The Mediterranean Pediatric FGIDs Project

1. The Mediterranean Pediatric FGIDs Project Dr. Elena Scarpato M.D. “Federico II” University of Naples

2. FGIDs • Functional Gastrointestinal Disorders (FGIDs) include a variable combination of age-dependent, chronic or recurrent gastrointestinal symptoms not otherwise explained by structural or biochemical abnormalities • Diagnosis and therapy of the FGIDs in children are not standardized and may vary between countries.

3. FGIDs Project: PRELIMINARY DATA • We have already performed, via an informal network including Pediatric Gastroenterological centers located in several European-Mediterranean Countries, a survey on prevalence, diagnosis and treatment of FGIDs or Irritable Bowel Syndrome (IBS) alone. • A standardized questionnaire was submitted to nine Paediatric Gastroenterological Centres (PC) located in Mediterranean countries: - Staiano Annamaria (coordinator), University Federico II, Naples, ITALY - Attard Thomas, University of Malta, Med School, Guardamangia, MALTA - Durmaz Ozlem, Istanbul University, Istanbul, TURKEY - Irastorza Inaki, Hospital Universitario de Cruces, Bilbao, SPAIN - Kolaček Sanja, Children's Hospital, Zagreb, CROATIA - Koleilat Aziz, Makassed University General Hospital, Beirut, LEBANON - Papadopoulou Alexandra, Children's Hospital P & A Kyriakou, Athens, GREECE - Roma Eleftheria, Aghia Sophia Children’s Hospital, Athens, GREECE - Shamir Raanan, Schneider Children's Medical Center of Israel, Tel Aviv, ISRAEL

4. The Questionnaire The questionnaire included different items assessing: - Cultural, psychosocial and dietary factors - Epidemiology - Clinical diagnosis and use of Rome Criteria - Treatment

5. Preliminary Data • Our preliminary data indicate that IBS prevalence is not known and diagnostic approach and treatment varies widely from Country to Country, and particularly so in pediatric patients. • Even less is known on prevalence, diagnosis and treatment of all the other FGIDs.

6. Preliminary Data • Our data indicate that FGIDs represent a real problem also in the Balkans and in Africa. • For this reason it is essential to correctly diagnose these disorders in order to optimize the use of economic resources and avoid unnecessary investigations (Eg: EGDS)

7. FGIDs Project: AIMS 1) To Assess • FGIDs prevalence • Modality of diagnosis and use of Rome Criteria • Way of treatment of these disorders in different Countries 2) To Standardize diagnostic algorithms and treatments of FGIDs 3) To Establish a European- Mediterranean network to share know-how and technology for the diagnosis and management of FGIDs

8. Expected Results To obtain • clear definition of FGIDs prevalence • dissemination of knowledge and practical skills for the identification and management of FGIDs • establishment of a network, expanded in the field outside the reference hospitals

9. Organization • Prevalence studies will be performed in the different centers. For each country, a coordinator will identify the first level health professionals fairly distributed across the entire national territory, in order to have the more reliable data on prevalence • A survey will be conducted to evaluate current implementation of guidelines in clinical practice. A representative from each involved center will be asked to complete a one page questionnaire investigating his approach to patients with FGIDs suggestive symptoms • The ‘hub & spoke’ methodology will be adopted for the progressive training at national level.

10. Organization • A multi-lingual project web site helps to share diagnostic guidelines, online consultations, data sharing and analysis, teleconferences • Training materials, for different levels and cultures, will be available on line • The applicability of guidelines will be evaluated based on the number of patients managed in full compliance with guidelines by trained pediatricians.

11. Gustav Klimt, Le tre età della donna - 1905