Do Frequent Multiple Functional Gastrointestinal Disorders in Infants Decrease their Quality of Life?
Multiple functional gastrointestinal disorders (FGIDs) are frequent in early infancy and are a key reason for parents to consult a pediatrician. Very little research has been done to compare infants presenting with only one complaint versus infants presenting with several symptoms - and the impact on their quality of life. Around 25 percent of medical visits of infants under four months of age are motivated by gastrointestinal symptoms, mainly colic and regurgitation.
Epidemiological data on FGIDs in infants is scarce, with little information collected at the pediatric primary healthcare level. FGIDs are described as separate entities, but there is evidence that these disorders occur in different combinations. Alterations in gut microbiota have been linked with several gastrointestinal findings, such as delayed gut maturation, infantile colic or excess gas and bloating, providing an indication that these symptoms are interconnected. A recent study in France, coordinated by the Robert Debré Hospital in Paris, set out to make a direct comparison of patient demographics and clinical factors between infants with single and multiple FGIDs.
The study involved 273 paediatricians across France in multiple primary pediatric outpatient practices and their work with around 2,800 infants in evaluation of FGID symptom incidence and influence. The pediatricians were asked to describe the incidence and impact of single or multiple FGIDs on infants during the first six months of life. Infants were healthy and born full-term and were aged newborn to six months. Infants included were presenting for the first time with one or several minor disgestive disorders. Of the infants included in the study, 21.8 percent presented with a single FGID and 78 percent had multiple FGIDs of which 63 percent had two symptoms and 15 percent had three or more. Regurgitation was the most common symptom in the group with a single FGID, while constipation had the lowest incidence. Gas/bloating with colic was the most common combination in the group with multiple FGIDs, and colic was the most frequently diagnosed related symptom, occurring in association with other gastrointestinal disorder in nearly 80 percent of patients.
At the same time as noting the symptoms and clinical solutions, such as a change in formula or medication, the pediatricians were asked to note demographic details and assess quality of life impact for the child and its family.
The comparison of infants with a single FGID and those presenting with several FGIDs revealed that multiple FGIDs were associated with similar demographic and clinical factors and the presence of these associated disorders had a negative impact on their quality of life.
Multiple FGIDs were found to be more likely associated with weight gain, drug prescriptions and impaired quality of life than single FGIDs. Several demographic characteristics occurred more frequently in infants with multiple FGIDs, such as shorter duration of breastfeeding, lower weight, increased incidence of prescribed medication and slower recovery. Pediatricians and parents should be made aware of these factors in infants presenting with multiple FGIDs. Strategies to improve quality of life need to be developed and implemented.
Multiple functional gastrointestinal disorders are frequent in formula-fed infants and decrease their quality of life. Bellaiche M, Oozeer R, Gerardi-Temporel G, Faure C, Vandenplas Y. Acta Paediatr. (2018)
