Irritable Bowel Syndrome (IBS) and Dyspepsia
At GI Care for Kids, many children are evaluated because of irritable bowel syndrome (IBS) and dyspepsia. These disorders include children who may present with abdominal pain, abnormal stool patterns, and nausea. Although some doctors use the term 'irritable bowel syndrome' for any child with abdominal pain, specific criteria for irritable bowel syndrome have been published. IBS is identified by the characteristics of the symptoms and infrequently, when needed, limited tests.
The "Rome criteria" can be helpful in establishing a diagnosis of IBS. These diagnostic criteria specify that to diagnose IBS a patient will have abdominal discomfort or pain with two of the following characteristics:
- Abdominal discomfort or pain relieved with defecation
- Onset associated with a change in stool frequency (going to the bathroom more or less often when the pain is present)
- Onset associated with a change in the form, or appearance, of stool (like diarrhea, constipation or mucus in the stool)
Irritable bowel syndrome is a common disorder affecting 10-15% of the entire U.S. population. IBS is sometimes referred to as spastic colon, nervous stomach, or irritable colon. It is considered a functional disorder; a functional disorder means that the problem in which the body's normal activities are not quite working right. For example, there may be extra sensitive intestines that respond with pain to normal digestion or normal movement of food along the intestinal tract. There may not be a blockage or an ulcer, but there may be bad cramps or bloating. Patients with IBS should not be having rectal bleeding. Endoscopy, x-ray, and blood tests are almost always normal with IBS. This is in contrast to inflammatory bowel disease or IBD in which these tests are almost always abnormal.
There may be disappointment by the family that all of these tests are normal, but it's really a good thing. It is better not to have a chronic disease like Crohn's disease or Ulcerative Colitis and our doctors may be able to help relieve some of the symptoms from IBS with changes in the diet or with medication. A number of research studies have shown over and over again that the best treatment for functional disorders like IBS may be therapy with a good psychologist. Psychological therapy can teach us how to relax our abdomen, distract our minds, and better cope with the annoying symptoms of IBS.
Similar to IBS, "dyspepsia" or "nonulcer dyspepsia" refers to a functional disorder that often causes pain and/or nausea in the upper abdomen. In many cases, this diagnosis is established after an upper endoscopy, which can help exclude other causes like ulcers, gastroesophageal reflux, allergic disorders, gastritis, and celiac disease. Sometimes dyspepsia causes annoying feelings of nausea, regurgitation, or pain. These symptoms may respond to diet changes, antacid therapy or again therapy with a psychologist.
Your pediatrician or family doctor should be the first to evaluate for IBS and dyspepsia. If your pediatrician needs help with diagnosis and treatment of suspected IBS or dyspepsia, you may be referred to our office. Functional disorders like IBS and dyspepsia are not caused by a blockage, infection, ulcer, or colitis. Functional disorders are not associated with fevers, rectal bleeding, or abnormal blood, urine or stool tests. Sometimes, these disorders may be associated with stressors in the family, like a new school, a conflict with friends or family, divorce (or stressed parents), or a recent illness or death in a child's family. It will be important for you to carefully consider all of the stressors in your child's life and discuss them with your pediatrician.
Please help us by bringing a copy of all previous lab tests and growth records with you to your specialist's appointment. Together, we will decide if further testing is needed and which treatments may be helpful. Before you see the gastroenterologist for these problems, it is a good idea to try a few simple dietary changes. You may wish to try a lactose free diet for a few days to see if milk (specifically the sugar in milk, lactose) is causing the problem. You can do this by eliminating cow's milk in the form of milk, cheese, cream, and ice cream for a few days. Sometimes it is as simple as reducing the child's intake of junk food, high fructose corn syrup (a sweetener found in many foods that can cause cramping and bloating), caffeine, sodas, or excessive spicy or fried foods.
As with any condition, please discuss your symptoms and concerns with your medical providers and especially notify them if there are any major changes in the symptoms.
Additional information can be found at these websites:
Links to the International Foundation for Functional Disorders:
A NY Times article on IBS/recurrent abdominal pain in children:
Amitriptyline, Nortriptyline, and Desipramine: What you need to know:
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