Functional Abdominal Pain: Time to Get Together and Move Forward

Abstract

Functional gastrointestinal disorders (FGID) include a combination of chronic or recurrent symptoms not explained by known biochemical or structural abnormalities. They represent a challenging group of conditions that are frequently misdiagnosed in children and are associated with significant morbidity and high health care costs. They account for more than 50% of the consultations in pediatric gastroenterology practice and 2% to 4% of all general pediatric office visits (1). Quality of life in patients with FGID is substantially poorer than in the general population or in those suffering from asthma or migraine (2). Children diagnosed with functional abdominal pain (FAP) or irritable bowel syndrome (IBS) have more abdominal and other somatic pain, functional impairment, and psychiatric symptoms than controls at 5-year follow-up (3), and one third to half of affected children experience persistence of abdominal pain into adulthood. Other studies have suggested an association between childhood functional abdominal pain and long-term comorbidity including depression, anxiety, lifetime psychiatric disorders, social phobia, and somatic complaints (4). In the last 5 years, interest in the study and recognition of FGID in children has escalated. Careful epidemiological studies have been conducted, diagnostic criteria have been proposed and validated, significant progress has been made in understanding the pathophysiological mechanisms underlying several of these conditions, and more evidence-based treatment approaches have been developed. The importance of a multidisciplinary approach to childhood FGID is now widely recognized, and functional disorders have gone from being conditions with the stigma of ‘‘being in the child’s head’’ or that were associated with