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Gastroenterology

In newborns

Functional gastrointestinal disorders
Pediatrics Gastroenterology

Functional gastrointestinal disorders are liable to manifest themselves from the first moments of life. The predominating pathologies vary according to age, but are accompanied by extensive involvement of the intestinal microbiota.

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About this article

Created 15 October 2019
Updated 27 October 2021

The main FGID in infants is colic. This disorder, whose pathophysiology is poorly understood, could originate in the microbiota and is thought to warrant new therapeutic approaches, as the efficacy of standard treatments has proven variable from one individual to another.

A DISEASE WITH IMPRECISE BOUNDARIES

Baby colic has an estimated prevalence of 5% to 28% depending on the study, and is a benign syndrome characterized by recurring bouts of crying, often accompanied by physical symptoms: clenched fists, straightened legs, facial redness. Appearing classically at around two weeks old, it reaches peak severity between 5 to 8 weeks and resolves spontaneously at around the age of 4 months. Its pathogenesis is still unclear, and diagnosis is currently based on Rome IV criteria. Organic causes are thought to represent only a small proportion of causes involved (5%). Additional factors such as an allergy to cow’s milk protein, family tensions and anxiety, etc. are likely to play a part.

CURRENT TREATMENTS

The diversity of causes makes patient care complex and encourages the diversification of treatment options, rendering treatment non-specific. What are the main current approaches? Drugs (mucosal protective agents, antispasmodics…), diet (modified diets, especially formulas based on casein hydrolysate, whey or soy milk…), behavioral techniques (chiropractic, reduced stimulation of the child…) and some probiotics.

INNOVATIVE ETIOLOGICAL HYPOTHESES INVOLVING THE MICROBIOTA

An international team has proposed three etiological hypotheses which could lead to new therapeutic approaches: first of all, immaturity of the enterohepatic circulation and of the action of bile acids leading to malabsorption of fats and other nutrients, as well as possible side effects on the intestinal microbiota.8 Secondly, intestinal dysbiosis, triggering an increase in nutrient fermentation and reduced levels of dehydroxylated bile acids in the colon. Finally, immaturity of the enteric nervous system resulting in abnormal sensorimotor function in the intestines and colon. The future characterization of these three mechanisms, which display numerous potential interactions, could lead to a more specific diagnosis and personalized management based on targeted biomarkers.8

Image
FGIDS-In-newborns-infography1
Sources

7 Devanarayana NM, Rajindrajith S. Irritable bowel syndrome in children: Current knowledge, challenges and opportunities. World J Gastroenterol. 2018 Jun 7

8 Camilleri M, Park SY, Scarpato E, et al. Exploring hypotheses and rationale for causes of infantile colic. Neurogastroenterol Motil. 2017;29(2):10.1111/nmo.12943.

9 Rodiño-Janeiro BK, Vicario M, Alonso-Cotoner C, Pascua-García R, Santos J. A Review of Microbiota and Irritable Bowel Syndrome: Future in Therapies. Adv Ther. 2018;35(3):289-310.

10 Zhao Y, Yu YB. Intestinal microbiota and chronic constipation. Springerplus. 2016;5(1):1130. Published 2016 Jul 19. 

Parthasarathy G, Chen J, Chen X, et al. Relationship Between Microbiota of the Colonic Mucosa vs Feces and Symptoms, Colonic Transit, and Methane Production in Female Patients With Chronic Constipation. Gastroenterology. 2016;150(2):367-79.e1.

Cao H, Liu X, An Y, et al. Dysbiosis contributes to chronic constipation development via regulation of serotonin transporter in the intestine. Sci Rep. 2017;7(1):10322.

 

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Tags
Dysbiosis Gut health Functional gastrointestinal disorders Microbiome Flora
    Focus
    Functional gastrointestinal disorders from childhood to adulthood
    • Pathophysiology
      • Functional gastrointestinal disorders: a set of diseases defined in correlation with the intestinal microbiota
      • Focus on the gut-brain axis
    • FGIDS: from infants to adults
      • In newborns
      • In children and adolescents
      • In adults
    • What could be the role of microbiota modulation?
      • Modulation of the microbiota by FMT: controversial results
      • FODMAP-free diet: not for all patients
      • Probiotics: what are the benefits?
    • Expert opinion
      • Dr. Marc Bellaiche: Managing FGIDs in children
    Created 15 October 2019
    Updated 27 October 2021

    About this article

    To know more about this topic.

    Main topic

    Functional gastrointestinal disorders

    Medical practice

    Pediatrics Gastroenterology

    Content type

    Dossier detail
    Focus on the gut-brain axis
    In children and adolescents
    Focus

    Functional gastrointestinal disorders from childhood to adulthood

    Pathophysiology

    Functional gastrointestinal disorders: a set of diseases defined in correlation with the intestinal microbiota Focus on the gut-brain axis

    FGIDS: from infants to adults

    In newborns In children and adolescents In adults

    What could be the role of microbiota modulation?

    Modulation of the microbiota by FMT: controversial results FODMAP-free diet: not for all patients Probiotics: what are the benefits?

    Expert opinion

    Dr. Marc Bellaiche: Managing FGIDs in children

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