국내 소아청소년에서 Rome III Criteria에 근거한 만성 복통 관련 기능 위장관 질환 연구

Chronic Abdominal Pain-related Childhood Functional Gastrointestinal Disorders Based on the Rome III Criteria in Korea

  • 한재준 (서울대학교 의과대학 소아과학교실) ;
  • 양혜란 (서울대학교 의과대학 소아과학교실) ;
  • 고재성 (서울대학교 의과대학 소아과학교실) ;
  • 서정기 (서울대학교 의과대학 소아과학교실)
  • Han, Jae-Joon (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Yang, Hye-Ran (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Ko, Jae-Sung (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Seo, Jeong-Kee (Department of Pediatrics, Seoul National University College of Medicine)
  • 투고 : 2009.07.31
  • 심사 : 2009.08.27
  • 발행 : 2009.09.30

초록

목 적: Rome III 기준을 적용하여 소아청소년 만성기능 복통 환아들을 진단하고 분류함으로써 각 아형 별특성에 대한 이해를 도모하여 임상적 적용에 도움을 주고자 하였다. 방 법: 2006년 7월부터 2007년 8월까지 만성 복통을 주소로 분당서울대학교병원 소아청소년과에 내원한 194명을 대상으로 소아청소년기 복통 설문지를 작성케 한 후 의료진이 문진과 진찰을 통해 설문답안을 수정하고 의학적 검사를 시행하여 기질적 질환을 배제한 후 전향적으로 시행하였다. 결 과: 전체 194명 중 복통 관련 기능 위장관 질환으로 확인된 환자는 167명(86.1%)이었으며, 평균 연령은 9.1${\pm}$3.2세, 복통의 유병기간은 2개월부터 85개월로 평균 17.6${\pm}$16.2개월이었고, 이 중 기능 소화불량이 49명 (29.3%)으로 가장 많았으며, 과민 대장증후군이 43명(25.7%), 복성 편두통이 13명(7.8%), 소아기 기능 복통이 45명(27.0%), 소아기 기능성 복통증후군이 21명(12.6%)이었다. 복통과 연관된 기능 위장관 질환의 진단 기준에 해당하지 않아 미분류된 환아는 17명(10.2%)이었다. 다른 아형들에 비해 소아기 기능 복통의 발병 연령이 상대적으로 낮고 진단 시까지의 유병기간이 짧았다(p<0.05). 결 론: Rome III 기준은 소아청소년 복통 관련 기능 위장관 질환의 평가에 좀더 포괄적이며 쉽게 적용할 수 있고 더 정확한 정보와 진단을 제공하여 임상적으로 유용할 것으로 생각된다.

Purpose: Chronic abdominal pain is a common complaint encountered in pediatric clinics. This study aimed to investigate chronic functional abdominal pain in Korean children and adolescents by applying the Rome III criteria. Methods: A prospective study on chronic abdominal pain in 194 patients was conducted between July 2006 and August 2007. The parents of the subjects were asked to respond to a questionnaire based on the Rome III criteria. These responses were evaluated by pediatricians, and subsequently, the patients were clinically evaluated. Results: On the basis of the results of the medical evaluation, 167 of the 194 patients (86.1%) were diagnosed with functional gastrointestinal disorders, i.e., no organic causes of chronic abdominal pain were detected during the medical evaluation. Of these 167 patients, 89.8% of the patients satisfied one of the Rome III criteria, while 10.2% of the patients did not satisfy any of the Rome III criteria for chronic abdominal pain-related functional gastrointestinal disorders (functional dyspepsia, 29.3%; irritable bowel syndrome, 25.7%; abdominal migraine, 7.8%; childhood functional abdominal pain, 27.0%; and childhood functional abdominal pain syndrome, 12.6%). Compared to other symptom subtypes, children with childhood functional abdominal pain experienced an earlier onset and a shorter duration of symptoms. Conclusion: The Rome III criteria are more comprehensive; the use of these criteria will provide more accurate information and better diagnoses for children and adolescents with chronic abdominal pain.

키워드

참고문헌

  1. Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr 1996;129:220-6. https://doi.org/10.1016/S0022-3476(96)70246-9
  2. Oster J. Recurrent abdominal pain, headache and limb pains in children and adolescents. Pediatrics 1972;50:429-36.
  3. Ramchandani PG, Fazel M, Stein A, Wiles N, Hotopf M. The impact of recurrent abdominal pain: predictors of outcome in a large population cohort. Acta Paediatr 2007;96:697-701. https://doi.org/10.1111/j.1651-2227.2007.00291.x
  4. Hotopf M, Carr S, Mayou R, Wadsworth M, Wessely S. Why do children have chronic abdominal pain, and what happens to them when they grow up- Population based cohort study. BMJ 1998;316:1196-200. https://doi.org/10.1136/bmj.316.7139.1196
  5. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1,000 school children. Arch Dis Child 1958;33:165-70. https://doi.org/10.1136/adc.33.168.165
  6. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology 2006;130:1377-90. https://doi.org/10.1053/j.gastro.2006.03.008
  7. Walker LS, Caplan-Dover A, Rasquin-Weber A. Manual for the Questionnaire on Pediatric Gastrointestinal Disorders. Nashville, TN: Department of Pediatrics, Vanderbilt University School of Medicine, 2000.
  8. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2006;130:1527-37. https://doi.org/10.1053/j.gastro.2005.08.063
  9. Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, et al. Childhood functional gastrointestinal disorders. Gut 1999;45 Suppl 2:60-8.
  10. Caplan A, Walker L, Rasquin A. Validation of the pediatric Rome II criteria for functional gastrointestinal disorders using the questionnaire on pediatric gastrointestinal symptoms. J Pediatr Gastroenterol Nutr 2005;41:305-16. https://doi.org/10.1097/01.mpg.0000172749.71726.13
  11. Walker LS, Lipani TA, Greene JW, Caines K, Stutts J, Polk DB, et al. Recurrent abdominal pain: symptom subtypes based on the Rome II Criteria for pediatric functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr 2004;38:187-91. https://doi.org/10.1097/00005176-200402000-00016
  12. Schurman JV, Friesen CA, Danda CE, Andre L, Welchert E, Lavenbarg T, et al. Diagnosing functional abdominal pain with the Rome II criteria: parent, child, and clinician agreement. J Pediatr Gastroenterol Nutr 2005;41:291-5. https://doi.org/10.1097/01.mpg.0000178438.64675.c4
  13. Lu CL, Lang HC, Chang FY, Chen CY, Luo JC, Wang SS, et al. Prevalence and health/social impacts of functional dyspepsia in Taiwan: a study based on the Rome criteria questionnaire survey assisted by endoscopic exclusion among a physical check-up population. Scand J Gastroenterol 2005;40:402-11. https://doi.org/10.1080/00365520510012190
  14. Dong L, Dingguo L, Xiaoxing X, Hanming L. An epidemiologic study of irritable bowel syndrome in adolescents and children in China: a school-based study. Pediatrics 2005;116:e393-6. https://doi.org/10.1542/peds.2004-2764
  15. Sperber AD, Shvartzman P, Friger M, Fich A. A comparative reappraisal of the Rome II and Rome III diagnostic criteria: are we getting closer to the 'true' prevalence of irritable bowel syndrome- Eur J Gastroenterol Hepatol 2007;19:441-7. https://doi.org/10.1097/MEG.0b013e32801140e2
  16. Ersryd A, Posserud I, Abrahamsson H, Simren M. Subtyping the irritable bowel syndrome by predominant bowel habit: Rome II versus Rome III. Aliment Pharmacol Ther 2007;26:953-61. https://doi.org/10.1111/j.1365-2036.2007.03422.x