Dr. Marc Bellaiche: Managing FGIDs in children
Dr. Marc Bellaiche is a Pediatric Gastroenterologist at the Teaching Hospital Robert Debré for Mothers and Children (Paris, France). His expertise on FGIDs in children help us underline the diagnostic complexity and raise avenues for treating the disorders under investigation (targeted pro and pre-biotics), especially in the first two years of life.
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What diagnostic difficulties do health professionals face?
As a reminder, Rome IV criteria include seven broad types of symptoms in newborns: regurgitation, cyclic vomiting, rumination, functional diarrhea, functional constipation, dyschezia, and colic (which is the most frequent FGID between 1 and 4 months of age). All health professionals are aware of the impact of FGIDs on the welfare of children and that of their parents, but general practitioners are less informed regarding Rome IV classification. Summarizing, clarifying, and spreading the criteria from the Rome Foundation would make it easier to implement current diagnostic tools, especially regarding treatment (be it medical or medico-psychological) of young children. After the age of two, childhood FGIDs look more like that of adults and are better addressed by practitioners.
Has the increasing awareness of the intestinal microbiota changed the situation?
I believe so. For instance, the definition of infant colic has been widened: etiological hypotheses are now based on the composition of the intestinal microbiota and not exclusively on standard clinical data. But treatment for FGDIs remains complicated in young children: there is more often a combination of disorders rather than a single one, as shown by a recent cohort study of 2,700 newborn children.30 Abundance of disorders explains the distress of some parents and increases difficulties to establish a diagnosis. For physicians, it is key to systematically refer to Rome IV criteria.
What are the priority therapeutic areas?
Beyond pain management, dysbiosis regulation with probiotics, is a promising therapeutic avenue. Swedish researchers were the first to work on the addition of specific strains of Lactobacillus (L. reuteri) and several studies and meta-analyses agree that these lactobacilli have proven their efficacy. According to a recent clinical study, the combination of two strains of Bifidobacterium breve could present a potential interest and decrease duration of crying in newborns with colic and fed with formula milk. Another novel concept: formulas that combine bifidogenic prebiotics (fructo-oligosaccharids and galacto-oligosaccharides) and that seem to reduce the duration of crying