Impact of Coronavirus disease 2019 pandemic in children with functional abdominal pain disorders: Data from long-term follow-up

ObjectiveWe aimed to compare symptom frequency and severity in children with functional abdominal pain disorders (FAPDs) and to evaluate anxiety, quality of life (QoL) and global health during Coronavirus disease 2019 (COVID-19) related quarantine and after 17 months.MethodsChildren diagnosed with FAPDs between October 2019 and February 2020 at 5 different centers were enrolled and prospectively interviewed during the COVID-19 quarantine and 17 months later when schools, hospital services, and routine activities had re-opened to the public. The patients were asked to complete the Rome IV questionnaire, the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) Generic Core Scale, the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and global health questionnaires. Data about COVID-19 infection and its clinical outcome were also collected.ResultsNinety-nine out of 180 (55%) children completed the follow-up. The number of patients reporting a worsening of their symptoms was significantly higher at follow-up when compared to the quarantine period (24/99 [24.2%] vs. 12/99 [12.1%]; p = 0.04). The PedsQL 4.0 subtotal score at follow-up significantly decreased at 17 months of follow-up (65.57 [0-100]) when compared to the quarantine (71 [0-100], p = 0.03). Emotional functioning was the most significantly reduced (Follow-up: 64.7 [0-100] vs. Quarantine: 75 [0-100]; p = 0.006). We did not identify significant differences in symptoms and QoL between COVID-19 infected children and the remaining cohort at the two time points.ConclusionsAn improvement of symptoms and QoL was observed during the quarantine, followed by a worsening at-follow-up. These findings reinforce the hypothesis that the nest effect overweighted COVID-19 fears during the quarantine and highlight the importance of psychological factors in symptom exacerbation What is Known Disorders of gut-brain interaction represent an ideal model to understand the potential psychological burden induced by the Coronavirus disease 2019 (COVID-19) pandemic. We previously demonstrated a significant improvement of symptoms and a satisfactory quality of life during COVID-19 related lockdown in children affected by disorders of gut brain interaction.What is New The long-term follow-up data of our cohort demonstrate a worsening of symptoms and health related quality of life after 17 months from the COVID-19 related lockdown when social activities, parents' work and school were being resumed. These findings provide insights on the environmental factors leading to the development and the exacerbation of symptoms in children and adolescents affected by functional abdominal pain-related disorders, possibly confirming the importance of parental proximity and the potential that school and social activities act as major stress drivers at this age. On the other hand, we reported no obvious influence of COVID-19 infection on the gastrointestinal symptoms in our cohort.