Pediatric DGBI (Functional GI Disorders): Diagnosis Algorithm & Comparison

Part 1: Algorithm (Decision Tree)

This algorithm is a simplified guide. Real-world diagnosis requires a detailed history, physical exam, and exclusion of organic causes. Consult the Rome IV criteria fully.

START | |-- Is the primary symptom NAUSEA and/or VOMITING? | | | |-- YES --> | | |-- Is there a pattern of RECURRENT, DISCRETE episodes? | | | | | | | |-- YES --> CYCLIC VOMITING SYNDROME (CVS) | | | | | | | |-- NO --> | | | | |-- Is bothersome NAUSEA the predominant symptom (not related to meals)? | | | | | | | | | | | |-- YES --> FUNCTIONAL NAUSEA | | | | | | | | | | | |-- NO --> | | | | | | |-- Is there RECURRENT VOMITING (not self-induced, no eating disorder)? | | | | | | | | | | | | | | | |-- YES --> FUNCTIONAL VOMITING | | | | | | | | | | | | | | | |-- NO --> | | | | | | | | |-- Is there REPEATED REGURGITATION/RECHEWING (without retching)? | | | | | | | | | | | | | | | | | | | |-- YES --> RUMINATION SYNDROME | | | | | | | | | | | | | | | | | | | |-- NO --> | | | | | | | | | | |-- Is there EXCESSIVE AIR SWALLOWING (belching, distention)? | | | | | | | | | | | | | | | | | | | | | | | |-- YES --> AEROPHAGIA | | | | | | | | | | | | | | | | | | | | | | | |-- NO --> Consider other diagnoses | | | |-- NO --> | | |-- Is the primary symptom ABDOMINAL PAIN? | | | | | | | |-- YES --> | | | | |-- Is there ABDOMINAL PAIN *ASSOCIATED WITH CHANGES IN STOOL* (frequency/form)? | | | | | | | | | | | |-- YES --> IRRITABLE BOWEL SYNDROME (IBS) | | | | | | | | | | | |-- NO --> | | | | | | |-- Is there *EPIGASTRIC PAIN or BURNING*, *POSTPRANDIAL FULLNESS*, or *EARLY SATIATION*? | | | | | | | | | | | | | | | |-- YES --> FUNCTIONAL DYSPEPSIA (FD) | | | | | | | | | | | | | | | |-- NO --> | | | | | | | | |-- Are there *PAROXYSMAL EPISODES of INTENSE PAIN* with associated symptoms (nausea, vomiting, headache)? | | | | | | | | | | | | | | | | | | | |-- YES --> ABDOMINAL MIGRAINE (AM) | | | | | | | | | | | | | | | | | | | |-- NO --> FUNCTIONAL ABDOMINAL PAIN - NOS (Not Otherwise Specified) | | | | | |-- NO --> | | | |-- Is the primary symptom DIFFICULTY DEFECATING or INCONTINENCE? | | | | | | | | | |-- YES --> | | | | | |-- Is there infrequent defecation, retentive posturing, painful bowel movements (signs of CONSTIPATION)? | | | | | | | | | | | | | |-- YES --> FUNCTIONAL CONSTIPATION | | | | | | | | | | | | | |-- NO --> NONRETENTIVE FECAL INCONTINENCE | END

Part 2: Comparison Table

Use this table to compare key features of each disorder after using the algorithm.

Feature Cyclic Vomiting Syndrome (CVS) Functional Nausea Functional Vomiting Rumination Syndrome Aerophagia
Primary Symptom Intense, recurrent vomiting Nausea Vomiting Regurgitation Air Swallowing, Distention
Pattern Discrete episodes with symptom-free intervals Persistent Recurrent After meals Throughout the day
Vomiting Prominent, paroxysmal Not consistently present Present, recurrent Not preceded by retching Possible
Nausea Prominent during episodes Primary symptom Possible Uncommon Possible
Relationship to Meals No direct relationship to every meal, but triggers can exist Generally unrelated No specific relationship Immediately after meals Exacerbated by eating
Distinguishing Feature Stereotypical episodes; return to baseline between episodes Predominant, persistent nausea Recurrent vomiting, no self-induction Repeated regurgitation, no retching Excessive air swallowing
Feature Irritable Bowel Syndrome (IBS) Functional Dyspepsia (FD) Abdominal Migraine (AM) Functional Abdominal Pain - NOS (FAP-NOS)
Primary Symptom Abdominal pain Epigastric pain/burning, fullness Intense abdominal pain Abdominal pain
Pain Relationship Related to defecation or stool changes Not related to defecation Paroxysmal episodes Not related to specific events
Associated Symptoms Changes in stool frequency/form, bloating Early satiation, nausea Nausea, vomiting, headache, photophobia, pallor Variable
Location of Pain Variable (can be anywhere in the abdomen) Epigastric Periumbilical, midline, diffuse Variable
Distinguishing Feature Pain associated with bowel habits; constipation/diarrhea predominant Upper GI symptoms (epigastric focus) Discrete episodes; associated migraine symptoms Pain not meeting criteria for other diagnoses
Feature Functional Constipation (FC) Nonretentive Fecal Incontinence (NRFI)
Primary Symptom Infrequent bowel movements Fecal soiling (incontinence)
Stool Consistency Hard, difficult to pass Usually normal consistency
Retention Possible (retentive posturing, large fecal mass in rectum) Absent
Distinguishing Feature Signs of stool retention, infrequent bowel movements Soiling without fecal retention

Disclaimer: This algorithm and comparison table are simplified tools and are not a substitute for clinical expertise. Pediatric functional GI disorders can be complex, and diagnosis requires a comprehensive approach. These tools are meant as learning aids and should not be used to make clinical decisions independently. Always consult with a qualified healthcare professional.