Paediatricians find the management of functional gastrointestinal disorders challenging and many feel pressured by parents into ordering unnecessary tests, a study shows.
Only 37% of paedaitricians are aware of the Rome III diagnostic criteria and 58% believe there are no widely-accepted diagnostic criteria for functional abdominal pain (FAP) and IBS, according to responses to a survey from 327 paediatricians in Australia and New Zealand.
Of those unfamiliar with the Rome criteria, 50% did not feel confident in making the diagnosis of FAP in a clinical vignette. Those who believed FAP was a diagnosis of exclusion were also more likely to request investigations such as coeliac serology, full blood count, stool and urine microscopy and culture, and abdominal ultrasound.
Almost all the paediatricians in the survey (93%) acknowledged that the requested investigations were unlikely to yield a diagnosis, but might help rule out alternatives before a diagnosis of FAP could be made..
Similarly for a clinical vignette of IBS, only 34% of paediatricians felt confident making a diagnosis if they were unaware of the Rome III criteria.
Most (70.5%) believed that families would be unlikely to accept an FAP diagnosis without investigations requested, and about a third believed that investigations allowed them to ‘buy time’ for acceptance of the diagnosis.
“Negative investigations such as endoscopy have not been shown to result in improved outcomes in children with FGID, calling into question the assumption that multiple investigations are necessary to allow acceptance of the diagnosis,” the study authors wrote in the Journal of Paediatrics and Child Health.
“Investigating patients with low rates of organic pathology also leads to frequent findings of uncertain clinical significance, which may result in unwarranted anxiety or further unnecessary investigations.”
Two thirds (66%) of paediatricians believed there was a lack of clear evidence for effective therapy for FAP and 60% thought there was a lack of evidence for IBS therapy. The most common management options included referral to a dietician (46%), advice on dietary modifications (34%), referral to a paediatric gastroenterologist (31%), suggesting use of probiotics (35%) and approaches based on CBT (30%).
The study authors commented that functional GI disorders were common in paediatric practice, and therefore greater awareness of evidence-based diagnostic criteria and management options (such as low FODMAP diet) was needed.
This would also “reduce expenditure on unnecessary investigations and health-care utilisation in children with these conditions, leading to better outcomes for these children and their families,” they said.