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Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R. Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders. World J Clin Pediatr 2025; 14:103323. [DOI: 10.5409/wjcp.v14.i2.103323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/14/2024] [Accepted: 01/02/2025] [Indexed: 03/18/2025] Open
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) in children present with chronic symptoms like abdominal pain, diarrhea, and constipation without identifiable structural abnormalities. These disorders are closely linked to gut-brain axis dysfunction, altered gut microbiota, and psychosocial stress, leading to psychiatric comorbidities such as anxiety, depression, and behavioral issues. Understanding this bidirectional relationship is crucial for developing effective, holistic management strategies that address physical and mental health.
AIM To examine the psychiatric impacts of FGIDs in children, focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood, such as attention-deficit/hyperactivity disorder, emphasizing the role of the gut-brain axis, emotional dysregulation, and psychosocial stress. Key mechanisms explored include neurotransmitter dysregulation, microbiota imbalance, central sensitization, heightening stress reactivity, emotional dysregulation, and symptom perception. The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.
METHODS A narrative review was conducted using 328 studies sourced from PubMed, Scopus, and Google Scholar, covering research published over the past 20 years. Inclusion criteria focused on studies examining FGID diagnosis, gut-brain mechanisms, psychiatric comorbidities, and psychosocial factors in pediatric populations. FGIDs commonly affecting children, including functional constipation, abdominal pain, irritable bowel syndrome, gastroesophageal reflux, and cyclic vomiting syndrome, were analyzed concerning their psychological impacts.
RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms, mediated by gut-brain axis dysfunction, dysregulated microbiota, and central sensitization. These physiological disruptions increase children’s vulnerability to anxiety and depression, while psychosocial factors - such as chronic stress, early-life trauma, maladaptive family dynamics, and ineffective coping strategies - intensify the cycle of gastrointestinal and emotional distress.
CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical, psychological, and dietary interventions. Parental education, early intervention, and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Paediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Nermin K Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Governmental Hospitals, Manama 26671, Bahrain
- Medical Microbiology Section, Department of Pathology, The Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel S Bediwy
- Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
- Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
| | - Reem Elbeltagi
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
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Gong S, Yu Z, Ding Y, Wang Y, Li X, Gu S. Characteristics of functional constipation and analysis of intestinal microbiota in children aged 0-4 in Zunyi region. BMC Pediatr 2025; 25:45. [PMID: 39825285 PMCID: PMC11748605 DOI: 10.1186/s12887-024-05383-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 12/30/2024] [Indexed: 01/20/2025] Open
Abstract
BACKGROUND Functional constipation (FC) significantly impacts children's health. This study investigates the prevalence and microbiota characteristics of FC in children aged 0-4 years in Zunyi area. METHODS From October to December 2023, 2039 children aged 0-4 years in Zunyi were selected using stratified sampling and cross-sectional survey methods. A questionnaire based on Rome IV diagnostic criteria was used. Twenty-nine children with FC were randomly selected as the functional constipation group (FCG), and 26 healthy children, matched for age, sex, and area, were selected as the control group (CG). RESULTS A total of 2051 questionnaires were collected, with 2039 valid responses. Among them, 151 children had FC, resulting in a prevalence rate of 7.4%. The prevalence rates in boys and girls were 6.6% and 8.5%, respectively, with no significant gender difference (P > 0.05). Alpha diversity analysis revealed higher richness and diversity of intestinal flora in the FCG compared to the CG. At the phylum level, Actinobacteria, Firmicutes, Proteobacteria, and Bacteroidetes were dominant in both groups. The FCG showed a higher relative abundance of Firmicutes, Actinobacteria, and Proteobacteria compared to the CG (P < 0.05). CONCLUSIONS The prevalence of FC in children aged 0-4 years in Zunyi is 7.4%. Disease characteristics vary with age and living environment but are unrelated to gender. The gut microbiota of children with FC shows significant alterations, with higher diversity and specific phyla abundance.
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Affiliation(s)
- Shungang Gong
- Department of Pediatric Surgery, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, No. 98, Feng Huang Road, Huichuan District, Zunyi, Guizhou, 563000, China
| | - Zhengbo Yu
- Department of Pediatric Surgery, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, No. 98, Feng Huang Road, Huichuan District, Zunyi, Guizhou, 563000, China
| | - Yuan Ding
- Department of Pediatric Surgery, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, No. 98, Feng Huang Road, Huichuan District, Zunyi, Guizhou, 563000, China
| | - Yue Wang
- Department of Pediatric Surgery, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, No. 98, Feng Huang Road, Huichuan District, Zunyi, Guizhou, 563000, China
| | - Xi Li
- Department of Pediatric Surgery, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, No. 98, Feng Huang Road, Huichuan District, Zunyi, Guizhou, 563000, China
| | - Shengli Gu
- Department of Pediatric Surgery, The Third Affiliated Hospital of Zunyi Medical University, The First People's Hospital of Zunyi, No. 98, Feng Huang Road, Huichuan District, Zunyi, Guizhou, 563000, China.
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Mogess WN, Mihretie TB, Habte ML, Feyisa TO, Areda BG, Ahmed ET, Diribsa GC, Zeleke M, Alemseged NM, Amentie E, Wodajo TB, Borushe TR. The magnitude of chronic constipation and associated factors among type 2 diabetic patients in Harar, Eastern Ethiopia. Clin Diabetes Endocrinol 2024; 10:33. [PMID: 39415289 PMCID: PMC11484241 DOI: 10.1186/s40842-024-00188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND Constipation, which affects 16% of adults worldwide, is a chronic health problem characterized by unsatisfactory frequency of bowel movements, causing pain, bloating or incomplete bowel movements. The study aims to assess the magnitude of chronic constipation and associated factors among T2DM patients attending the endocrinology outpatient clinic at Hiwot Fana Comprehensive Specialized University Hospital from January 1 to May 30, 2023. METHODS Hospital-based cross-sectional study design was carried out to assess the magnitude and associated factors of chronic constipation among T2DM patients at Hiwot Fana Comprehensive Specialized University Hospital. Using a single population formula 300 T2DM patients were enrolled in this study. The data was analyzed by using the Epi-Data 4.6 and SPSS version 25. Descriptive, bivariate, multivariate, and logistic regression were used. P < 0.05 was used to declare association. RESULTS 300 T2DM patients participated in this survey. Of these 137 (45.7%) were male and 163 (54.3%) were female and the mean age was 58.57 ± 11.09 SD years, the range from 35 to 85 years. The prevalence of constipation was 73 (24.3%) (95% CI: 0.196-0.296). Education status above high school (AOR: 0.151.95% CI: 0.032-0.718), less than 7 h of sleep per day (AOR: 12.39.95% CI: 2.712-56.69), frequent depression (AOR: 6, 84, 95% CI: 2.639-17.743), parents with constipation (AOR: 6.843.95% CI: 2.639-17.743), daily water intake < 1300 ml (AOR: 4.760.95% CI: 1.146-19.773), TAG levels below 150 mg/dl (AOR: 0.050, 95% CI: 0.015-0.166), HbAlc between 6 and 7% (AOR: 0.013.95% CI: 0.001-0.132) ,HbAlc between 7.1 and 8% (AOR: 0.006, 95% CI: 0.001-0.067), and LDL levels were significantly associated with chronic constipation in T2DM patients. CONCLUSIONS The prevalence of chronic constipation was considerable in T2DM patients. Education level above high school, less than 7 h of sleep per day, frequent depression, parents with constipation, daily water intake < 1300 ml, TAG and HbAlc play a significant role in the development of chronic constipation in T2DM patients. T2DM patients can reduce the extent of constipation by treating the above problem in a timely and timely manner.
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Affiliation(s)
- Wubshet Nebiyu Mogess
- Department of Medical Anatomy, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Tefera Belsty Mihretie
- Department of Medical Anatomy, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mezgebu Legesse Habte
- Department of Medical Biochemistry, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teka Obsa Feyisa
- Department of Medical Biochemistry, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bilisuma Girma Areda
- Department of Medical Biochemistry, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ebsa Tofik Ahmed
- Department of Medical Biochemistry, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getahun Chala Diribsa
- Department of Medical Physiology, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mastewal Zeleke
- Department of Medical Physiology, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Natan Muluberhan Alemseged
- Department of Emergency Medicine and Critical Care, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Eyobel Amentie
- Department of Surgery, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tegenu Balcha Wodajo
- Department of Nursing, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewekel Reshid Borushe
- Department of Medical Biochemistry, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Chowdhury K, Sinha S, Kumar S, Haque M, Ahmad R. Constipation: A Pristine Universal Pediatric Health Delinquent. Cureus 2024; 16:e52551. [PMID: 38249647 PMCID: PMC10797657 DOI: 10.7759/cureus.52551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 01/23/2024] Open
Abstract
Constipation suffered by children is a global public health problem. Functional constipation (FC) brings about deteriorating effects in the children's lives who suffer from it. The risk factors for the development of constipation include the consumption of a diet low in fiber and high in calories (such as the consumption of fast food), a sedentary lifestyle with a lack of exercise, a family history of constipation, and emotional and psychological stress endured by children in their families. It is one of the most common causes of stomachaches in children. FC may lead to fecal incontinence (FI), anal fissures, recurrent urinary tract infections (RUTI), and enuresis in children. Severe constipation may result in stool becoming rock-hard and inflexible in the rectum, which is clinically identified as fecal impaction. It is imperative to perform clinical evaluation and treatment, including pharmacological (the use of stimulant and osmotic laxatives) and non-pharmacological (education, changes in diet, intervention to promote positive behavior and address any emotional issues, toilet training, and physiotherapy for the pelvic floor) interventions. In the case of refractory patients, neuromodulation, the irrigation of the anal canal, and surgical management may be needed. It is essential to lead a healthy, stress-free lifestyle with plenty of exercise and a balanced diet rich in fiber (such as fruits and vegetables) so children can have regular bowel habits and thrive.
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Affiliation(s)
- Kona Chowdhury
- Department of Pediatrics, Gonoshasthaya Samaj Vittik Medical College, Dhaka, BGD
| | - Susmita Sinha
- Department of Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Karnavati Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, BGD
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Bokova E, Svetanoff WJ, Rosen JM, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1078. [PMID: 37371309 DOI: 10.3390/children10061078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. METHODS A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5-10 years. RESULTS The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test. CONCLUSION Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Wendy Jo Svetanoff
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - John M Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, DC 20001, USA
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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