Management of children with non-acute abdominal pain and diarrhea in Dutch primary care: a retrospective cohort study based on a routine primary care database (AHON)

Figures & data

Table 1. Data collection for patient characteristics and outcomes.

	Moment of assessment		Method of assessment
	Baseline consultation	One year follow-up	Database query	Hand-searched in free-text documentation^a
Characteristics
Gender	X		X
Age	X		X
Type of symptoms	X			X
Duration of symptoms	X			X
Final diagnosis	X	X		X
GP management
Diagnostic tests	X		X	X
Medicine prescriptions	X		X	X
Follow-up consultations	X	X	X
Referral	X	X		X

^aHand-searched in free-text documentation of the baseline consultation for all contacts assigned an inclusion ICPC code during a one-year follow-up period.

Figure 1. Flow chart of patient inclusion. ICPC: International Classification of Primary Care. ^aNot reliable for prevalence calculation due to invalid estimation of numerator. ^bInclusion ICPC codes are shown in Supplementary Material S1. ^cICPC code D99.06: celiac disease; ICPC code D94: inflammatory bowel disease. ^dThese include correspondence with other healthcare professionals, processing test results, and prescribing medication. ^eDouble inclusions due to duplicate pseudonymized identification numbers were removed (n = 11).

Table 2. Characteristics of children presenting with non-acute abdominal pain and/or diarrhea in general practice.

Characteristic	n = 2200
Male, n (%)	905 (41.1)
Age, median years (IQR)	10.4 (7.0–14.6)
Symptoms, n (%)
Abdominal pain	1732 (78.7)
Diarrhea	173 (7.9)
Both	295 (13.4)
Duration of symptoms, n (%)
>1 week < 2 months	846 (38.5)
≥2 months	721 (32.8)
Unclear	633 (28.8)
Diagnosis according to GP during baseline consultation, n (%)^a
Abdominal pain, cause unknown	772 (30.5)
Constipation	545 (21.5)
Irritable bowel syndrome	222 (8.7)
Functional abdominal pain	212 (8.4)
Gastrointestinal infection	204 (8.1)
Diarrhea, cause unknown	201 (7.9)
Gastritis / heartburn	80 (3.2)
Urinary tract infection	72 (2.8)
Suspicion of celiac disease	47 (1.9)
Gynaecological diagnosis	44 (1.7)
Food intolerance / allergy	24 (0.9)
Suspicion of appendicitis	20 (0.8)
Suspicion of inflammatory bowel disease	19 (0.8)
Other	43 (1.7)
No diagnosis	26 (1.0)

^aEach child can have multiple diagnoses, as documented by the GP. Denominator = 2531.

Table 3. Final diagnosis in 2200 children presenting in general practice with non-acute abdominal pain and/or diarrhea.

Diagnosis received by one year of follow-up, n = 2200	n (%)
Functional gastrointestinal disorders
Abdominal pain with unknown cause	702 (31.9)
Constipation	467 (21.2)
Irritable bowel syndrome or functional abdominal pain	386 (17.5)
Diarrhea with unknown cause	153 (7.0)
Multiple FGIDs^a	77 (3.5)
Functional dyspepsia	51 (2.3)
Organic diseases manageable in primary care
Gastroenteritis	158 (7.2)
Urinary tract infection	25 (1.1)
Gastritis	11 (0.5)
Lactose intolerance	7 (0.3)
Dysmenorrhea	7 (0.3)
Vaginitis	2 (0.1)
Pregnancy	1 (0.1)
Pelvic inflammatory disease	1 (0.1)
Respiratory infection	1 (0.1)
Mesenteric lymphadenitis	1 (0.1)
Organic diseases requiring management in secondary care
Inflammatory bowel disease	8 (0.4)
Celiac disease	6 (0.3)
Food allergy	3 (0.1)
Endometriosis	1 (0.1)
Cholelithiasis	1 (0.1)
Anterior cutaneous nerve entrapment syndrome	1 (0.1)
Ovarian torsion	1 (0.1)
Hyperthyroidism	1 (0.1)
Umbilical hernia	1 (0.1)
Unspecified
Without referral	73 (3.3)
Referred to secondary care	54 (2.5)

^aCombination of constipation and/or irritable bowel syndrome and/or functional abdominal pain and or functional dyspepsia.

Table 4. GP management at the baseline consultation and during follow-up among 2200 children.

	Baseline consultation	One year follow-up
Children with ≥ 1 diagnostic test, n (%)	709 (32.2)	NA
C-reactive protein	422 (19.2)
Leukocytes	382 (17.4)
Hemoglobin	367 (16.7)
Creatinine	246 (11.2)
Urinalysis^a	244 (11.1)
Glucose	206 (9.4)
Erythrocyte sedimentation rate	202 (9.2)
Thyroid stimulating hormone	201 (9.1)
Thrombocytes	179 (8.1)
Immunoglobulin A / anti-tissue transglutaminase	140 (6.4)/126 (5.7)
Children with ≥ 1 medicine prescription, n (%)	760 (34.5)	NA
Laxatives	597 (27.1)
Drugs for acid related disorders	79 (3.6)
Anti-infective agents	36 (1.6)
Analgesics	35 (1.6)
Diarrhea and vomiting inhibitors	29 (1.3)
Antispasmodics	22 (1.0)
Contraception	16 (0.7)
Other	20 (0.9)
Children with ≥ 1 (follow-up) consultation, n (%)	552 (25.1)	457 (20.8)
Face-to-face consultation, n (%)	399 (18.1)	386 (17.5)
Only telephone or e-mail consultation, n (%)	153 (6.9)	71 (3.2)
Number of follow-up consultations (median, IQR)	1 (1–2)	2 (1–3)
Children with ≥ 1 referral, n (%)	79 (3.6)	278 (12.6)
To secondary care	55 (2.5)	231 (10.5)^c
Within primary care systems^b	23 (1.0)	54 (2.5)^d
Unknown	1 (0.05)	4 (0.2)
Time between baseline consultation and first referral, weeks (median, IQR)	NA	6.9 (2.0–22.6)

^aUrinalysis: chemical urine tests in the general practice.

^bReferrals within primary care systems (e.g. dietician, physical therapist, or psychotherapist).

^cFour children were referred to secondary care during the baseline consultation.

^dOne child was referred within primary care during the baseline consultation.