Children Dyspepsia Symptoms Questionnaire Discriminates Dyspeptic versus Non-Dyspeptic and Organic versus Functional Dyspepsia in Children and Adolescents with Chronic Abdominal Pain

Abstract

Background: Chronic Abdominal Pain (CAP) is common in children/adolescents, and Dyspepsia is a symptom complex. Their investigation represents a significant burden and a great deal regarding the initial work-up. Consequently, scoring based on clinical symptoms and patients' characteristics comparing organic and functional Dyspepsia would be valuable in assessing CAP. Objective: To develop and validate a dyspepsia symptoms questionnaire to identify patients with Dyspepsia and discriminate between functional and organic subtypes. Methods: A single-centre, observational, prospective cohort study in a convenience sample of consecutive cases of children/adolescents for CAP. Inclusion criteria: age of 5- 17 years; CAP according to Apley and von Baeyer & Walker criteria; uninvestigated Dyspepsia. Exclusion criteria: genetic, neurological and mental disorders, history of gastrointestinal surgery, active gastrointestinal bleeding, and inflammatory bowel disease. The Questionnaire was developed in four steps: Step 1. Generation of terms. Step 2. Construct the Preliminary Questionnaire. Step 3. A pilot survey confirmed that the Questionnaire was comprehensible. Step 4. The final Children Dyspepsia Symptoms Questionnaire (CDSQ) was based on a Cronbach's alpha coefficient of 0.74. Detailed Clinical protocols for CAP, Alarm signs, and CDSQ were applied at the inclusion visit. The pain was determined using a Pain Faces Scale, and Pain Intensity was obtained. Results: The study was performed on 338 patients, with no difference in baseline characteristics between Dyspepsia and Non-dyspepsia. The comparisons of CDSQ items between Dyspepsia and Non-dyspepsia reach higher values for Dyspepsia in epigastric pain, retrosternal pyrosis, concomitant epigastric pain and retrosternal pyrosis, belching, early satiety, nausea, and postprandial fullness. The comparisons of CDSQ items between Organic and Functional groups reach higher values for Organic Dyspepsia in retrosternal pyrosis, concomitant epigastric pain and retrosternal pyrosis, nausea and belching. Alarm signs were higher for Organic Dyspepsia, except for unintentional weight loss. There was a positive and statistically significant correlation between the CDSQ score and its eight items' components for the Dyspepsia and the Non-Dyspepsia group. No effect of age of patients, sex, and duration of symptoms was found for CDSQ. Conclusion: The CDSQ is a brief questionnaire, cost-effective and well suited for uninvestigated Dyspepsia. Patients reported significantly more severe symptoms in Dyspepsia than Non-Dyspepsia. Thus, the primary application of this discriminative instrument is case-finding in epidemiological surveys and clinical trials. Assumed that the CDSQ differentiating organic from functional Dyspepsia would help manage unnecessary endoscopy procedures, compared with a strategy that would entail prompt endoscopy for all patients.