Impact of early life events (ELE) and family dynamics for developments of abdominal pain predominate functional gastrointestinal disorders (AP-FGIDs) in 5-12 age group

Abstract

INTRODUCTION The pathophysiology of AP-FGIDs in children are poorly understood. Animal and human studies have suggested that adverse ELE such as pain or stress can induce long-term changes in the neurons. Apart from the abuse other aspects in early life have not been well investigated. METHODS ELE were evaluated in 182 school children with AP-FGIDs (62.1% girls, mean age 8.5, SD 2.1) and 571 children without AP-FGIDs recruited as controls (51.1% girls, mean age 8.8 SD 1.9 ) using a translated and pretested parental questionnaire. AP- FGIDs were diagnosed by Rome III criteria. RESULTS Compared to controls AP-FGIDs patients were low in birth order (1.7 vs. 1.9 p=0.01). Birth order of the parents, maternal and paternal age of marriage and number of members in the house were not associated with AP-FGIDs (p >0.05, Independent sample T test.). Prenatal complications (14.8% vs. 7.4% p= 0.002) and post-natal complications and receiving PBU care (7.7% vs. 3.1% p=0.008) were significantly higher in AP-FGIDs. Gestational period, mode of delivery, duration of hospital stay, period of exclusive breast feeding and duration of breast feeding were not significantly different (p>0.05). Presence of a family member with abdominal pain lasting more than 2 months and the presence of a family member with chronic pain (other than abdominal pain) in the family is also significantly higher in AP-FGIDs families (p<0.0001, Chi-square test). CONCLUSION ELEs occurring during pre and post-natal periods, which is a vulnerable period for developing neurons may be an important contributory factor for the development of AP-FGIDs. Familial predisposition for development of AP-FGIDs highlight the possible genetic basis for pathogenesis of AP-FGIDs. Breast feeding does not protective against the development of AP-FGIDs.