Thanks for sharing!

One of the workshop leaders was med-peds and shared what a difference you all make for these patients :)

- We acknowledged that transition is hard for everyone, including neurotypical adolescents
- While independence may not be the goal for everyone, assessing patient wishes and cognitive abilities can help define transition goals
- Space to talk to providers alone promotes self-advocacy!

Teens also had great feedback for improving the video, including having youth actors, discussion of STI symptoms, and closed captioning for accessibility.

Final presentation is a review of feeding issues and breast milk, including a review of possible causes of feeding issues (prematurity most common) as well as the different components of breastmilk and why it’s recommended.

Cool to learn that brestfed babies are less selective with solid foods!

Great summary slide for management of functional abdominal disorders, affirming a lot that I do already so glad to know I’m on the right track.

Absolutely! Taking notes on how to apply all of this :) side note: would love to try and meet up in IL before I move later this year

Melatonin has been shown effective to improve sleep and belly pain.

Good support for peppermint oil and amitriptyline.

Be willing to offer a range of medications. Some patients will get better on something, but some will not respond to any.

Medication use: no single medication for functional disorders treats all symptoms. Many GI medications are not better than placebo, but the placebo effect is still valid because patients feel BETTER!

Probiotics shows moderate benefit with only weak evidence. Also consider that some are costly.

Recent study of low fodmap diet in teens in Europe showed statistical significance, but no clinical significance.

Diets also have significant side effects, including increased risk of eating disorders.

Treatment requires a holistic approach.
- Sleep can make symptoms better
- Physical activity helps to get away from “flight or fight” response
- Social media and phone use associated with worse symptoms
- diet interventions may not be effective (more due to hypersensitivity).

Make diagnosis of functional disorders as a positive diagnosis. Symptoms are REAL!

Don’t use the word “just” to explain the diagnosis and explain why further testing are not indicated.

Allergy testing and IBD panel are useless in abd pain. Can consider stool calprotectin if patient has diarrhea.

Constipation must be diagnosed by patient history NOT x-ray. Patients with IBS constipation type do not experience improvement in pain with resolved constipation.

Important not to overtest. There is no test for confirming pain.

Families don’t hear what they say, they are looking at our reaction. When we order more tests, we are sending the message that families should worry.

Diagnosis needs a good history & physical exam. Not everyone needs testing.

Yes! I always feel a little like an observer here since I’m not academic, but this and last year’s locations have been too good to pass up

After inciting event end, the gut nerves are still hypersensitive. It can lead to central sensitization, leading to pain in other areas.

Pain leads to increased anxiety, which worsens pain (pic below).

Given role of stress in pain, interesting to note that consults for abd pain ⬇️ in summer.

There is a genetic correlation between anxiety and IBS. Body has a predisposition to shoot pain and nausea alarms to the abdomen in response to stress. These symptoms are REAL. It’s a hypersensitivity.

42% of patients with IBS have a fam hx. Stressful experiences (ACEs) increase risk of IBS by 2x.

Next presentation: chronic abdominal pain

Presents all over the world with a 11-13% prevalence. Seeing pain as either a chronic organic issue or psychopathology is inaccurate.

Rome criteria helps describe conditions, using a positive diagnosis, not a diagnosis of exclusion.

Biosimilars have highly similar structure, potency (can use similar doses), and efficacy. FDA review must also confirm safety.

Now reviewing evaluation of fever of unknown origin. Love a stepwise approach.
Phase 1 is a general screen, phase 2 after 2 weeks of fever, and phase 3 if continued fever with systemic involvement. Here’s phase 1 recommendations. Later phases should involve consults to ID +/- other services