Carlos Alberto Velasco-Benítez

Introduction: Proctalgia fugax (PF) is an anorectal disorder characterized by sudden, transient episodes of rectal pain. Although it has traditionally been described in adults, its recognition in pediatrics has gained relevance with its inclusion in the Rome V Criteria. Objective: To determine the prevalence of PF according to the Rome IV Criteria for adults modified for pediatrics, in schoolchildren and adolescents attending a Public School in Cali, Colombia. Methods: An observational, descriptive, cross-sectional study was conducted in schoolchildren and adolescents aged 10–18 years. Demographic, clinical, and socioaffective variables were collected. Questionnaires were administered to identify disorders of gut-brain interaction (DGBIs) (QPGS-IV), quality of life (PedsQL), and anx-iety/depression (PROMIS-Anxiety/PROMIS-Depression). PF was defined using the Rome IV Criteria for adults modified for pediatrics. Statistical analysis included measures of central tendency and the chi-square or Fisher's exact test, with p< 0.05 considered statis-tically significant. Results: A total of 199 schoolchildren and adolescents were included (mean age 14.3 ± 2.0 years; 75.4% adolescents; 53.8% male; 39.7% mixed race). Regarding socioaffective variables, 65.8% had separated or divorced parents; school and social ab-senteeism were present in 43.2% and 34.2%, respectively; impaired quality of life in 53.8%; anxiety in 35.2%; and depression in 37.2%. The prevalence of any DGBI was 28.1%, defecation-related DGBIs 16.6%, and PF 3.0%. None of the variables analyzed showed significant differences for PF, except anxiety (p=0.002). Conclusions: PF was identified in 3.0% of the participants, showing that it can occur in schoolchildren and adolescents, with anxiety being an important factor to consider.

Background/Objectives: Children with sickle cell disease (SCD) experience gastrointes-tinal symptoms; the contribution of disorders of gut–brain interaction (DGBIs) to this symptom burden remains underrecognized, particularly in low-middle-income coun-tries. This study aimed to determine the prevalence of DGBIs and associated factors in children with SCD. Methods: Descriptive cross-sectional study conducted in two pediatric centers in Cali, Colombia. Children aged 4-18 years with confirmed SCD were included. DGBIs were identified using the Questionnaire for Pediatric Gastrointestinal Symptoms–Rome IV. Sociodemographic/familial/clinical variables were obtained. Quality of Life was assessed using the Pediatric Quality of Life Inventory. Uni-bivariate, and multivariable logistic regression analyses were performed. Results A total of 103 patients were included. Prevalence of DGBIs was 11.7%. The most common functional constipation (7.8%), fol-lowed by functional dyspepsia (3.9%). Overlap was observed in 1.0%. Quality of life was impaired in 34.9%. This was reflected in 66.7% school absenteeism of patients with DGBIs compared of those without (38.5%) (OR=3.20; 95%CI=0.77-15.45; p=0.062). In the bivariate analysis, living with both parents, asthma, positive sickling test, and history of hema-tologic replacement therapy showed a trend toward association with DGBI. In the mul-tivariable analysis, asthma and history of transfusion also showed a trend toward asso-ciation, statistical significance was not reached. Conclusions: DGBIs are present in a clinically relevant proportion of children with SCD and represent a potentially under-diagnosed comorbidity. Quality of life was impaired. The incorporation of systematic screening using standardized Rome Criteria may improve the identification of DGBIs and strengthen the comprehensive management of these children.

Objective: Irritable bowel syndrome (IBS) is the most frequent abdominal‐pain–predominant disorder of gut–brain interaction (DGBI). Because the pediatric Rome IV criteria require abdominal pain and stool changes for at least 4 days per month over 2 months, adolescents whose pain coincides with menstruation may be misclassified as IBS. We aimed to determine whether menstrual‐associated gastrointestinal symptoms contribute to the reported IBS prevalence. Methods: We conducted a cross‐sectional study of 3521 school‐aged females (10–16 years) from public and private schools in Colombia. Participants completed the validated Spanish Rome IV Pediatric Questionnaire for Gastrointestinal Symptoms, which included questions on temporal relation between pain, bowel habits, and menstruation. These symptoms were defined as occurring during days of active bleeding, without inclusion of a pre‐ or postmenstrual window. Results: Of 3336 analyzable surveys (mean age 13.3 ± 1.8 years), 2926 (87.7%) were postmenarcheal. Overall, 609/2926 (20.8%) met criteria for ≥ 1 DGBI, including 45 participants (1.5%) who met criteria for IBS. Among postmenarcheal participants with IBS, 62.2% reported abdominal pain and bowel‐habit changes exclusively during menstruation. Conclusions: A substantial proportion of adolescents meeting pediatric Rome IV criteria for IBS reported symptoms confined to menstruation, demonstrating a clinically relevant diagnostic overlap between dysmenorrhea and IBS. Because the Rome IV pediatric algorithm does not distinguish menstrual‐only pain from chronic abdominal pain, menstrual‐associated gastrointestinal symptoms may resemble those of IBS and complicate diagnostic decision‐making. Further studies are needed to clarify whether these presentations reflect menstrual‐related gastrointestinal symptoms alone or a distinct subset of DGBI.

Background: Disorders of the gut–brain interaction (DGBIs) constitute a group of functional conditions widely described in adults; however, some of these have not been included in pediatric Rome criteria, despite the fact that they may manifest during childhood. Early identification of these conditions is relevant due to their clinical/psychosocial impact as well as their effect on quality of life. The aim was to determine the prevalence and associated factors of some DGBIs described in adults according to the Rome IV criteria in pediatric population. Methods: An observational/prospective/cross-sectional study was conducted in toddlers, school-aged children, and adolescents from three Colombian cities. The adapted Questionnaire for Pediatric Gastrointestinal Symptoms Rome IV (QPGS-IV) using adult criteria was applied, along with quality-of-life scales and PROMIS for anxiety/depression. Descriptive uni/bivariate analyses were performed as well as a multivariate logistic regression model. Results: A total of 704 participants were included (13.7 ± 2.8 years old). The prevalence of DGBIs described in adults according to QPGS-IV was 5.8%, with proctalgia fugax being the most frequent. In the bivariate analysis, race, school/social absenteeism, depressive traits, and impaired quality of life were significantly associated. In the multivariate model depressive traits (OR = 4.08; 95%CI = 1.82–9.12; p = 0.001), school (OR = 2.51; 95%CI = 1.06–5.98; p = 0.036), and social absenteeism (OR = 4.04; 95%CI = 1.70–9.62; p = 0.002) were the factors independently associated. Conclusions: These adult DGBIs, according to the QPGS-IV, can occur in pediatric populations and are closely related to psycho-emotional and functional factors. These are mainly associated with depression and school/social absenteeism, supporting the need for a biopsychosocial approach and a revision of the pediatric diagnostic criteria.

Background: Infant colic is a frequent and distressing disorder of early infancy. The Rome IV criteria define colic as occurring from birth until 5 months of age, although emerging evidence suggests that symptoms may persist beyond this threshold. This study aimed to determine the prevalence of infant colic beyond 5 months and evaluate whether the Rome IV diagnostic age cutoff accurately reflects the clinical course of the disorder. Methods: We conducted a cross‐sectional, multicenter study across four regions of Colombia during the. Caregivers of infants aged 1–12 months were recruited from general pediatrics and pediatric gastroenterology outpatient clinics. Infant colic was diagnosed using the validated Spanish version of the Rome IV Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS‐IV). Demographic data were analyzed descriptively, and comparisons between age groups (1–4 months vs. 5–12 months) were performed using Fisher's exact test. Key Results: A total of 1236 infants were included. Twenty‐one (1.7%) met symptomatic Rome IV criteria for infant colic. Prevalence was 3.0% (18/600) at 1–4 months and 0.5% (3/636) at 5–12 months ( p < 0.001). No significant differences were found by sex ( p = 0.39) or prematurity ( p = 0.26). Fourteen percent of all colic cases occurred beyond 5 months, and none beyond 8 months of age. Conclusions and Inferences: Infant colic was common during early infancy but rare beyond 5 months, confirming that the Rome IV cutoff reflects the typical clinical course for most infants. However, a small subgroup with persistent symptoms beyond 5 months suggests that the current time boundary may not encompass the full spectrum of infant colic.

Background: Disorders of the gut–brain interaction (DGBIs) constitute a group of func-tional conditions widely described in adults; however, some of these have not been in-cluded in pediatric Rome Criteria, despite the fact that they may manifest during childhood. Early identification of these conditions is relevant due to their clini-cal/psychosocial impact, as well as their effect on quality of life. The aim was to determine the prevalence and associated factors of some DGBIs described in adults according to the Rome IV Criteria in pediatric population. Methods: An observation-al/prospective/cross-sectional study was conducted in toddlers, school-aged children, and adolescents from three Colombian cities. The adapted Questionnaire for Pediatric Gas-trointestinal Symptoms Rome IV (QPGS-IV) using adult criteria was applied, along with quality-of-life scales and PROMIS for anxiety/depression. Descriptive uni/bivariate analyses were performed, as well as a multivariate logistic regression model. Results: 789 participants were included (13.7±2.8 years old). The prevalence of DGBIs described in adults according to QPGS-IV was 5.8%, proctalgia fugax being the most frequent. In the bivariate analysis, race, school/social absenteeism, depressive traits, and impaired quality of life were significantly associated. In the multivariate model depressive traits (OR=4,08; 95%CI=1,82-9,12; p=0,001), school (OR=2,51; 95%CI=1,06-5,98; p=0,036), and social ab-senteeism (OR=4,04; 95%CI=1,70-9,62; p=0,002) were the factors independently associated. Conclusions: These adult’s DGBIs according to the QPGS-IV can occur in pediatric pop-ulations and are closely related to psychoemotional and functional factors. They are mainly associated with depression and school/social absenteeism, supporting the need for a biopsychosocial approach and a revision of pediatric diagnostic criteria.

Background/Objectives: Dengue is one of the leading causes of morbidity in children in endemic regions. Capillary leakage is the pathophysiological hallmark of severe dengue, and ultrasound has established as a sensitive tool for its early detection. However, evidence in the pediatric population remains limited. The aim of this study was to identify the presence of capillary leakage detected by ultrasound and its associations in children with dengue. Methods: Observational/descriptive/cross-sectional/retrospective study conducted in patients between 6 months and 14 years old with confirmed dengue and warning signs or severe dengue, treated at the Hospital Universitario del Valle in Cali, Colombia, between July 2019 and June 2020. Ultrasound examinations were performed and interpreted by radiologists following an institutional standardized protocol. Associations with capillary leakage were evaluated using the chi-square test and their respective OR and 95% CI. Results: A total of 132 children were included. Ultrasound capillary leakage was identified in 95.5%, mainly ascites (83.3%), pleural effusion (46.2%), hepatomegaly (40.9%), and vesicular thickening (39.4%). Associated factors were belonging to school/adolescent group (OR = 13.52; 95% CI = 1.41–646.51; p = 0.0031), elevated alanine aminotransferase (OR = 11.06; 95% CI = 1.32–94.82; p = 0.0007), and aminotransferase levels grades C–D (OR = 6.87; 95% CI = 0.82–54.59; p = 0.0110). Thrombocytopenia and hypoalbuminemia were common. Three deaths (0.9%) occurred in the initially confirmed cohort prior to ultrasound-based inclusion, all of whom presented multiple risk factors for capillary leakage. Conclusions: In this cohort ultrasound showed high sensitivity for detecting capillary leakage in pediatric dengue and was associated with school-age/adolescents and liver involvement. Its systematic use could improve early identification of severe forms and optimize clinical management in resource-limited settings.

Introducción. La prevalencia mundial de síndrome de rumiación es del 1,0% según los criterios diagnósticos de Roma IV. Objetivos. Identificar la prevalencia y las posibles asociaciones del síndrome de rumiación en preescolares, escolares y adolescentes de Colombia, México y Ecuador, según los criterios de Roma IV. Materiales y métodos. Estudio prospectivo, observacional, de corte transversal y descriptivo realizado en tres países latinoamericanos. De la base de datos del Grupo Functional International Digestive Epidemiological Research Survey - FINDERS Group, se incluyeron a niños y adolescentes de entre 5 y 18 años, que respondieron el Cuestionario para Síntomas Digestivos Pediátricos Roma IV en español. Se analizaron variables sociodemográficas, familiares, clínicas y nutricionales. El análisis estadístico incluyó medidas de tendencia central y dispersión para la descripción univariada de las variables. Posteriormente, se realizaron análisis bivariados mediante las pruebas de Chi-cuadrado o Fisher, y se calcularon odds ratios (OR), con sus respectivos intervalos de confianza del 95%. Se consideró un valor de p < 0,05 como estadísticamente significativo. Resultados. Fueron incluidos 10.089 niños (12,7 +/- 3,1 años; 55,6% femeninos; 52,1% mestizos). Se diagnosticó síndrome de rumiación en el 0,8%. En el 3,4% se observó una sobreposición de rumiación con otros trastornos funcionales. Se observó una asociación entre rumiación y las siguientes variables: género femenino (OR = 2,10; IC 95%: 1,24 - 3,66; p = 0,0032) y con sobreposición con otros trastornos funcionales, como estreñimiento y aerofagia (p = 0,000). Conclusión. La prevalencia del síndrome de rumiación en preescolares, escolares y adolescentes de tres países latinoamericanos es similar a lo relatado a nivel mundial. El análisis bivariado mostró asociaciones con el sexo femenino y la sobreposición con otros trastornos funcionales.

Background/Objectives: Dengue is one of the leading causes of morbidity in children in endemic regions. Capillary leakage is the pathophysiological hallmark of severe dengue, and ultrasound has established as a sensitive tool for its early detection. However, evidence in pediatric population remains limited. The aim of this study was to identify the presence of capillary leakage detected by ultrasound and its associations in children with dengue. Methods: Observational/descriptive/cross-sectional/retrospective study conducted in patients between 6-months and 14-years-old with confirmed dengue and warning signs or severe dengue, treated at the Hospital Universitario del Valle in Cali, Colombia, between July 2019 and June 2020. Ultrasound examinations were performed and interpreted by radiologists following an institutional standardized protocol. Associations with capillary leakage were evaluated using the chi-square test and their respective OR and 95%CI. Results: A total of 132 children were included. Ultrasound capillary leakage was identified in 95.5%, mainly ascites (83.3%), pleural effusion (46.2%), hepatomegaly (40.9%), and vesicular thickening (39.4%). Associated factors were belonging to school/adolescent group (OR=13.52; 95%CI=1.41–646.51; p=0.0031), elevated alanine aminotransferase (OR=11.06; 95%CI=1.32–94.82; p=0.0007), and aminotransferase levels grades C–D (OR=6.87; 95%CI=0.82–54.59; p=0.0110). Thrombocytopenia and hypoalbuminemia were common. Three deaths (0.9%) occurred in the initially confirmed cohort prior to ultrasound-based inclusion, all of whom presented multiple risk factors for capillary leakage. Conclusions: In this cohort ultrasound showed high sensitivity for detecting capillary leakage in pediatric dengue and was associated with school-age/adolescents and liver involvement. Its systematic use could improve early identification of severe forms and optimize clinical management in resource-limited settings.