Assuntos
Anormalidades Induzidas por Medicamentos/prevenção & controle , Serviços de Saúde do Adolescente , Anticonvulsivantes/efeitos adversos , Anticoncepção/métodos , Epilepsia/tratamento farmacológico , Cuidado Pré-Concepcional/métodos , Serviços de Saúde Reprodutiva , Adolescente , Anticonvulsivantes/uso terapêutico , Aconselhamento Diretivo/métodos , Feminino , Humanos , Adulto JovemRESUMO
OBJECTIVE: To examine gastric function, as well as the presence of somatic complaints, anxiety symptoms, and functional gastrointestinal disorders (FGIDs), in adolescents with anorexia nervosa (AN) before and after nutritional rehabilitation. STUDY DESIGN: Sixteen females with AN and 22 healthy controls with similar demographic profiles were included. Gastric emptying (measured as residual gastric volume) and gastric accommodation (measured as postprandial antral diameter) were assessed with abdominal ultrasonography. Participants completed the Children's Somatization Inventory (CSI), the Screen for Child Anxiety-Related Emotional Disorders, and the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version. All testing was repeated 3-4 months later. RESULTS: Body mass index in the AN group improved over time (P = .012). Fasting gastric parameters were similar in the 2 groups. Maximum postprandial antral diameter was significantly greater in controls compared with the AN group (P = .008). Only adolescents with AN demonstrated a significant increase in maximum postprandial diameter at repeat testing (P = .009). There was no difference in residual gastric volume between the 2 groups. Initial CSI scores were higher in adolescents with AN (P < .0001), including higher scores for nausea and abdominal pain. CSI scores were significantly lower in adolescents with AN (P = .035). Initial scores on the Screen for Child Anxiety-Related Emotional Disorders were significantly higher in adolescents with AN (P = .0005), but did not change over time. Adolescents with AN met significantly more criteria for FGIDs (P = .003). CONCLUSION: Adolescents with AN have impaired gastric accommodation that improves after nutritional rehabilitation, have significantly more somatic complaints, and meet more criteria for anxiety disorders and FGIDs. After nutritional rehabilitation, somatization improves and FGIDs become less common, but symptoms of anxiety persist.
Assuntos
Anorexia Nervosa/dietoterapia , Ansiedade/etiologia , Esvaziamento Gástrico , Gastroenteropatias/etiologia , Transtornos Somatoformes/etiologia , Adolescente , Anorexia Nervosa/complicações , Anorexia Nervosa/fisiopatologia , Anorexia Nervosa/psicologia , Ansiedade/diagnóstico , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Gastroenteropatias/diagnóstico , Humanos , Modelos Lineares , Modelos Logísticos , Estudos Prospectivos , Testes Psicológicos , Autorrelato , Método Simples-Cego , Transtornos Somatoformes/diagnóstico , Estômago/diagnóstico por imagem , Estômago/fisiopatologia , Inquéritos e Questionários , Resultado do Tratamento , Ultrassonografia , Adulto JovemRESUMO
OBJECTIVE: To determine whether children with symptoms of internalizing psychiatric disorders have a greater prevalence of pain-predominant functional gastrointestinal disorders (FGIDs) and migraine-like headaches. STUDY DESIGN: Children and adolescents aged 6-18 years were recruited from a behavioral health center (n = 31) and a primary care center (n = 36). Subjects completed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-based symptom inventory questionnaires to screen for internalizing psychiatric disorders, the Questionnaire on Pediatric Gastrointestinal Symptoms, and a somatic distress assessment interview. RESULTS: Thirty-three subjects (19 of 31 from the behavioral health center and 14 of 36 from the primary care center) screened positive for symptoms of anxiety or depressive disorders. The remainder screened negative and served as controls. Pain-predominant FGIDs were more common in the group with symptoms of anxiety or depression compared with controls (prevalence, 51.5% vs 8.8%; P = .0002). Migraine headaches occurred in 57.6% of the subjects with internalizing psychiatric disorders vs 23.5% of the control group (P = .006). The prevalence of functional constipation did not differ significantly between the 2 groups. The data remained essentially unchanged when analyzed within each center of recruitment. CONCLUSION: Youths with anxiety or depressive symptoms are more likely to suffer from pain-predominant FGIDs and migraine-like headaches, but not from functional constipation. The lack of an association between functional constipation and internalizing psychiatric symptoms suggests that FGIDs associated with pain may bear a specific relationship to emotional disorders.