Functional gastrointestinal disorders in adolescents during online learning

Sumardi F. Simanjuntak; Titis Prawitasari; Muzal Kadim; Teny Tjitra Sari; Hartono Gunardi; Yvan Vandenplas; Badriul Hegar

doi:10.14238/pi63.5.2023.353-60

Sumardi F. Simanjuntak
Titis Prawitasari
Muzal Kadim
Teny Tjitra Sari
Hartono Gunardi
Yvan Vandenplas
Badriul Hegar Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta https://orcid.org/0000-0002-5924-1664

DOI: https://doi.org/10.14238/pi63.5.2023.353-60

Keywords: Rome IV criteria; functional abdominal pain; adolescent; online learning

Abstract

Background The COVID-19 pandemic necessitated the use of online schooling in order to comply with national and local lockdown guidelines. Online learning required students and teachers to adapt to a new method of schooling. The inability of adolescents to adapt to their environment can interfere with their psychosocial condition and become a risk factor for functional gastrointestinal disorders (FGID).

Objective To determine the prevalence of FGID in adolescents and evaluate possible risk factors that existed during online learning.

Methods This cross-sectional study was done in children aged 12-18 years who participated in online learning during the COVID-19 pandemic. The diagnosis of FGID was based on Rome IV criteria. Psychosocial problems were assessed using the Pediatric Symptom Checklist Questionnaire–17 (PSC-17) which includes internalization, externalization, and attention subscales. Subjects with a PSC-17 mixed subscale total score of >15 were considered as having an increased likelihood of having a behavioral health disorder. Data were collected by online questionnaires via Google Forms.

Results Of 1,413 participants, 23% experienced FGID; of these, 32.6% had >2 FGID diagnostic criteria. Upon multivariate analysis, internalization psychosocial problems were the most common risk factors for FGID, followed by mixed subscale psychosocial problems, unstable internet connection, and not understanding of the material.

ConclusionThe prevalence of FGID in adolescents in this study is 23%. Environmental and psychosocial conditions are interrelated as risk factors for FGID in adolescents during online learning in the COVID-19 pandemic.

References

1. Drossman DA, Hasler WL. Rome IV-functional GI disorders: disorders of gut-brain interactions. Gastroenterology. 2016;150:1257-61. DOI: https://doi.org/ 10.1053/j.gastro.2016.03.035.
2. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993; 38:1569-80. DOI: https://doi.org/10.1007/BF01303162.
3. Everhart J, Ruhl C. Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases. Gastroenterology. 2009;136: 376-86. DOI: https://doi.org/ 10.1053/j.gastro.2008.12.015.
4. Agarwal N, Spiegel BM. The effect of irritable bowel syndrome on health-related quality of life and health care expenditures. Gastroenterol Clin North Am. 2011;40:11-9. DOI: https://doi.org/ 10.1016/j.gtc.2010.12.013.
5. Boronat AC, Ferreira-Maia AP, Matijasevich A, Wang YP. Epidemiology of functional gastrointestinal disorders in children and adolescents: A systematic review. World J Gastroenterol. 2017;23: 3915-27. DOI: https://doi.org/ 10.3748/wjg.v23.i21.3915.
6. Devanarayana NM, Rajindrajith S. Irritable bowel syndrome in children: Current knowledge, challenges and opportunities. World J Gastroenterol. 2018;24: 2211–35. DOI: https://doi.org/ 10.3748/wjg.v24.i21.2211.
7. Ho KY, Kang JY, Seow A. Prevalence of gastrointestinal symptoms in a multiracial Asian population, with particular reference to reflux-type symptoms. Am J Gastroenterol. 1998;93:1816-22. DOI: https://doi.org/ 10.1111/j.1572-0241.
8. Son YJ, Jun EY, Park JH. Prevalence and risk factors of irritable bowel syndrome in Korean adolescent girls: a school-based study. Int J Nurs Stud. 2009;46:76-84. DOI: https://doi.org/ 10.1016/j.ijnurstu.2008.07.006.
9. Oswari H, Alatas SA, Hegar B, Cheng W, Pramadyani A, Benninga MA, et al. Epidemiology of Paediatric constipation in Indonesia and its association with exposure to stressful life events. BMC Gastroenterol. 2018;18:146. DOI: https://doi.org/10.1186/s12876-018-0873-0.
10. Scarparto E, Quitadamo P, Roman E, Scarpato E , Quitadamo P, Roman E, et al. Functional gastrointestinal disorders in children: a survey on clinical approach in the Mediterranean area. J Pediatr Gastroenterol Nutr. 2017;64:e142-e146. DOI: https://doi.org/10.1097/MPG.0000000000001550.
11. Wiguna T, Manengkei PK, Pamela C, Rheza AM, Hapsari WA. Masalah emosi dan perilaku pada anak dan remaja di poliklinik jiwa anak dan remaja RSUPN dr. Ciptomangunkusumo (RSCM), Jakarta. Sari Pediatri. 2010;12:270-7.
12. Abidah A, Hidaayatullaah HN, Simamora RM, Fehabutar D, Mutakinati L, Suprapto N. The impact of Covid-19 to Indonesian education and its relation to the philosophy of “Merdeka Belajar.” Studies in Philosophy of Science and Education. 2020;1:38-49.
13. Murphy JM, Bergmann P, Chiang C, Sturner R, Howard B, et al. The PSC-17 : Subscale scores, reliability, and factors structure in a new national sample. Pediatrics. 2016;138:e20160038. DOI: https://doi.org/10.1542/peds.2016-0038
14. Robin SG, Keller C, Zwiener R, Hyman PE, Nurko S, Saps M, et al. Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV criteria. J Pediatr. 2018;195:134-9. DOI: https://doi.org/10.1016/j.jpeds.2017.12.012.
15. Bathia V, Deswal S, Seth S, Kapoor A, Sibal A, Gopalan S. Prevalence of functional gastrointestinal disorders among adolescents in Delhi based on Rome III criteria: a school-based survey. Indian J Gastroenterol. 2016;35:294–8. DOI: https://doi.org/10.1007/s12664-016-0680-x.
16. Sagawa T, Okamura S, Kakizaki S, Zhang Y, Morita K, Mori M. Functional gastrointestinal disorders in adolescents and quality of school life. J Gastroenterol Hepatol. 2013;28:285-90. DOI: https://doi.org/ 10.1111/j.1440-1746.2012.07257.x.
17. Korterink J, Devanarayana NM, Rajindrajith S, Vlieger A, Benninga MA. Childhood functional abdominal pain: mechanisms and management. Nat Rev Gastroenterol Hepatol. 2015;12:159–71. DOI: https://doi.org/ 10.1038/nrgastro.2015.21.
18. Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, Van Tilburg M. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2016;150:1456-68. DOI: https://doi.org/10.1053/j.gastro.2016.02.015.
19. Fillekes L, Prayogo A, Alatas SF, Hegar B. Irritable bowel syndrome and its associated factors in adolescents. Paediatr Indones. 2014;54:344-50. DOI: https://doi.org/10.14238/pi54.6.2014.344-50.
20. Devanarayana NM, Adhikari C, Pannala W, Rajindrajith S. Prevalence of functional gastrointestinal diseases in a cohort of Sri Lankan adolescents: comparison between Rome II and Rome III criteria. J Trop Pediatr. 2011;57:34–9. DOI: https://doi.org/10.1093/tropej/fmq039.
21. Spinelli M, Lionetti F, Pastore M, Fasolo M. Parents' stress and children's psychological problems in families facing the COVID-19 outbreak in Italy. Front Psychol. 2020;11:1713. DOI: https://doi.org/10.3389/fpsyg.2020.01713.
22. McHale SM, Updegraff KA, Whiteman SD. Sibling relationships and influences in childhood and adolescence. J Marriage Fam. 2020;74:913-30. DOI: https://doi.org/10.1111/j.1741-3737.2012.01011.x.
23. Spiegel B, Strickland A, Naliboff BD, Mayer EA, Chang L. Predictors of patient-assessed illness severity in irritable bowel syndrome. Am J Gastroenterol. 2008;103:2536–43. DOI: https://doi.org/ 10.1111/j.1572-0241.2008.01997.x.
24. Rajindrajith S, Devanarayana NM, Weerasooriya L, Hathagoda W, Benninga MA. Quality of life and somatic symptoms in children with constipation: a school-based study. J Pediatr. 2013;163:1069–72. DOI: https://doi.org/ 10.1016/j.jpeds.2013.05.012.
25. Harefa S, Sihombing GLA. Students’ perception of online learning amidst the Covid-19 pandemic: a study of junior, senior high school, and college students in a remote area. F1000Res. 2022;10:867. DOI: https://doi.org/10.12688/f1000research.52152.2.
26. Alazzam M, Al-Sagarat A, Razeq NA, Alsaraireh FA. Depression and anxiety among school adolescent females: A national study from Jordan. School Psychology International. 2021;42: 014303432110171. DOI: https://doi.org/10.1177/01430343211017181.
27. Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, et al. Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress. J Pediatr Gastroenterol Nutr. 2011;53:659–65. DOI: https://doi.org/ 10.1097/MPG.0b013e3182296033.
28. Saps M, Seshadri R, Sztainberg M, Schaffer G, Marshall BM, Di Lorenzo C. A prospective school-based study of abdominal pain and other common somatic complaints in children. J Pediatr. 2009;154:322–6. DOI: https://doi.org/ 10.1016/j.jpeds.2008.09.047.
29. Song SW, Park SJ, Kim SH, Kang SG. Relationship between irritable bowel syndrome, worry and stress in adolescent girls. J Korean Med Sci. 2012;27:1398–404. DOI: https://doi.org/ 10.3346/jkms.2012.27.11.1398.
30. Sutomo R, Ramadhani FPR, Hanifa INH. Prevalence and associated factors of psychosocial and behavioral problems in Indonesian adolescent students during the COVID-19 pandemic. Front Pediatr. 2022:10:908384. DOI: https://doi.org/10.3389/fped.2022.908384.