Subtypes and some clinical aspects of irritable bowel Syndrome in children

Abstract

INTRODUCTION: Irritable bowel syndrome (IBS) is a common paediatric functional gastrointestinal disorder affecting 6-13% of children and adolescents. In adults IBS is divided into four main subtypes: diarrhoea predominant IBS, constipation predominant IBS, mixed IBS and untypable IBS. The subtypes have not been characterised in children. OBJECTIVES: The objective of this study was to assess IBS subtypes in 10-16-year old children, their symptomatology and gender difference. DESIGN, SETTING AND METHOD: One hundred and seven children with IBS and 1610 healthy controls aged 10-16years were recruited from 8 randomly selected schools, in 4 randomly selected provinces (out of 9 provinces) in Sri Lanka. Data was collected using a previously validated, self administered questionnaire based on Rome III criteria, it was distributed in examination settings to ensure privacy and confidentiaiity and was filled under the guidance of research assistants. IBS was defined using Rome 111 criteria. RESULTS: Constipation predominant IBS (IBS-C), diarrhoea predominant IBS (IBS-D) and mixed IBS (1BS-M) were present in 27-28%. Untypable IBS (1BS-U) was seen in 17.8%. IBS was more common in girls (59.8% vs. 40.2% in boys, p=0.001; p<0.01). Straining, urgency and feeling of incomplete evacuation were seen in 74-78% children with IBS. Intestinal-related symptoms such as bloating, flatulence, nausea, vomiting and burping, and extraintestinal symptoms such as headache, sleeping difficulty, limb pain and photophobia were significantly higher in affected children (p<0.05). Burping was more commonly seen in boys with IBS (p<0.05). CONCLUSIONS: IBS-C, IBS-D and IBS-M had almost equal distribution while IBS-U had a relatively lower prevalence. Girls were significantly more commonly affected than boys (p<0.01). Intestinal-related and extra-intestinal symptoms were seen in a significantly higher percentage of children with IBS (p<CLQ5).