Journal of Pediatric Gastroenterology and Nutrition, Sep 1, 2005
Introduction: Determining the definitive diagnosis for abdominal pain in children remains a chall... more Introduction: Determining the definitive diagnosis for abdominal pain in children remains a challenge for pediatricians. Rome Criteria for pediatric functional gastrointestinal disorders is a tool to be tested. Methods: Eighty-four consecutive patients with abdominal pain seen at a tertiary pediatric gastrointestinal outpatient clinic, from 1999 to 2000, were interviewed at presentation and followed up for 3 years. The interview methods included the assessment of symptoms defined by the Pediatric Rome Criteria. Results: Patients were classified as follows: Thirty-two patients did not fulfill the subtypes of Rome Criteria for abdominal pain: 25 were diagnosed with an organic disease and 7 referred total remission of the symptom after the first clinical assessment. Fifty-two patients (median age 9.3 years, min. 5 years, max. 13 y; 50% boys) fulfilled the Pediatric Rome Criteria for abdominal pain: 26 (50%) patients fulfilled the Criteria for functional abdominal pain, 24 patients (46.2%) for functional dyspepsia (18 for dismotility-like dyspepsia and 6 for ulcer-like dyspepsia) and, one patient (3.8%) for irritable bowel syndrome. Patients' evolution in the three-year follow-up period was the following: Nine patients left the abdominal pain Rome criteria and were classified in the functional constipation criteria. Seven patients, from those 32 who had not fulfilled the Rome Criteria, could be inserted in the irritable bowel syndrome during the follow up, based on the fact that the initial diagnosis of lactose intolerance, which had been confirmed by oral tolerance test, could not be maintained after excluding lactose from the patients' diet. Conclusion: Lactose intolerance, functional constipation and irritable bowel syndrome were conditions that might lead to a misinterpretation in the use of the Rome Criteria for pediatric abdominal pain. ROUTINE COMBINED ESOPHAGEAL IMPEDANCE AND pH MEASUREMENT IN CHILDREN.
Presentación de casos clínicos RESUMEN La enfermedad de Ménétrier es una gastroenteropatía perded... more Presentación de casos clínicos RESUMEN La enfermedad de Ménétrier es una gastroenteropatía perdedora de proteínas. Definida como una entidad rara y de causa desconocida, la mayoría de los casos reportados la han asociado a infecciones virales. En los pacientes pediátricos, presenta un comienzo agudo con un curso benigno y autolimitado. Se caracteriza por tener pliegues gástricos engrosados que, generalmente, involucran el cuerpo y el fundus gástrico, asociados a hipoalbuminemia, debido a la pérdida de proteína sérica a través de la mucosa. A continuación, se exponen dos casos clínicos de síndrome de Ménétrier infantil asociado a infección por citomegalovirus. Palabras clave: enfermedad de Ménétrier, enteropatía perdedora de proteínas, citomegalovirus, gastropatía hipertrófica.
La enfermedad inflamatoria intestinal pediátrica (EIIP) es una patología inflamatoria crónica de ... more La enfermedad inflamatoria intestinal pediátrica (EIIP) es una patología inflamatoria crónica de origen multifactorial. Su incidencia está en aumento a nivel mundial y nuestro país estaría experimentando este cambio. Se puede iniciar en edades muy precoces o más tardía en la adolescencia. Clásicamente se manifiesta con diarrea con o sin sangre, dolor abdominal, baja de peso y falla en el crecimiento, también puede tener síntomas extraintestinales los cuales pueden ser la única manifestación inicialmente. El diagnóstico se realiza en base a la historia clínica, examen físico, imágenes y endoscopia con biopsia, estas últimas permitirán confirmar el diagnóstico. Se han descrito dos estrategias de tratamiento top down y step up, en ambas el objetivo es la curación de la mucosa. La clave del manejo se centra en el control de síntomas y de la inflamación evitando las complicaciones de la enfermedad y los efectos secundarios de los tratamientos.
Introduction Gastroesophageal reflux disease (GERD) is the most common long-term complication in ... more Introduction Gastroesophageal reflux disease (GERD) is the most common long-term complication in esophageal atresia (EA) patients. Fundoplication in EA is controversial but may be an option in those with maximum GER therapy failure, acute life-threatening event, failure to thrive, persistent esophagitis, and recurrent anastomotic stenosis. Aim The aim of this study was to compare GERD characteristics according pH-MII parameters in EA patients with and without fundoplication. Materials and Methods Retrospective review of pH-MII tracings performed at a Gastroenterology Unit between 2011 and 2018 was carried out. Inclusion criteria were children under 18 years with history of EA, with and without fundoplication, with both pH-MII and endoscopy performed, histology of esophageal biopsies, and off antireflux medications at the moment of examination. GER therapy failure was the indication for surgery. The total number of reflux episodes (acid, nonacidic), bolus and acid clearance time (ACT...
Journal of Pediatric Gastroenterology & Nutrition, 2017
Objectives: The aim of the study was to determine whether esophageal baseline impedance (BI) valu... more Objectives: The aim of the study was to determine whether esophageal baseline impedance (BI) values in children could be predictive of esophagitis. Materials and Methods: Multichannel intraluminal impedance (MII) tracings of children 3 to 17 years of age suspected of having gastroesophageal reflux and esophagitis, who had also undergone upper endoscopy with multiple esophageal biopsies, were reviewed. Patients with eosinophilic esophagitis were excluded. Esophagitis was assessed by macroscopic and microscopic parameters. Esophageal histology was reported by 2 blinded independent pathologists unaware of the MII results. Mean BI was automatically calculated in the different MII channels (ch) by the specific software without removing any episode of increased/decreased BI. BI results were plotted against macroscopic and histological scores for each channel. Results: Tracings of 87 children, 53 boys, were evaluated. Mean age was 7.4 years: 45 had histologic esophagitis, 8 macroscopic. Hi...
Cow's milk allergy is a growing concern in the practice of pediatrics. The impression of an i... more Cow's milk allergy is a growing concern in the practice of pediatrics. The impression of an increasing incidence, similar to what has been reported in other latitudes, has determined the need for guidelines to help in the diagnosis and treatment of this disease. A group of pediatric specialists met to discuss the "state of the art" and propose local guidelines to deal with cow's milk allergy. The aim has been to contribute in the understanding of the pathophysiology, environmental factors, and clinical expressions of this problem, and help pediatricians in the overall management.
Revista de la Facultad de Ciencias Médicas (Córdoba, Argentina), 2011
To determine whether changes related to age in gastroesophageal reflux (GER) in infants and child... more To determine whether changes related to age in gastroesophageal reflux (GER) in infants and children are due to acid, non acid reflux or both, as determined by 24 hr pH probe (pH) and Multichannel Intraluminal Impedance (MII). Tracings of simultaneous pH-MII from 243 infants and children who presented with either digestive or respiratory symptoms attributable to GER were reviewed and analyzed using Mann-Whitney U test. The number of GER episodes recorded was similar among children with predominantly gastrointestinal and those with respiratory symptoms. A significantly higher total number of GER episodes was observed by pH probe and MII in children under 22.8 mos of age compared with those who were older (median 159 vs. 110.5, p = 0.002). There was no significant change with age of acid reflux (AR) parameters. The changes observed were due to the significant decrease of non AR for all parameters measured, regardless of the presenting symptom. The decrease in GER parameters that is ob...
Journal of Pediatric Gastroenterology & Nutrition, 2014
Multi-item measures of inflammatory bowel disease (IBD) activity based on clinical, laboratory, a... more Multi-item measures of inflammatory bowel disease (IBD) activity based on clinical, laboratory, and/or endoscopic variables do not take into consideration the impact on the patients' emotional aspects and adaptation to the disease. The aim of the present study was to evaluate concordance between parent and child ratings of health-related quality of life on the IMPACT-III questionnaire in children with IBD. The IMPACT-III questionnaire was used to measure quality of life in 27 patients (mean age 14.2 ± 3 years, 40% girls) and one of their parents (82% mothers). Most of the patients had inactive disease at the time of the study. Differences between parent-proxy ratings and child ratings on the IMPACT-III were compared via paired-samples t tests, intraclass correlation coefficients, and standardized difference scores. Parent-proxy and patient ratings were similar on total IMPACT-III and its related domains (bowel symptoms, systemic symptoms, social functioning, body image, treatment/interventions), except that significant differences on emotional functioning ratings were found (P = 0.003). Intraclass correlation coefficients showed medium-to-large effect sizes (range 0.52-0.88) and standardized difference scores showed varying degrees of bias depending on the domain measured (range -0.64 to 0.32). Parents served as a good proxy for quality-of-life ratings in this population of pediatric patients with IBD. The degree of concordance between parent and child scores, however, varied, as observed in the present study in which parents underreported their child's health-related quality of life on the IMPACT-III emotional functioning domain.
Journal of Pediatric Gastroenterology and Nutrition, 2006
Background: The relationship between the increased intestinal permeability observed in several ac... more Background: The relationship between the increased intestinal permeability observed in several acute and chronic diseases and the expression of tight junctions (TJ) proteins is not well established. Our aim was to investigate the expression at transcriptional level of 3 transmembrane TJ proteins, Occludin, Claudin-1, Claudin-2 and of 2 scaffold TJ proteins, zonula occludens-1 (ZO-1) and Myosin 9B in intestinal biopsies from patients affected by celiac disease (CD), Crohn's disease (CrD), peptic ulcer disease (PUD) and type 1 diabetes (IDDM). Methods: Samples of small intestinal mucosa were taken from the second/third portion of the duodenum from all the subjects studied. After total RNA extraction and cDNA synthesis, quantitative real time polymerase chain reaction assays with SYBR Green was performed. Data were normalized by using18S rRNA as standard. Results: Shown in the Table. A significant down-regulation of all 5 genes studied was observed in patients affected by celiac disease before gluten-free diet, while no significant change was observed in IDDM patients. Conclusions: The down-regulation of TJ transmembrane or/and intracellular components observed in all but IDDM might explain the increased intestinal permeability reported in these pathological conditions. The meaning of TJs disruption in the pathogenesis of each of this pathological condition warrants further investigation. The normal transcriptional level observed in celiacs on GFD suggests that the down-regulation of TJs in CD is reversible and secondary to gliadin exposure rather than to a genetic predisposition.
Cuadro 1. Definiciones SUMMARY Cow's milk allergy is a growing concern in the practice of pediatr... more Cuadro 1. Definiciones SUMMARY Cow's milk allergy is a growing concern in the practice of pediatrics. The impression of an increasing incidence, similar to what has been reported in other latitudes, has determined the need for guidelines to help in the diagnosis and treatment of this disease. A group of pediatric specialists met to discuss the "state of the art" and propose local guidelines to deal with cow's milk allergy. The aim has been to contribute in the understanding of the pathophysiology, environmental factors, and clinical expressions of this problem, and help pediatricians in the overall management.
... Lancet 1980; 22: 1097-1099. 6. Barbato M, Miglietta M, Viola F, Iualinell V, Frediani T et al... more ... Lancet 1980; 22: 1097-1099. 6. Barbato M, Miglietta M, Viola F, Iualinell V, Frediani T et al. Impact of modification of diagnosis techniques and criteria on the presentation of celiac disease in the last 16 years. Minerva Pediatr 1996; 48: 359-363. ...
free time, current stress level, time spend on physical activity, skipped breakfast(s) per week, ... more free time, current stress level, time spend on physical activity, skipped breakfast(s) per week, and the number of servings of fruits, vegetables, caffeinated beverages, and dariy products consumed on a typical day. RESULTS: Out of 26 cases who completed both questionnaires, N=16 showed an improvement of .1 point in GI symptom scores (on a scale = 0-40), with 10 showing no change (N=6) or worse symptoms (N=4). In the group that showed improvement, the following factors improved as well: Anxiety (M= 5.42 in spring; M= 3.11 in summer, p,0.003), parental protective responses (M=14.7 in spring, M=11.9 in summer, p,0.05), vegetable consumption (M=2.71 in spring, M=1.62 in summer, p ,0.048), intense physical activity (M=1.69 in spring, M=1.00 in summer, p ,0.024) and sleep quality (M= 31.3 in spring, M=36.1 in summer, p ,0.009). The degree of change in pain was correlated with the degree of change in fast food (r=.76), caffeine (r=.63), protectiveness (r=-.36), and free time (r=.40). In the group who did not show improvement in pain or pain deteriorated during the summer, a decrease in stress level (M=2.10 in spring, M=1.50 in summer, p,0.024) was observed. Degree of changes in pain were correlated with degree of changes in skipping of breakfast (r=.45), vegetable consumption (r=-.72), and caffeine (r=.46). CONCLUSIONS: This is the first study to identify factors that may explain seasonal variation in FAP. If abdominal pain improves, anxiety, sleep quality, vegetable consumption, parental response to child's pain and physical activity also show improvements during the summer. We do not know from this pilot work if these factors cause or result from the changes in abdominal pain. Longitudinal studies with larger samples are needed. This type of research is important in revealing future targets in the prevention and management of FAP.
Journal of Pediatric Gastroenterology and Nutrition, Sep 1, 2005
Introduction: Determining the definitive diagnosis for abdominal pain in children remains a chall... more Introduction: Determining the definitive diagnosis for abdominal pain in children remains a challenge for pediatricians. Rome Criteria for pediatric functional gastrointestinal disorders is a tool to be tested. Methods: Eighty-four consecutive patients with abdominal pain seen at a tertiary pediatric gastrointestinal outpatient clinic, from 1999 to 2000, were interviewed at presentation and followed up for 3 years. The interview methods included the assessment of symptoms defined by the Pediatric Rome Criteria. Results: Patients were classified as follows: Thirty-two patients did not fulfill the subtypes of Rome Criteria for abdominal pain: 25 were diagnosed with an organic disease and 7 referred total remission of the symptom after the first clinical assessment. Fifty-two patients (median age 9.3 years, min. 5 years, max. 13 y; 50% boys) fulfilled the Pediatric Rome Criteria for abdominal pain: 26 (50%) patients fulfilled the Criteria for functional abdominal pain, 24 patients (46.2%) for functional dyspepsia (18 for dismotility-like dyspepsia and 6 for ulcer-like dyspepsia) and, one patient (3.8%) for irritable bowel syndrome. Patients' evolution in the three-year follow-up period was the following: Nine patients left the abdominal pain Rome criteria and were classified in the functional constipation criteria. Seven patients, from those 32 who had not fulfilled the Rome Criteria, could be inserted in the irritable bowel syndrome during the follow up, based on the fact that the initial diagnosis of lactose intolerance, which had been confirmed by oral tolerance test, could not be maintained after excluding lactose from the patients' diet. Conclusion: Lactose intolerance, functional constipation and irritable bowel syndrome were conditions that might lead to a misinterpretation in the use of the Rome Criteria for pediatric abdominal pain. ROUTINE COMBINED ESOPHAGEAL IMPEDANCE AND pH MEASUREMENT IN CHILDREN.
Presentación de casos clínicos RESUMEN La enfermedad de Ménétrier es una gastroenteropatía perded... more Presentación de casos clínicos RESUMEN La enfermedad de Ménétrier es una gastroenteropatía perdedora de proteínas. Definida como una entidad rara y de causa desconocida, la mayoría de los casos reportados la han asociado a infecciones virales. En los pacientes pediátricos, presenta un comienzo agudo con un curso benigno y autolimitado. Se caracteriza por tener pliegues gástricos engrosados que, generalmente, involucran el cuerpo y el fundus gástrico, asociados a hipoalbuminemia, debido a la pérdida de proteína sérica a través de la mucosa. A continuación, se exponen dos casos clínicos de síndrome de Ménétrier infantil asociado a infección por citomegalovirus. Palabras clave: enfermedad de Ménétrier, enteropatía perdedora de proteínas, citomegalovirus, gastropatía hipertrófica.
La enfermedad inflamatoria intestinal pediátrica (EIIP) es una patología inflamatoria crónica de ... more La enfermedad inflamatoria intestinal pediátrica (EIIP) es una patología inflamatoria crónica de origen multifactorial. Su incidencia está en aumento a nivel mundial y nuestro país estaría experimentando este cambio. Se puede iniciar en edades muy precoces o más tardía en la adolescencia. Clásicamente se manifiesta con diarrea con o sin sangre, dolor abdominal, baja de peso y falla en el crecimiento, también puede tener síntomas extraintestinales los cuales pueden ser la única manifestación inicialmente. El diagnóstico se realiza en base a la historia clínica, examen físico, imágenes y endoscopia con biopsia, estas últimas permitirán confirmar el diagnóstico. Se han descrito dos estrategias de tratamiento top down y step up, en ambas el objetivo es la curación de la mucosa. La clave del manejo se centra en el control de síntomas y de la inflamación evitando las complicaciones de la enfermedad y los efectos secundarios de los tratamientos.
Introduction Gastroesophageal reflux disease (GERD) is the most common long-term complication in ... more Introduction Gastroesophageal reflux disease (GERD) is the most common long-term complication in esophageal atresia (EA) patients. Fundoplication in EA is controversial but may be an option in those with maximum GER therapy failure, acute life-threatening event, failure to thrive, persistent esophagitis, and recurrent anastomotic stenosis. Aim The aim of this study was to compare GERD characteristics according pH-MII parameters in EA patients with and without fundoplication. Materials and Methods Retrospective review of pH-MII tracings performed at a Gastroenterology Unit between 2011 and 2018 was carried out. Inclusion criteria were children under 18 years with history of EA, with and without fundoplication, with both pH-MII and endoscopy performed, histology of esophageal biopsies, and off antireflux medications at the moment of examination. GER therapy failure was the indication for surgery. The total number of reflux episodes (acid, nonacidic), bolus and acid clearance time (ACT...
Journal of Pediatric Gastroenterology & Nutrition, 2017
Objectives: The aim of the study was to determine whether esophageal baseline impedance (BI) valu... more Objectives: The aim of the study was to determine whether esophageal baseline impedance (BI) values in children could be predictive of esophagitis. Materials and Methods: Multichannel intraluminal impedance (MII) tracings of children 3 to 17 years of age suspected of having gastroesophageal reflux and esophagitis, who had also undergone upper endoscopy with multiple esophageal biopsies, were reviewed. Patients with eosinophilic esophagitis were excluded. Esophagitis was assessed by macroscopic and microscopic parameters. Esophageal histology was reported by 2 blinded independent pathologists unaware of the MII results. Mean BI was automatically calculated in the different MII channels (ch) by the specific software without removing any episode of increased/decreased BI. BI results were plotted against macroscopic and histological scores for each channel. Results: Tracings of 87 children, 53 boys, were evaluated. Mean age was 7.4 years: 45 had histologic esophagitis, 8 macroscopic. Hi...
Cow's milk allergy is a growing concern in the practice of pediatrics. The impression of an i... more Cow's milk allergy is a growing concern in the practice of pediatrics. The impression of an increasing incidence, similar to what has been reported in other latitudes, has determined the need for guidelines to help in the diagnosis and treatment of this disease. A group of pediatric specialists met to discuss the "state of the art" and propose local guidelines to deal with cow's milk allergy. The aim has been to contribute in the understanding of the pathophysiology, environmental factors, and clinical expressions of this problem, and help pediatricians in the overall management.
Revista de la Facultad de Ciencias Médicas (Córdoba, Argentina), 2011
To determine whether changes related to age in gastroesophageal reflux (GER) in infants and child... more To determine whether changes related to age in gastroesophageal reflux (GER) in infants and children are due to acid, non acid reflux or both, as determined by 24 hr pH probe (pH) and Multichannel Intraluminal Impedance (MII). Tracings of simultaneous pH-MII from 243 infants and children who presented with either digestive or respiratory symptoms attributable to GER were reviewed and analyzed using Mann-Whitney U test. The number of GER episodes recorded was similar among children with predominantly gastrointestinal and those with respiratory symptoms. A significantly higher total number of GER episodes was observed by pH probe and MII in children under 22.8 mos of age compared with those who were older (median 159 vs. 110.5, p = 0.002). There was no significant change with age of acid reflux (AR) parameters. The changes observed were due to the significant decrease of non AR for all parameters measured, regardless of the presenting symptom. The decrease in GER parameters that is ob...
Journal of Pediatric Gastroenterology & Nutrition, 2014
Multi-item measures of inflammatory bowel disease (IBD) activity based on clinical, laboratory, a... more Multi-item measures of inflammatory bowel disease (IBD) activity based on clinical, laboratory, and/or endoscopic variables do not take into consideration the impact on the patients' emotional aspects and adaptation to the disease. The aim of the present study was to evaluate concordance between parent and child ratings of health-related quality of life on the IMPACT-III questionnaire in children with IBD. The IMPACT-III questionnaire was used to measure quality of life in 27 patients (mean age 14.2 ± 3 years, 40% girls) and one of their parents (82% mothers). Most of the patients had inactive disease at the time of the study. Differences between parent-proxy ratings and child ratings on the IMPACT-III were compared via paired-samples t tests, intraclass correlation coefficients, and standardized difference scores. Parent-proxy and patient ratings were similar on total IMPACT-III and its related domains (bowel symptoms, systemic symptoms, social functioning, body image, treatment/interventions), except that significant differences on emotional functioning ratings were found (P = 0.003). Intraclass correlation coefficients showed medium-to-large effect sizes (range 0.52-0.88) and standardized difference scores showed varying degrees of bias depending on the domain measured (range -0.64 to 0.32). Parents served as a good proxy for quality-of-life ratings in this population of pediatric patients with IBD. The degree of concordance between parent and child scores, however, varied, as observed in the present study in which parents underreported their child's health-related quality of life on the IMPACT-III emotional functioning domain.
Journal of Pediatric Gastroenterology and Nutrition, 2006
Background: The relationship between the increased intestinal permeability observed in several ac... more Background: The relationship between the increased intestinal permeability observed in several acute and chronic diseases and the expression of tight junctions (TJ) proteins is not well established. Our aim was to investigate the expression at transcriptional level of 3 transmembrane TJ proteins, Occludin, Claudin-1, Claudin-2 and of 2 scaffold TJ proteins, zonula occludens-1 (ZO-1) and Myosin 9B in intestinal biopsies from patients affected by celiac disease (CD), Crohn's disease (CrD), peptic ulcer disease (PUD) and type 1 diabetes (IDDM). Methods: Samples of small intestinal mucosa were taken from the second/third portion of the duodenum from all the subjects studied. After total RNA extraction and cDNA synthesis, quantitative real time polymerase chain reaction assays with SYBR Green was performed. Data were normalized by using18S rRNA as standard. Results: Shown in the Table. A significant down-regulation of all 5 genes studied was observed in patients affected by celiac disease before gluten-free diet, while no significant change was observed in IDDM patients. Conclusions: The down-regulation of TJ transmembrane or/and intracellular components observed in all but IDDM might explain the increased intestinal permeability reported in these pathological conditions. The meaning of TJs disruption in the pathogenesis of each of this pathological condition warrants further investigation. The normal transcriptional level observed in celiacs on GFD suggests that the down-regulation of TJs in CD is reversible and secondary to gliadin exposure rather than to a genetic predisposition.
Cuadro 1. Definiciones SUMMARY Cow's milk allergy is a growing concern in the practice of pediatr... more Cuadro 1. Definiciones SUMMARY Cow's milk allergy is a growing concern in the practice of pediatrics. The impression of an increasing incidence, similar to what has been reported in other latitudes, has determined the need for guidelines to help in the diagnosis and treatment of this disease. A group of pediatric specialists met to discuss the "state of the art" and propose local guidelines to deal with cow's milk allergy. The aim has been to contribute in the understanding of the pathophysiology, environmental factors, and clinical expressions of this problem, and help pediatricians in the overall management.
... Lancet 1980; 22: 1097-1099. 6. Barbato M, Miglietta M, Viola F, Iualinell V, Frediani T et al... more ... Lancet 1980; 22: 1097-1099. 6. Barbato M, Miglietta M, Viola F, Iualinell V, Frediani T et al. Impact of modification of diagnosis techniques and criteria on the presentation of celiac disease in the last 16 years. Minerva Pediatr 1996; 48: 359-363. ...
free time, current stress level, time spend on physical activity, skipped breakfast(s) per week, ... more free time, current stress level, time spend on physical activity, skipped breakfast(s) per week, and the number of servings of fruits, vegetables, caffeinated beverages, and dariy products consumed on a typical day. RESULTS: Out of 26 cases who completed both questionnaires, N=16 showed an improvement of .1 point in GI symptom scores (on a scale = 0-40), with 10 showing no change (N=6) or worse symptoms (N=4). In the group that showed improvement, the following factors improved as well: Anxiety (M= 5.42 in spring; M= 3.11 in summer, p,0.003), parental protective responses (M=14.7 in spring, M=11.9 in summer, p,0.05), vegetable consumption (M=2.71 in spring, M=1.62 in summer, p ,0.048), intense physical activity (M=1.69 in spring, M=1.00 in summer, p ,0.024) and sleep quality (M= 31.3 in spring, M=36.1 in summer, p ,0.009). The degree of change in pain was correlated with the degree of change in fast food (r=.76), caffeine (r=.63), protectiveness (r=-.36), and free time (r=.40). In the group who did not show improvement in pain or pain deteriorated during the summer, a decrease in stress level (M=2.10 in spring, M=1.50 in summer, p,0.024) was observed. Degree of changes in pain were correlated with degree of changes in skipping of breakfast (r=.45), vegetable consumption (r=-.72), and caffeine (r=.46). CONCLUSIONS: This is the first study to identify factors that may explain seasonal variation in FAP. If abdominal pain improves, anxiety, sleep quality, vegetable consumption, parental response to child's pain and physical activity also show improvements during the summer. We do not know from this pilot work if these factors cause or result from the changes in abdominal pain. Longitudinal studies with larger samples are needed. This type of research is important in revealing future targets in the prevention and management of FAP.
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