Functional defecation disorders in children: PACCT criteria versus Rome II criteria

Objectives To evaluate the clinical validity and applicability of the Paris Consensus on Childhood Constipation Terminology (PACCT) versus the Rome 11 criteria for pediatric functional defecation disorders (FDDs). Study design Children from infancy to 17 years who had been referred to a tertiary center for chronic constipation were recruited for the study. A prospective longitudinal design was used. The Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) for parents of children age 0 to 4 and 4 to 17 years and for children age 10 to 17 years was used for diagnosis of FDDs. Results Children (n = 128; mean age, 67.2 months; 62 males) were screened consecutively. FDDs were diagnosed significantly more often by PACCT than by the Rome 11 criteria (112 [88.9%] vs 60 [47.6%]; P =.001). The agreement Cohen's kappa test showed k =.173. A statistically significant difference was reported between Rome 11 and PACCT in the 4- to 17-year-old group (P =.001). Seybalous, pebble-like stools and defecation with straining were the main symptoms reported (80%), followed by painful defecation (66%). Conclusions The PACCT criteria show greater applicability than the Rome 11 criteria for FDDs. The poor agreement implies that they do not identify the same types of patients. Because such a high percentage of constipated children reported the symptoms of defecation with straining, scybalous pebble-like stools, and painful defecation, including these symptoms in any revised criteria should be taken into consideration.