The Association between adverse life events and abdominal pain-predominant functional gastrointestinal disorders.

Abstract

BACKGROUND: Abdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs) are a common public health problem in children. The precise aetiology of AP-FGIDs is far from clear. Psychological stress and all forms of child abuse are known predisposing factors to develop AP-FGIDs. The main objective of this study is to study the association between adverse life events (ALEs) and development of AP-FGIDs. METHODS: A cross sectional, school based study was conducted in Gampaha district of Sri Lanka. All children aged 13-18 years were recruited from four randomly selected semi-urban schools in the district after obtaining consent from parents, school administration and children themselves. A translated and validated, self-administered questionnaire consisting of four parts was used for data collection. Part I was the Rome III questionnaire for functional gastrointestinal disorders, self-report form for children above 10 years. Part II was a questionnaire on exposure to adverse life events. Part III was the Sinhala (the native language) version of the PedsQL, Pediatric Quality of Life Inventory 4.0 (Generic Core Scales). Part IV was the Child Somatization Inventory. The questionnaire was administered under examination setting to ensure confidentiality and privacy. Research assistant were present during filling the questionnaire for provide assistance and verifications. AP-FGIDs were defined using the Rome III criteria. RESULTS: A total of 1792 children were included in the analysis (males 975 [54.4%], mean age 14.4 years, SD 1.3 years years). Out of them, 305 (17.0%) had AP-FGIDs. ALEs that showed a significant association with AP-FGIDs include, parental substance abuse (25.1% vs. 16.0% in controls, p = 0.015) and domestic violence (28.5% vs. 16.1%, p = 0.02). Children with AP-FGIDs exposed to ALEs have a higher somatization index compared to children not exposed to ALEs (16.9 vs. 13.4, p = 0.003), and a lower overall health-related quality of life (HRQoL) score (81.8 vs. 85.1, p = 0.02). The scores they obtained for psycho-social (86.4 vs. 92.4, p < 0.0001) and emotional (72.5 vs. 77.7, p = 0.03) domains of the HRQoL were also lower than that of children with no such experiences. CONCLUSIONS: Exposure to ALEs predispose children to develop AP-FGIDs. Experience of childhood ALEs deleteriously affects the HRQoL and somatization of children with AP-FGIDs.