Abstract
Functional abdominal pain disorders (FAPDs) are common in pediatrics and according to the Rome IV criteria they can be divided into four different subcategories: (1) functional dyspepsia (FD), (2) irritable bowel syndrome (IBS), (3) abdominal migraine (AM), and (4) functional abdominal pain – not otherwise specified (FAP-NOS). These disorders are characterized by chronic abdominal pain (≥2 months), and in the case of IBS, alterations in stool pattern. FAPDs in children are associated with decreased quality of life and school attendance, but the pathophysiology underlying FAPDs is not completely understood and diagnosis is generally symptom-based. Due to the heterogeneity of therapeutic trials and the quality of evidence supporting these interventions, management of childhood FAPDs remains challenging. This thesis describes novel insights regarding diagnostic and management strategies, shared decision making (SDM) and clinical outcome measures for research, with the aim to enhance patient care, improve quality of care, and allow better evidence-based decision making.
In part I of this thesis, we focus on improving pediatric FAPD diagnosis. We evaluated the use of pictograms to improve symptom evaluation and the clinical value of two screening workups. In part II and III of this thesis, we focus on different management strategies. Current available treatment options for pediatric patients with FAPDs include education, reassurance and lifestyle changes, non-pharmacological options, such as psychosocial interventions, and pharmacological options. However, management remains mostly symptom-based because no gold standard of treatment exists. To give an up-to-date overview on the efficacy and safety of most used interventions, we described the results of three systematic reviews on psychosocial, dietary and pharmacological interventions in children with FAPDs. Part IV of this thesis describes the implementation and feasibility of a SDM-intervention in children and the development of a ‘core outcome set’ (COS), an agreed minimum set of outcomes that should be measured and reported in trials in a certain area.
In part I of this thesis, we focus on improving pediatric FAPD diagnosis. We evaluated the use of pictograms to improve symptom evaluation and the clinical value of two screening workups. In part II and III of this thesis, we focus on different management strategies. Current available treatment options for pediatric patients with FAPDs include education, reassurance and lifestyle changes, non-pharmacological options, such as psychosocial interventions, and pharmacological options. However, management remains mostly symptom-based because no gold standard of treatment exists. To give an up-to-date overview on the efficacy and safety of most used interventions, we described the results of three systematic reviews on psychosocial, dietary and pharmacological interventions in children with FAPDs. Part IV of this thesis describes the implementation and feasibility of a SDM-intervention in children and the development of a ‘core outcome set’ (COS), an agreed minimum set of outcomes that should be measured and reported in trials in a certain area.
| Original language | English |
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| Qualification | Doctor of Philosophy |
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| Award date | 14 Apr 2023 |
| Publication status | Published - 14 Apr 2023 |
