Chronic Abdominal Pain

Abstract

Listen

Translate article

1. Brynie Slome Collins, MD* 2. Dan W. Thomas, MD† 1. *Clinical Fellow, Children's Hospital of Los Angeles, Los Angeles, Calif 2. †Editorial Board After completing this article, readers should be able to: 1. Define chronic abdominal pain (CAP). 2. Differentiate between functional and nonfunctional CAP. 3. Describe the symptom-based subtypes of CAP based on the Rome III criteria. 4. Diagnose and treat each subtype defined by the Rome III criteria. 5. Determine when referral to a pediatric subspecialist is necessary. Chronic abdominal pain (CAP) is a frequent childhood complaint encountered by primary care physicians as well as by pediatric and surgical subspecialists. The exact prevalence of CAP is unknown, although the literature reports that 13% of middle school children and 17% of high school children experience weekly abdominal pain and that this complaint accounts for 2% to 4% of all pediatric office visits. The economic cost related to CAP in children also is unknown, but it is likely to be substantial, given that expenses associated with irritable bowel syndrome (IBS) in adults (prevalence, 11% to 14%) have been estimated to be $8 to $30 billion per year. First introduced into the literature by Apley and Naish in 1958, the term CAP, also previously called “recurrent abdominal pain” or “RAP,” was used to describe children who experienced at least three bouts of pain severe enough to affect daily activities over a period of at least 3 months. Throughout the last 5 decades, however, CAP has changed definitions several times, most recently being used to describe all children who have abdominal pain for which a specific cause cannot be identified. We now understand that CAP is not a specific diagnosis, but rather a description of a heterogeneous group of patients who have a variety of symptoms. In children, CAP usually is functional; that is, no readily identifiable physiologic, structural, or biochemical abnormalities are present. In 1997, a pediatric workshop was held in Rome, Italy, to standardize the diagnostic criteria for …