Children with disorders of gut-brain interaction in primary care versus hospital care: A comparison of characteristics.

Abstract

Objectives: To compare characteristics of children with functional abdominal pain (FAP) or irritable bowel syndrome (IBS) between primary and hospital care.

Methods: This study makes a cross-sectional comparison of baseline data from two randomised controlled trials (RCTs): one in Dutch primary care and one in Dutch hospital care, including secondary and tertiary care. This study included children aged 8-17 years old with FAP or IBS fulfilling the Rome III or IV criteria. Outcome measures were age, gender, Rome criteria diagnosis, duration of abdominal pain symptoms, pain intensity and frequency scores, school absenteeism, pain beliefs, somatisation score, anxiety and depression scores, and health-related quality of life scores.

Results: A total of 367 children were compared (110 in primary care, 257 in hospital care). Children seen in primary care were younger (9.8 years, 95% confidence interval [CI]: 9.4-10.7 vs. 13.6 years, 95% CI: 12.9-14.1), had a lower abdominal pain intensity score (12.0, 95% CI: 9.0-13.0 vs. 15.0, 95% CI: 15.0-16.0), frequency score (10.5, 95% CI: 9.0-13.5 vs. 16.0, 95% CI: 14.0-17.0) and somatisation score (15.0, 95% CI: 12.0-17.0 vs. 22.0, 95% CI: 20.0-25.0) compared to hospital care. A lower proportion of children had missed school because of their abdominal pain (57.3%, 95% CI: 48.2-66.4 vs. 75.9%, 95% CI: 70.4-80.9). Other characteristics were similar between groups.

Conclusions: Children in primary care may differ from those in hospital care in terms of age, pain, somatisation, and school absenteeism, suggesting potential treatment response differences. Therefore, research in primary care is needed to guide evidence-based treatment and appropriate referral decisions for general practitioners.

Clinical trial registration: Primary care study: ClinicalTrials.gov NCT05636358. Hospital care study: Dutch Trial Register NL2597.