| Objective To investigate the epidemiology and clinical features of children with functional dyspepsia(FD)in Chongqing,in order to achieve the early diagnosis and appropriate treatment,and to avoid unnecessary diagnostic approaches.Methods The clinical data of 376 children with FD diagnosed in the gastroenterology clinic of Children's Hospital of Chongqing Medical University from September 2016 to August 2018 were analyzed.A literature review on diagnosis and treatment of childhood FD was also conducted.Results(1)The prevalence of FD in children and adolescents aged4-18 years in the gastroenterology clinic of Children's Hospital of Chongqing Medical University(a tertiary care center)was 26.2%,and significantly higher in girls(33.00%)than in boys(21.35%,P<0.001),but significantly lower in adolescents(aged 12-18 years,15.57%)than in children(aged 4-7 years,25.07%,P=0.009;aged 7-12 years,29.26%,P<0.001).(2)A total of 376 children with FD were enrolled,including 176boys and 200 girls.The median age at diagnosis was 7.1 years.The median duration of disease was 10.5 months.The most common symptom was epigastric pain found in 328 cases(87.23%),followed by eructation in 160cases(42.55%),nausea in 122 cases(32.45%),early satiety in 118 cases(31.38%),postprandial fullness in 79 cases(21.01%)and vomiting in 76cases(20.21%),rare symptoms including regurgitation in 38 cases(10.11%),abdominal distension in 22 cases(5.85%)and epigastric burning in 8 cases(2.13%).376 cases were accepted the blood routine test,fecal occult blood test and abdominal ultrasound.Mild anemia were seen in 27cases(7.18%);151 cases(40.16%)showed positive in fecal occult blood test;204 case(54.26%)showed enlarged mesenteric lymph nodes in abdominal ultrasound;Gastroscope indicated superficial gastritis in all 60cases(100.00%).137 cases(36.44%)coexist with functional constipation,11 cases(2.93%)with irritable bowel syndrome,and 5 cases(1.33%)with functional nausea or functional vomiting.Treatment includes disease education and medication.After the first visit,338 cases were followed-up effectively with 6 months,162 cases(47.93%)were cured,79 cases(23.37%)were alleviated,the overall effective rate was 71.30%.97 cases were ineffective,of which 64 cases had clinical type conversion.(3)376cases with FD include 123 cases(32.7%)with epigastric pain syndrome(EPS),55 cases(14.6%)with postprandial distress syndrome(PDS),and198 cases(52.7%)with overlapping type(Overlap).There were no significant differences in gender,age,duration of disease and treatment effectiveness.The symptoms among three clinical types were statistically different(?~2=242.655,P<0.001).Medium intensity correlation was seen between the clinical symptoms and the clinical types(Cramer'V=0.357,P<0.001).(4)Among 338 patients who were followed up,122 patients treated with omeprazole(PPI group),216 cases treated without omeprazole(Non-PPI group),the effective rate in PPI group and Non-PPI group was74.59%and 69.44%,without significant difference(?~2=1.009,P=0.315);but the cure rate in PPI group(56.56%)was significant higher than in Non-PPI group(43.06%,P=0.017).The effective rate in PPI-group was higher in all FD tpyes:EPS(82.69%VS 72.58%),PDS(100.00%VS73.33%),Overlap(66.67%VS 66.05%),but the difference was not statistically significant(P>0.2).The cure rate and the effective rate in PPI-group among EPS,PDS and Overlap were 48.08%VS 100.00%VS60.61%and 82.69%VS 100.00%VS 66.67%,without significant difference(P=0.091,P=0.086).Conclusion Children with FD are common clinically,especially in girls aged 4-12 years.Main clinical manifestations include epigastric pain,eructation,nausea,early satiety,postprandial fullness and vomiting.Accroding to the symptoms,FD can be devided into three types:EPS,PDS and Overlap,and the switch among subtypes is found.Diagnosis is based on medical history,but not excessive auxiliary examinations.Disease education and comprehensive treatment are effective,while acid suppression treatment is inefficient in our study. |
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