Dolor abdominal crónico/recurrente

Trastornos funcionales gastrointestinales (RomaIV,2016) (escolares y adolescentes) APROXIMACIÓN DIAGNÓSTICA Y TERAPÉUTICA | 29 2. Síndrome de intestino irritable: Debe incluir todo lo siguiente:  Dolor abdominal al menos 4 días al mes asociado con uno o mas de : 1. Relacionado con la defecación 2. Cambio en frecuencia de deposiciones 3. Cambio en forma o apariencia de deposiciones  En niños con estreñimiento el dolor no se resuelve al solucionarlo Subtipos :  Predominio de diarrea  Predominio de estreñimiento  Inespecífico  Eliminado “disconfort”  Definida diferencia entre estreñimiento funcional y SII con estreñimiento  Papel de la calprotectina fecal  Subtipos Tratamiento:  Probióticos  Aceite de menta  Dieta de eliminación (FODMAPS) Si se resuelve el dolor al solucionar el estreñimiento: estreñimiento funcional. Eiminado “disconfort” Rationale for changes in diagnostic criteria. The term discomfort was removed from Rome III criteria, as it is not clear whether the distinction between pain and discomfort is quantitative or qualitative. The difference between functional constipation and IBS with constipation has been clarified. As many as 75% of children with constipation report pain,38 and studies have shown IBS patients often receive a diagnosis of functional constipation.39 The committee recommends that patients with constipation and abdominal pain initially be treated for constipation only. If abdominal pain resolves with constipation treatment, the patient has functional constipation. If pain does not resolve with appropriate constipation treatment alone, the patient likely has IBS with constipation. IBS subtypes, analogous to those described in adults, are now included in Rome IV. While the evidence base for IBS subtypes in children is limited, the committee thought that establishing the concept of subtypes in children might be useful for research Purposes.