Can absence patterns at school identify kids with chronic GI problems?

Children who frequently miss school due to abdominal complaints are far more likely to suffer from disorders of the gut-brain axis, such as irritable bowel syndrome, than from conditions detectable through medical tests, new research from UVA Health Children’s suggests.

The study, led by pediatric gastroenterologist Stephen M. Borowitz, MD, and fourth-year medical student Seth M. Tersteeg, found that children who missed more than three days of school in the previous month were nearly five times more likely to have a functional gastrointestinal disorder than a diagnosable disease. Those who had been homebound for the entire month were nearly eight times more likely to suffer from such disorders.

“We suspect that one of the biggest reasons children with functional gastrointestinal disorders are more likely to miss lots of school is because of what is often a long delay in making a definitive diagnosis,” Borowitz said in a statement. “The longer the child goes without an explanation of why they are having symptoms and what can be done to lessen those symptoms, the more anxious, fearful, and frustrated the child and the family become. In general, the quicker we can identify what is going on and begin treatment, the better the outcome.”

Functional GI disorders, which include conditions such as IBS and functional abdominal pain, do not have a clear underlying cause that can be detected through lab tests. Despite their prevalence—accounting for up to 38% of pediatrician visits—there has been little research examining the connection between these conditions and school absenteeism.

To explore this link, researchers reviewed 674 visits to UVA Health Children’s Pediatric Gastroenterology Clinic between September 2016 and June 2017. Their findings, published in Frontiers in Pediatrics, revealed that 82% of children who missed more than three days of school in a month were ultimately diagnosed with a functional GI disorder. Among the 408 children with functional disorders, the most common diagnoses were functional constipation (36%), functional abdominal pain (35%), and IBS (31%).

The study suggests that asking about school absenteeism could help physicians more quickly identify children suffering from functional GI disorders, leading to earlier interventions and improved outcomes.