Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 944-951
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.944
Association between functional abdominal pain disorders and asthma in adolescents: A cross-sectional study
Manori Vijaya Kumari, Niranga Manjuri Devanarayana, Lakmali Amarasiri, Shaman Rajindrajith
Manori Vijaya Kumari, Department of Physiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura 50000, North Central Province, Sri Lanka
Niranga Manjuri Devanarayana, Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama 11010, Western Province, Sri Lanka
Lakmali Amarasiri, Clinical Physiologist and Senior Lecturer in Physiology, Faculty of Medicine, University of Colombo, Sri Lanka
Shaman Rajindrajith, Department of Pediatrics, Faculty of Medicine, University of Kelaniya, Ragama 11010, Western Province, Sri Lanka
Author contributions: Kumari MV contributed to designing the study, collected, analyzed, and interpreted the data, and drafted the initial manuscript; Devanarayana NM, Amarasiri L, and Rajindrajith S conceptualized the study, contributed to designing the study, and critically analyzed the final manuscript for important intellectual content. All authors approved the final manuscript.
Institutional review board statement: The Ethics Review Committee of Faculty of Medicine and Allied Sciences of Rajarata University of Sri Lanka has granted the ethical approval for this study.
Informed consent statement: Parental/guardian written informed consent was obtained.
Conflict-of-interest statement: The authors declare no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Niranga Manjuri Devanarayana, MBBS, MD, PhD, Professor, Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama 11010, Western Province, Sri Lanka. niranga@kln.ac.lk
Telephone: +94-777-90093900 Fax: +94-11-2958337
Received: August 13, 2018
Peer-review started: August 13, 2018
First decision: October 5, 2018
Revised: November 10, 2018
Accepted: November 14, 2018
Article in press: November 15, 2018
Published online: December 6, 2018
Processing time: 117 Days and 5.1 Hours
ARTICLE HIGHLIGHTS
Research background

Both functional abdominal pain disorders (FAPDs) and asthma are highly prevalent diseases among children and have a significant individual and public health impact. Chronic recurrent nature of both diseases is known to impair the health related quality of life (HRQoL) of affected individuals and drain a large amount of public funds in treating exacerbations and long-term follow-up.

Research motivation

Studies among adults have shown a potential association between irritable bowel syndrome and bronchial asthma and suggested the possibility of common patho-physiology for both disorders. However, no studies have attempted to evaluate the association between these two highly prevalent diseases in children.

Research objectives

The main objective of our study is to explore the association between FAPDs and asthma in children and their impact on HRQoL.

Research methods

A cross-sectional survey was conducted among school children aged 13-15 years. Multi-stage sampling technique was used to select the study population. We used validated Rome III questionnaire and International Study on Asthma and Allergies in Childhood questionnaire to assess gastrointestinal and respiratory symptoms. Pediatric quality of life inventory (PedsQL Generic Core Scale) was used to assess HRQoL. Rome III criteria were used to diagnose FAPDs. Students reporting to have both physician diagnosed asthma and wheezing during the previous year were categorized as having asthma. HRQoL was computed using the standard protocol.

Research results

A total of 1101 questionnaires were included in the final analysis. We found asthma in 14.3% of children and at least one type of FAPD in 9.2% of children. The logistic regression analysis model showed an independent association between asthma and functional abdominal pain (FAP), functional dyspepsia (FD), and abdominal migraine (AM). Upper gastrointestinal symptoms such as abdominal pain, bloating, nausea, and loss of appetite were significantly associated with asthma. Quality of life scores in both children with asthma and those with FAPDs were lower when compared to normal children.

Research conclusions

We found a clear association between asthma and three FAPDs, namely, FAP, FD, and AM, suggesting the possibility of asthma and FAPDs sharing same pathophysiological mechanisms. Generalized smooth muscle dysfunction in both gastrointestinal and respiratory tracts could be triggered simultaneously through autonomic dysfunction, which could have been one potential pathophysiological mechanism to explain this association. Furthermore, it is also possible that common immunological phenomena such as mast cell dysfunction and altered TH2 response could drive the pathophysiology of both disorders.

Research perspectives

In this study we highlighted the potential association between two common pediatric disorders (asthma and FAPDs). Future studies should be directed to explore underlying pathophysiological basis for this association, especially focusing on smooth muscle dysfunction and immune dysregulation of both gastrointestinal and respiratory systems.