Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children (Acta Paediatr 2006; 95 : 573-580)

Sir,I read the article by Ludvigsson, JF for the ABIS studygroup with interest (1). This large population-based co-hort study demonstrates an interesting relationship betweenanorexia and paracetamol use between 1 and 2.5 years.Anorexia might be a result of abdominal pain; however, au-thors have clearly suggested that paracetamol use was notlinked to abdominal pain. Anorexia as well as abdominalpain is more common in constipated children (2). RomaEetal.demonstrated that anorexia was 27.5% in consti-pated children and 5.2% in control subjects. We also in-vestigated the prevalence and associated factors in consti-pation in Bolu in 3453 primary school children (age 6–14years) (a city located in the western Black Sea region ofTurkey) and found that 12.7% of 820 constipated childrenhad poor appetite (whereas remaining had good or moder-ate appetite according to mothers) compared to 7.3% in non-constipated children according to the mother’s self report(p<0.01, OR=1.895% CI 1.4–2.3) (3). So it might be in-teresting to examine the correlation of anorexia to paraceta-mol use while controlling for the constipation in the presentstudy.