1. The Mediterranean Pediatric FGIDs Project Dr. Elena Scarpato M.D. “Federico II” University of Naples

2. FGIDs Functional Gastrointestinal Disorders (FGIDs) include a variable combination of age-dependent, chronic or recurrent gastrointestinal symptoms not otherwise explained by structural or biochemical abnormalities Diagnosis and therapy of the FGIDs in children are not standardized and may vary between countries.

3. We have already performed, via an informal network including Pediatric Gastroenterological centers located in several European-Mediterranean Countries, a survey on prevalence, diagnosis and treatment of FGIDs or Irritable Bowel Syndrome (IBS) alone. A standardized questionnaire was submitted to nine Paediatric Gastroenterological Centres (PC) located in Mediterranean countries: - Staiano Annamaria (coordinator), University Federico II, Naples, ITALY - Attard Thomas, University of Malta, Med School, Guardamangia, MALTA - Durmaz Ozlem, Istanbul University, Istanbul, TURKEY - Irastorza Inaki, Hospital Universitario de Cruces, Bilbao, SPAIN - Kolaček Sanja, Children's Hospital, Zagreb, CROATIA - Koleilat Aziz, Makassed University General Hospital, Beirut, LEBANON - Papadopoulou Alexandra, Children's Hospital P & A Kyriakou, Athens, GREECE - Roma Eleftheria, Aghia Sophia Children’s Hospital, Athens, GREECE - Shamir Raanan, Schneider Children's Medical Center of Israel, Tel Aviv, ISRAEL FGIDs Project: PRELIMINARY DATA

4. The Questionnaire The questionnaire included different items assessing: - Cultural, psychosocial and dietary factors - Epidemiology - Clinical diagnosis and use of Rome Criteria - Treatment

5. Preliminary Data Our preliminary data indicate that IBS prevalence is not known and diagnostic approach and treatment varies widely from Country to Country, and particularly so in pediatric patients. Even less is known on prevalence, diagnosis and treatment of all the other FGIDs.

6. Our data indicate that FGIDs represent a real problem also in the Balkans and in Africa. For this reason it is essential to correctly diagnose these disorders in order to optimize the use of economic resources and avoid unnecessary investigations (Eg: EGDS) Preliminary Data

7. FGIDs Project: AIMS 1) To Assess - FGIDs prevalence - Modality of diagnosis and use of Rome Criteria - Way of treatment of these disorders in different Countries 2) To Standardize diagnostic algorithms and treatments of FGIDs 3) To Establish a European- Mediterranean network to share know-how and technology for the diagnosis and management of FGIDs

8. Expected Results To obtain clear definition of FGIDs prevalence dissemination of knowledge and practical skills for the identification and management of FGIDs establishment of a network, expanded in the field outside the reference hospitals

9. Organization Prevalence studies will be performed in the different centers. For each country, a coordinator will identify the first level health professionals fairly distributed across the entire national territory, in order to have the more reliable data on prevalence A survey will be conducted to evaluate current implementation of guidelines in clinical practice. A representative from each involved center will be asked to complete a one page questionnaire investigating his approach to patients with FGIDs suggestive symptoms The ‘hub & spoke’ methodology will be adopted for the progressive training at national level.

10. A multi-lingual project web site helps to share diagnostic guidelines, online consultations, data sharing and analysis, teleconferences Training materials, for different levels and cultures, will be available on line The applicability of guidelines will be evaluated based on the number of patients managed in full compliance with guidelines by trained pediatricians. Organization

11. Gustav Klimt, Le tre età della donna - 1905