessing gastrointestinal symptoms and psychosocial characteristics. Biopsy results of esophagus, stomach, and duodenum were reviewed. Results: From the total sample of 461 patients (mean age 11.87 years, 62% girls), 127 (28%) underwent EGD with biopsy (mean age 12.1 years, 57% girls). Upper abdominal gastrointestinal symptoms predicted EGD referral, and psychosocial characteristics did not. From the total of 127 patients who underwent EGD, complete biopsy results were available for 124 patients and were negative at all sites for 34.7% of patients (n ¼43), equivocal for 20.2% (n ¼25), and positive at 1 or more sites for 45.2% (n ¼56). Boys were more likely than girls to have positive biopsy results (56.6% vs 36.6%, P

OBJECTIVES Abdominal pain is a frequent childhood complaint, comprising 2% to 4% of all reasons for pediatric office visits. Patients referred for evaluation of chronic abdominal pain (CAP) frequently present with comorbid nonspecific somatic symptoms that may complicate the medical evaluation and lead to unnecessary diagnostic tests and procedures. We tested the hypothesis that multiple nongastrointestinal (GI) symptoms in children presenting with CAP is a marker for clinically significant levels of depressive symptoms. METHODS Participants were 400 consecutive new patients (ages 8-17 years; 63% female) referred to the pediatric gastroenterology clinic for evaluation of abdominal pain of > 3 months' duration. Patients reported how frequently they experienced 7 non-GI symptoms. Patients were screened for depression with the Children's Depression Inventory. RESULTS On the basis of their Children's Depression Inventory scores, 58 (15%) patients had a positive screen for clinically significant depressive symptoms. Patients with a positive versus negative depression screen did not differ by sex, pain duration or laboratory evidence of organic disease. Patient report of > or = 3 non-GI symptoms maximized sensitivity (71%) and specificity (75%) in prediction of depression screening results. With each addition of a non-GI symptom, the odds of a positive screen for depression doubled. CONCLUSIONS For patients with and without organic disease findings associated with CAP, the presence of > or = 3 non-GI symptoms should signal the practitioner to evaluate for depression and may be used as an indicator of the likelihood of depression in the absence of specific inquiry into emotional symptoms.

Objective: The aim of this study was to develop a questionnaire assessing symptoms associated with pediatric functional gastrointestinal disorders (FGIDs) and to provide preliminary evidence for its validity and reliability in a tertiary care setting. Methods: The Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) was designed as both a parent report and child self-report measure based on the pediatric Rome II criteria for FGIDs. It was constructed in English, translated into French, and pilot tested in both languages. Initial validation was performed using the French version. Participants were 315 consecutive new patients aged 4 to 18, and their parents, presenting to a gastroenterology clinic and classified as having a functional problem. Content validity, item discrimination capacity, and reliability (parent-child concordance and temporal stability) were examined. Results: Analyses of parent and child reports indicated that all items were pertinent and variably distributed. Although children were reliable reporters, up to 42% of parents did not know about their children's gastrointestinal functioning. As many as 60% of parents of children 10 to 18 could not respond to questions about defecation and subjective symptoms. Concordance was generally fair to good, with Kappas and intraclass correlations of 0.40 to 0.70 on most items. Test-retest reliability was moderate to good for the majority of items. Conclusion: This study supports the content validity of the QPGS. Form A is a reliable measure for parents of children 4 to 9 years old, but the child self-report Form C appears to be more reliable for 10 to 18 year olds.

Children and adolescents with chronic abdominal pain pose unique challenges to their caregivers. Affected children and their families experience distress and anxiety that can interfere with their ability to perform regular daily activities. Although chronic abdominal pain in children is usually attributable to a functional disorder rather than to organic disease, numerous misconceptions, insufficient knowledge among health care professionals and inadequate application of knowledge may contribute to a lack of effective management. This clinical report accompanies a technical report on childhood chronic abdominal pain and provides guidance for the clinician in the evaluation and treatment of children with chronic abdominal pain. The conclusions are based on the evidence reviewed in the technical report and on consensus achieved among subcommittee members.

Children and adolescents with chronic abdominal pain pose unique challenges to their caregivers. Affected children and their families experience distress and anxiety that can interfere with their ability to perform regular daily activities. Although chronic abdominal pain in children is usually attributable to a functional disorder rather than to organic disease, numerous misconceptions, insufficient knowledge among health care professionals and inadequate application of knowledge may contribute to a lack of effective management. This clinical report accompanies a technical report on childhood chronic abdominal pain and provides guidance for the clinician in the evaluation and treatment of children with chronic abdominal pain. The conclusions are based on the evidence reviewed in the technical report and on consensus achieved among subcommittee members.