School absenteeism as a predictor of functional gastrointestinal disorders in children 2024 Tersteeg and Borowitz

[Andy]

Introduction: Chronic abdominal complaints are common in school-aged children. Most affected children do not have underlying organic diseases but suffer from functional gastrointestinal disorders. While many children with chronic abdominal complaints experience school problems, no prospective studies have examined if school absenteeism is more common among children suffering from functional as opposed to organic gastrointestinal disorders. The purpose of this study was to determine if there is an association between school absenteeism and functional gastrointestinal disorders in children presenting to a pediatric gastroenterology clinic with chronic gastrointestinal complaints.

Methods: Over a single year, families of school-aged children presenting to a pediatric gastroenterology clinic with gastrointestinal complaints were asked how many days of school their child had missed in the previous month due to their symptoms. At least six months after their visit, each child's final diagnosis was established and categorized as a functional disorder or an organic disease. Differences between children suffering from each diagnosis type were compared using unpaired t-tests.

Results: Children with functional gastrointestinal disorders were more likely to experience significant school absenteeism than children with gastrointestinal diseases. Missing more than three days of school in the month prior to their visit had a negative predictive value of 82% for a gastrointestinal disease and being homebound from school during the month prior to their visit had a negative predictive value of 88% for a gastrointestinal disease. As compared to children with functional disorders, those with organic diseases were more likely to have missed three or fewer days of school in the previous month (sensitivity = 93%) and to have attended any school in the previous month (sensitivity = 99%).

Discussion: Our data suggest children with functional gastrointestinal disorders are more likely to experience significance school absenteeism than children suffering from organic diseases. We suspect this may be due to higher perceived levels of pain and symptom catastrophizing caused by the duration and character of the diagnostic process, as well as biopsychosocial characteristics of these children.

Open access, https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2024.1503783/

 

[boolybooly]

I see and what is the empirical test for "functional gastrointestinal disorder"? There is none. It is a diagnosis arrived at by failing to diagnose by known methods. It is not a diagnosis, just an unprovable hypothesis.

Yet known methods are not infallible. It is likely there are conditions not understood by medical science. For example the discovery of obelisk viroids only last year demonstrated how much there remains to be discovered about the digestive system and how little we do in fact know about the real world.

Diagnosing functional gastrointestinal disorder assumes an omniscience we simply don't have.

This is pseudoscience posing as academia, being used to legitimise anti-sick prejudice and patient blaming, to serve powerful interests who can grant funding, not science.

 

[Peter T]

We suspect this may be due to higher perceived levels of pain and symptom catastrophizing caused by the duration and character of the diagnostic process, as well as biopsychosocial characteristics of these children.

What are ‘biopsychosocial characteristics’? Presumably a value judgement on the child and/or their parents/carers.

Also is there any evidence that ‘duration and character of the diagnostic process’ causes misperception of pain and symptom catastrophizing? Never mind this can be helped by not undertaking any formal assessment and putting a functional label on the child as quickly as possible. (Note, this was written with a sarcastic intent in my composition.)

 

[Yann04]

> I have an undiagnosed disease.
> I have to miss loads of school because I need to go from doctor to doctor to get loads of tests because they haven’t found what is wrong yet.

This study: “you miss more school because you are catastrophising” *facepam*

I would say its because you are having more appointments and aren’t getting the support you need. If I have a “respected” diagnosis, necessary accomodations are far more likely to be made.

 

[Chestnut tree]

So if tests did not show a cause for complaints then you have a functional disorder, according to the authors of this study. That does not seem the right way to diagnose a disease.

The ethics statement is also worrying. No written informed consent necessary? Why is this waived?

Reminds me of the research involving children that @dave30th wrote about. https://virology.ws/2018/01/02/trial-by-error-the-school-absence-study-revisited/

Edit; rephrased the first 2 sentences

 

[Yann04]

I submitted a short comment because this felt quite close to me.

My long COVID and ME did initially start out as a gastrointestinal presentation and I initially got the diagnosed of IBS and GERD (which are included as FGIDs in this study). I did indeed miss loads of school but this was because
1) I was a ping pong ball getting thrown from doctor to doctor with appointments in the middle of the day every week.
2) FGIDs were my “diagnosis” but they were the only diagnosed part of a much more disabling illness (now I know that is ME).

 

[dave30th]

What are ‘biopsychosocial characteristics’? Presumably a value judgement on the child and/or their parents/carers.

They don't mention this again. hard to know what that means. They do talk about socioeconomic position and demographics, but I'm not sure if that's what is meant by "biopsychosocial characteristics." Are those supposed to be personality traits, social circumstances, or what?

 

[Sean]

Biopsychosocial means whatever the person using the term wants it to mean.

 

[Amw66]

How much research has been done on paediatric microbiome to be able to label things ? Genuine query as I don't have any knowledge in this area .

My eldest daughter hit 14 and had to have a " pee card" at school to enable her to get out of classes to go to the loo. The fact that she was academically bright probably ensured this was not an issue. She didn't have utis and it was put down to " hormones" . Whilst not as bad, it's still an issue.

How are painful periods classified in something like this? Something which can be acutely embarrassing for many adolescents, and could easily be described as something else .

Also , how do other misunderstood conditions factor into this .
Anxiety alters gut
Infections alter gut
Are gut issues a thing with neurodivergent kids ? Yasko/ James etc would think so

It strikes me that there may need to be a bit more delving to be done before any conclusions can be drawn

Seems a cheap shot

 

[Yann04]

Seems a cheap shot

Agreed. This is what I sent.

Dear Editors,

FGID is not a diagnosis supported by direct empirical evidence; rather, it is a label applied when known diagnostic methods fail to yield a result. This does not constitute a diagnosis in the scientific sense but a useful clinical grouping of cases. To treat FGIDs as a homogenous group in the causative sense is to presume medicine a complete project, that anything medicine cannot yet explain must not be a biomedical disease. This assumption is provably false, as we still have pathways and genes that aren’t understood.

We often see diagnoses like FGIDs used to rationalise patient-blaming narratives. This study perpetuates this; the implication with little evidence behind it, that children with FGIDs miss school due to “symptom catastrophising” risks perpetuating harmful stereotypes.

Consider an alternative explanation: children with FGIDs may miss more school because they require repeated appointments, testing, and medical evaluations, none of which yield answers. Without a definitive diagnosis, these children are less likely to receive appropriate accommodations or support, or an effective treatment, further compounding the problem.

Framing this issue as a failure of the children’s perception rather than the medical system’s limitations minimises the struggles these children and their families face. It risks shifting responsibility away from improving diagnostic tools or addressing systemic barriers, and towards the patients themselves.

 

[tornandfrayed]

Excellent letter @Yann04