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The guideline entitled 'Functional abdominal pain in children' has been developed by a multidisciplinary working group on behalf of the Dutch Pediatric Association in 2015. - History and physical examination are essential in diagnosing pediatric functional abdominal pain. Additional diagnostic testing is of limited value when alarm symptoms are absent. - Reassurance and education of both the child and parent(s), are the cornerstones in the treatment of pediatric functional abdominal pain. - In case of persisting symptoms, hypnotherapy or cognitive behavioral therapy can be started. There is no evidence for any pharmacological treatment

Functional constipation and functional non-retentive faecal incontinence are common problems in childhood; these functional defaecation disorders are diagnosed according to the Rome IV criteria. Here we describe the role of an abdominal X-ray in diagnosing functional defaecation disorders, and address the limited additional value of a plain abdominal X-ray. In limited cases it may be helpful to determine colonic transit time using an abdominal X-ray to differentiate between functional constipation and functional non-retentive faecal incontinence. The diagnostic value of abdominal X-rays in children with functional abdominal pain will be discussed. The aims of this article are to explore ways of reducing unnecessary use of abdominal X-rays and reducing unnecessary radiation exposure in children with functional defaecation disorders and functional abdominal pain

The application of combined pH and multichannel intraluminal impedance (pH-MII) monitoring has enhanced the recognition and characterization of gastro-oesophageal reflux disease (GORD). Its main advantages over traditional pH monitoring lie in the additional ability to detect non-acid gastro-oesophageal reflux (GOR), to discern between liquid and gas GOR and to determine the proximal extent of a GOR episode. When conducted in combination with manometry, it reveals information on the relationship between oesophageal pressures and oesophageal bolus flow, enhancing the evaluation of oesophageal function testing in terms of assessment of mechanisms of oesophageal bolus clearance. The measurement of mean impedance baseline has also provided novel insights into oesophageal mucosal integrity changes as an indicator of oesophageal inflammation. However, a few clinical and technical shortcomings, of which some are specific to the paediatric population, must be considered when interpreting study results and limit the diagnostic value of pH-MII monitoring in children. In this chapter, the technical aspects of pH-MII monitoring will therefore first be addressed, and, second, the current clinical benefits and limitations of oesophageal pH-MII in children will be highlighted.

BACKGROUND: Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines. METHODS: Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation. RESULTS: This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants CONCLUSIONS: This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.

From Creative Crowds to Creative Tourism: A search for creative tourism in small and medium sized cities. Teun den Dekker and Marcel Tabbers Barcelona Creative Tourism. Caroline Couret COLIN’s creative tourism experiences: The opportunities for the province of Noord-Brabant, The Netherlands. Kristel Zegers

Probiotics are defined as 'live micro-organisms that confer a health benefit on the host if administered in adequate amounts'. There are only limited data in the literature regarding the efficacy and safety of lactobacilli for various gastrointestinal indications in children. Lactobacillus rhamnosus GG (LGG) has no added value in the treatment of children with functional constipation. Lactobacilli do seem to be effective in rotavirus diarrhoea. They seem safe and shorten the duration of the diarrhoea by about 1 day. For the prevention of infectious diarrhoea, lactobacilli are only moderately effective and the clinical relevance is unclear. There is 1 controlled study in which LGG had a preventive effect on the development of atopic eczema (but not of allergy to cow's milk) in newborn infants

Video-capsule endoscopy was used in 4 children with unexplained symptoms of the small intestine. Each patient swallowed a capsule of 11 by 27 mm, which contained a camera that takes 2 images per second (in children aged less than 8 years, the capsule was placed in the duodenum under sedation). In a 3-year-old girl with rectal bleeding following partial resection of the colon and small intestine, ulcers were seen proximal to the ileorectal anastomosis. In a 14-year-old boy with Crohn's disease and an abnormal growth curve, multiple stenoses of the small intestine were seen. In an 8-year-old boy with rectal bleeding, a solitary polypoid mass was seen that, upon operation, appeared to be the result of a partially invaginated Meckel's diverticulum. In a 17-year-old boy with weight loss, rectal bleeding and colitis, abnormalities were seen that were consistent with Crohn's disease. Patients were treated based on the endoscopic results and subsequently recovered. Video-capsule endoscopy is non-invasive and painless and provides better images of the small intestine than a standard endoscopic and radiological examination