Recurrent abdominal pain.

Abstract

1. Paul N. Thiessen, MD* 1. *Editorial Board. Clinical Professor of Pediatrics, B.C. Children’s Hospital, Vancouver, B.C., Canada After completing this article, readers should be able to: 1. Characterize the epidemiology and classification of recurrent abdominal pain. 2. List the major clinical conditions that manifest with recurrent abdominal pain. 3. Describe the most important findings in the history and physical examination of the child who has recurrent abdominal pain that suggest an organic medical condition. 4. Outline a targeted approach to ordering investigations that will confirm or disprove suspected organic disease. 5. Delineate the prognosis of recurrent abdominal pain. Recurrent abdominal pain (RAP) is a frequent and troublesome complaint in childhood and adolescence, and the search for a cause and a credible approach to management can be taxing for both family and physician. The term “recurrent abdominal pain” was coined by the British pediatrician John Apley, who first published on the subject in 1958. His definition included at least three attacks of pain occurring over a period of 3 months that were severe enough to affect activities and for which no organic cause was identified. In practice, the definition may include any child or adolescent who has RAP for which the family seeks medical attention and explanation, even if the duration of the pain does not adhere strictly to the Apley definition. The definition explicitly excludes the many causes of acute abdominal pain, which lie outside the scope of this review. There is wide variation in the threshold of severity and frequency that must be crossed before a family will seek medical attention for a child who has RAP. Inevitably, parents want a clear explanation and reassurance that no sinister causes lurk undetected, and the clinician wants to oblige but often lacks the conviction that organic causes have been excluded. The most difficult challenge for the clinician is to determine to what extent diagnostic studies should be employed before the label “recurrent abdominal …