Children who missed more than 3 days of school as a result of gastrointestinal symptoms had an 82% likelihood of having a functional gastrointestinal disorder rather than an organic disease, according to a recent study.
In the prospective study, conducted at the University of Virginia and published in Frontiers in Pediatrics, investigators examined the association between school absenteeism and functional gastrointestinal disorders (FGIDs) in children presenting with chronic gastrointestinal complaints. Given that FGIDs are diagnoses of exclusion and lack identifiable organic causes, the investigators sought to determine whether affected children exhibited higher rates of school absenteeism compared with those diagnosed with organic gastrointestinal diseases.
Between September 2016 and June 2017, the investigators included children aged 5 to 19 years who presented to the Pediatric Gastroenterology Clinic with gastrointestinal symptoms. Parents reported the number of school days missed in the previous month because of these symptoms. At least 6 months following the initial visit, a retrospective chart review classified each child’s final diagnosis as either an FGID or an organic gastrointestinal disease. Differences in absenteeism between the groups were analyzed using unpaired t-tests.
Among 674 children evaluated, 61% (n = 408) of them were diagnosed with FGIDs, whereas 39% (n = 266) of them had organic gastrointestinal diseases. Children with FGIDs were more likely to experience major school absenteeism. Specifically, missing over 3 days of school in the past month had a negative predictive value (NPV) of 82% (95% confidence interval [CI] = 74.07%–88.01%) for an organic diseases, while being homebound (≥ 20 absences) had an NPV of 88% (95% CI = 69.92%–96.20%). In contrast, children with organic diseases were more likely to have missed 3 or fewer days of school (sensitivity = 92.86%, 95% CI = 89.07%–95.65%) and to have attended at least 1 day of school in the past month (sensitivity = 98.97%, 95% CI = 96.74%–99.77%).
Among the 408 children diagnosed with FGIDs, the most common conditions were functional constipation (n = 148, 36%), functional abdominal pain (n = 144, 35%), and irritable bowel syndrome (n = 130, 31%). Among the children with organic diseases, inflammatory bowel disease accounted for 155 cases (58%), followed by other conditions (n = 86, 32%) and celiac disease (n = 25, 9%).
The findings suggested that school absenteeism could provide diagnostic insight, with increased absences correlating with a higher likelihood of an FGID rather than an organic gastrointestinal disease. The investigators hypothesized that symptom perception, catastrophizing, and the prolonged diagnostic process may contribute to increased absenteeism in children with FGIDs. The study highlighted the potential clinical utility of evaluating school absenteeism as part of the assessment of pediatric gastrointestinal complaints.
The authors reported no conflict of interest.
