Cause Of Recurrent Abdominal Pain Research Articles

Rezidivierende, stärkste Oberbauchschmerzen bei einem 45-jährigen Patienten

A 45-year-old patient presented with a history of recurrent abdominal pain of unknown origin. The CT scan of the abdomen demonstrated a thickened mesenteric root and a segmental ileus of the jejunum. Laparotomy revealed a neuroendocrine tumour of the small bowel. Such tumours are rare causes of recurrent abdominal pain. Especially when the CT scan of the abdomen reveals mesenteric abnormalities (desmoplastic reaction) and/or a segmental ileus, a neuroendocrine tumour of the small bowel should be considered. The therapy of choice is resection of the tumour followed by systemic therapy including somatostain analogues and chemotherapy in the case of a hormone secreting tumour or metastases.

Investigation of Helicobacter pylori infection in ??-thalassaemia major patients with recurrent abdominal pain

Recurrent abdominal pain (RAP) affects many children, especially those affected by beta-thalassaemia major. The role of Helicobacter pylori is still unclear in children with RAP. The aim of the present study was the comparison of beta-thalassaemia major patients and normal controls with RAP in H. pylori infection. The factors influencing H. pylori prevalence were also investigated. A series of 50 beta-thalassaemia major cases (30 female, 20 male; aged 6-25 years) and 50 age-matched and sex-matched controls, both presenting with RAP, were recruited during a period of 18 months. The study participants were obtained through a multistage random sampling method among those that met Apley's criteria. All the patients and controls had undergone diagnostic oesophagogastroduodenoscopy with biopsy. H. pylori infection was confirmed by two histopathological examinations on an endoscopy sample and a rapid urease test. H. pylori infection in thalassaemic patients was more common than in controls [34/50 (68%) versus 30/50 (60%)], but this higher frequency was not statistically significant. A clear relationship was found between the prevalence of H. pylori and age, duration of transfusion/chelation programmes, pain duration and splenectomy. In contrast, H. pylori did not correlate with abdominal pain characteristics, blood group, serum ferritin level and pathology of the upper gastrointestinal tract. The most frequent endoscopy abnormality was gastritis (72%). Nausea and heartburn were the leading associated symptoms. The high prevalence of H. pylori infection suggests that H. pylori should be remembered as a probable cause of RAP in beta-thalassaemia major patients.

GENETIC PREDISPOSITION FOR PRIMARY HYPOLACTASIA OF THE ADULT TYPE IN CHILDREN AND ADOLESCENTS WITH RECURRENT ABDOMINAL PAIN

Aim: Primary hypolactasia of the adult type (HL) presents clinically as lactose intolerance (LI), a frequent cause of recurrent abdominal pain (RAP). It bears the risk of impaired bone growth due to avoidance of dairy products and thus inadequate calcium intake. Using a molecular genetic assay, genetic predisposition for HL was found in 24% of female adults in our region. There are only few data on this predisposition in children and adolescents as assessed by this method. We used it to determine genetic HL predisposition in children and adolescents with RAP to identify individuals at risk for LI and impaired bone growth. Methods: From VII-XII'04 65/220 patients with self reported RAP fulfilled the ROME II criteria for RAP (f: 38; m: 27; 25/65 < 8 yrs. 40/65 > 8 yrs.) and presented clinically with LI. The LCT genotypes CC, TC and TT were determined by an allele specific PCR-based assay (defining the LCT-[13910]-polymorphism near the lactase phlorizin hydrolyse gene), using 150 microliters of capillary blood or saliva. For compliance reasons lactose H2 breath tests were performed in the elder patients only (17/65). Results: 36/65 patients with RAP and clinical LI were CC homozygote (55.4%; f: 24, m: 12). 23/65 (35.4%; f: 12, m: 11) were TC heterozygote and 6/65 (9.2%; f: 3, m: 3) TT homozygote. 9/17 patients undergoing H2 breath tests had positive results: 7/9 had the CC-, and 2/9 the TC-genotype. Genotypes of the 8 patients with negative results were as follows: CC = 3, TC = 2, TT = 3. Summary: 90.8% of patients with RAP and clinically suspected LI had the CC or TC genotype for HL. Because these genotypes are both associated with a higher risk for osteoporosis, these patients and those with positive H2 breath tests are warranting close observation. An explanation for the negative functional test results in the 3 CC patients might be a higher individual threshold to the oral lactose load. Conclusion: The PCR-based genotyping for lactose gene polymorphisms presented might serve as a valuable screening method for paediatric patients with RAP and at risk for LI and osteoporosis that needs to be performed only once, is unexpensive, easy and feasible from minute blood and saliva volumes respectively.

Irritable bowel syndrome: the commonest cause of recurrent abdominal pain in children.

Apley, working in Bristol, UK, defined recurrent abdominal pain (RAP) in 1958. After extensive investigations, he found that 8% of children presenting to his clinic with RAP had an organic pathology. The aims of this study were to identify (1) causes of RAP using modern methodology, (2) factors associated with organic RAP and (3) children with non-organic RAP who fulfill the diagnostic criteria for irritable bowel syndrome (IBS). Children, aged over 3 years, presenting with RAP were prospectively recruited to this study. They had a detailed questionnaire completed, a full examination with screening tests (blood for coeliac screen, Helicobacter pylori antibody titre, inflammatory markers, serum amylase, liver function tests, and full blood count, urine and stool analyses and abdominal ultrasonography). Endoscopy and oesophageal pH monitoring were performed if clinically indicated. IBS was diagnosed if the child had no organic pathology and fulfilled the Rome II criteria. Out of 103 children (median age of 10 years, mean 10.04, SD +/-3.44), 31 children (30%) had organic pathologies. Factors associated with organic pain were nocturnal symptoms (P<0.01) and abdominal tenderness (P<0.005) and with non-organic pain were periumbilical locality (P<0.002), pain alleviation on defaecation (P<0.04) and low fibre diet (P<0.005). Of children with non-organic pain, 37/52 (51%) fulfilled the criteria for IBS (36% of the total). Of children presenting with recurrent abdominal pain in a hospital setting, 30% have a diagnosable organic aetiology compared to 8% in Apley's time. Irritable bowel syndrome, however, may be the commonest cause of recurrent abdominal pain and should be considered.

P0846 THE ROLE OF INTESTINAL PROTOZOA IN RECURRENT ABDOMINAL PAIN

Introduction: Intestinal protozoa are considered potential pathogens that could be a cause of recurrent abdominal pain (RAP).The aims of the study were to assess the prevalence of protozoal infection, especially with respect to Giardia lamblia (gl), Dientamoeba fragilis (df) and Blastocystis hominis (bh), in children with RAP, and to determine if these parasites have a causative role in some of the patients with RAP. Methods: 100 consecutive patients (57 F, 43 M; mean age 8.76 [range 4.15–15.97] years) who were presented in the hospital of one of the authors (CG) with RAP were investigated for intestinal protozoa. Inclusion criteria: >4 years old, >3 episodes of abdominal pain in the last 3 months, severe enough to affect the daily activities of the child, and referral by a general practitioner. Three stool samples were collected on 3 separate days into 1 vial each. From the stool samples in the 1st and 3rd vial, containing sodium acetate acetic acid formalin (SAF) fixative, parasitological assessment was performed using an iron haematoxylin-Kinyoun (IHK) staining procedure and a Giardia lamblia specific ELISA. The unpreserved 2nd stool sample was examined for (oo)cysts and spores of protozoa. When parasites were detected, patients were treated with metronidazole (20 mg/kg/day for gl, 35–50 mg/kg/day for df and bh) for 10 days. Because of intolerance or refusal of metronidazole some children were treated with tinida-zole (two dosages of 75 mg/kg 1 week apart) or, in case of df, paromomycine (25–35 mg/kg/day for 7 days). At least 1 week after the end of treatment stool examination was repeated, followed by evaluation of complaints during at least 6 months. Results: 6 patients failed to bring stool samples. Of the remaining 94 patients 34 carried parasites (gl [4], df [12], bh [10], df+bh [6], gl+df+bh [2]). 8 patients had spontaneous resolution of abdominal pain. The remaining 26 patients were treated. Faecal control thereafter was negative in 22 patients (gl [3], df [10], bh [4], df+bh [3], gl+df+bh [2]). Of these 22, 12 patients showed resolution of abdominal pain after treatment (gl [0], df [7], bh [1], df+bh [2], gl+df+bh [2]); 11 of these carried df. Conclusion: A significant proportion of children with abdominal pain (34 out of 94) was infected with intestinal parasites. Spontaneous resolution of abdominal pain without eradication of parasites is not unusual. In slightly over half of the patients eradication of parasites resulted in persistent disappearance of abdominal pain; the prevalence of df in these patients suggests a potential role for this parasite in RAP.

P0835 RECURRENT ABDOMINAL PAIN AND HELICOBACTER PYLORI INFECTION IN CHILDREN

Introduction: Recurrent abdominal pain (RAP) is a significant problem in the pediatric population [1], and there has been much recent interest in the role that Helicobacter pylori (Hp) might play in this disorder [2], [3], [4]. The purpose of this study was to look at the causes of RAP in children, the prevalence of Hp infection, and the correlation between this infection and upper gastrointestinal inflammation. Methods: This is a cross-sectional study of 135 children aged 4–15 years in the Children’s Hospitals No 1 and No 2 during a 6-month period in 2001. Patients complaining of RAP underwent upper gastrointestinal endoscopy in order to identify any underlying organic pathology and determine the prevalence of Hp infection. Results: Characteristics of the 135 children with RAP include: under 10 years of age (67.4%), girls (55.6%), living in rural areas (52.6%), and from high income-families (64.4%). Histologically confirmed mucosal inflammation was found in 85 out of 135 children (63%), with gastritis (26.7%), duodenitis (16.3%), gastro-duodenitis (14.8%), and oesophago-gastroduodenitis (5.2%). The Hp infection rate (33.6%) increased with abnormal findings by gross examination (p < 0.0001); children with the endoscopic findings of gastritis (p < 0.0001), duodenitis (p = 0.018), gastro-duodenitis (p = <0.0001) and oesophago-gastroduodenitis (p < 0.0001) were infected more commonly. Boys older than 10 years (p = 0.03), pain that wakes the child from sleep (p = 0.003), prolonged pain over 15 minutes (p = 0.023), anorexia (p = 0.04), vomiting (p = 0.044), and gastrointestinal bleeding (p = 0.0002) were all associated with gastrointestinal inflammation on biopsy. Conclusion: Our data suggests that gastrointestinal pathology is more common than previously thought in children with RAP and that gastritis was the most prominent finding. Hp infection is a relatively important factor in the etiology of upper gastrointestinal inflammation in RAP syndrome, especially in gastro-duodenitis. Follow-up studies are needed to determine the role of Hp eradication therapy in children with RAP.

Çocuklarda tekrarlayan karın ağrısı ve helicobacter pylori enfeksiyonu Orijinal Araştırma

Helicobacter pylori H pylori is a gram negative spiral organism which colonises the gastric mucosa in humans It is the major cause of chronic gastritis and peptic ulcer disease both in children and adults Confusion exists as to whether or not H pyolori associated gastritis is a cause of recurrent abdominal pain in the absence of duodenal ulcer disease The evidence to date strongly suggests that in the absence of duodenal ulcer disease H pylori infection is not an important cause of recurrent abdominal pain in children Should H pylori be treated in children without peptic ulcer disease? At present the evidence suggests that eradication of H pylori in patients without duodenal ulcer disease is unnecessary The enormous body evidence however suggests that this organism has an important role in the pathogenicity of duodenal ulcer disease in adults and children Eradication should be considered as a major part of the treatment of duodenal ulcer disease Key words: helicobacter pylori recurrent abdominal pain duodenal ulcer chronic gastritis child

Isolated visceral angioedema induced by an ace-inhibitor: an unusual cause of recurrent abdominal pain

Isolated visceral angioedema induced by an ace-inhibitor: an unusual cause of recurrent abdominal pain

Recurrent abdominal pain.

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 …

Recurrent abdominal and flank pain in children with idiopathic hypercalciuria

To evaluate the role of idiopathic hypercalciuria (IH) as a cause of recurrent abdominal pain (RAP) in children. We retrospectively reviewed the medical records of 124 children referred for various complaints who had 24-h urine calcium excretion greater than 2 mg/kg/d or random urine calcium-creatinine ratio greater than 0.18 mg/mg. Fifty-two children with various clinical complaints had RAP or flank pain. These comprised of 22 males and 30 females, 9 mo to 15.9 y of age, mean 6.7 +/- 3.5 y. A family history of urolithiasis was present in 50% of all the children. Only 6 of the 52 children with abdominal pain had renal stones. In addition to abdominal pain, 27 children had hematuria and 10 had urinary incontinence. Mild metabolic acidosis was present in three children, parathyroid hormone activity elevated in two and serum vitamin D activity was increased in nine. All children were treated with increased fluid intake and a reduction in dietary sodium and oxalate and some required treatment with thiazide and antispasmodics. Forty-five cases responded to treatment, 5 failed to improve from therapy, and 2, which were not followed up as patients, were not available. We describe 52 children with RAP or back pain due to IH and recommend that IH be considered in the differential diagnosis of RAP in childhood.

Recurrent abdominal and flank pain in children with idiopathic hypercalciuria

Objective: To evaluate the role of idiopathic hypercalciuria (IH) as a cause of recurrent abdominal pain (RAP) in children. Patients and methods: We retrospectively reviewed the medical records of 124 children referred for various complaints who had 24-h urine calcium excretion greater than 2mg/kg/d or random urine calcium-creatinine ratio greater than 0.18mg/mg. Results: Fifty-two children with various clinical complaints had RAP or flank pain. These comprised of 22 males and 30 females, 9 mo to 15.9 y of age, mean 6.7 3.5 y. A family history of urolithiasis was present in 50% of all the children. Only 6 of the 52 children with abdominal pain had renal stones. In addition to abdominal pain, 27 children had hematuria and 10 had urinary incontinence. Mild metabolic acidosis was present in three children, parathyroid hormone activity elevated in two and serum vitamin D activity was increased in nine. All children were treated with increased fluid intake and a reduction in dietary sodium and oxalate and some required treatment with thiazide and antispasmodics. Forty-five cases responded to treatment, 5 failed to improve from therapy, and 2, which were not followed up as patients, were not available. Conclusion: We describe 52 children with RAP or back pain due to IH and recommend that IH be considered in the differential diagnosis of RAP in childhood.

Recurrent abdominal pain, food allergy and endoscopy

Gastrointestinal food allergy, a well-recognized clinical entity, has a wide spectrum of clinical features, including cutaneous, respiratory and gastrointestinal symptoms and objective abnormalities. The gastrointestinal alterations in food allergy have been described throughout the gastrointestinal tract. Recurrent abdominal pain (RAP) is a common complaint in school-age children. The findings among children with RAP of an underlying food allergy associated with mucosal pathology of the foregut may support a causal relationship between food allergy and RAP. Further studies are needed to elucidate whether well-documented food allergy (based on double-blind placebo-controlled food challenges) is a major cause of RAP.

Elective laparoscopic cholecystectomy.

Gallbladder stones are very common in patients with sickle cell disease and are the cause of recurrent abdominal pain. Their management has been highly controversial, especially for children. Nonoperated patients and those treated on an emergency basis have a very high rate of morbidity (>50%). We performed a retrospective review of a series of 29 homozygous SS sickle cell children who underwent laparoscopic cholecystectomy between 1991 and April 1998. Only in one case a conversion was necessary (early in the series). Exploration of the common bile duct was done via intraoperative cholangiography. There were no mortalities. The morbidity rate was 17%; (however, of the five patients concerned, four suffered from hyperthermia for 2 days. All of the children were improved and enjoyed resolution of their abdominal pain. We believe that elective laparoscopic cholecystectomy at the earliest time possible, along with correct perioperative management, is the treatment of choice for cholelithiasis in children with sickle cell disease.

Place d' Helicobacter pylori dans les douleurs abdominales de l'enfant

Helicobacter pylori (H. pylori) colonizes the human stomach, especially during childhood. H. pylori gastritis, in the absence of duodenal ulcer, does not appear to be associated with specific symptoms. After eradication of H. pylori infection, abdominal pain is improved only in children with duodenal ulcer. Children with H. pylori gastritis cannot be distinguished from uninfected children on the basis of initial symptoms. However, although not demonstrated, a relationship between H. pylori and recurrent abdominal pain might exist since some studies showed that H. pylori-infected children present more frequent pain related to meals or ulcer-like symptoms. These discrepancies could be explained by the fact that H. pylori is probably not a frequent cause of recurrent abdominal pain. The use of refined clinical characteristics of abdominal pain could be of help identifying a subgroup of patients with abdominal pain in whom H. pylori infection needs to be sought and treated. Recent pediatric consensus conferences recommend testing for H. pylori infection by endoscopy only those patients presenting symptoms suggestive of an organic origin.

Is There a Reduction of Postoperative Adhesion Formation in the Pediatric Age Group after Laparoscopy Compared with Open Surgery?

ABSTRACT Background and Purpose: Intraperitoneal adhesions are the most frequent cause of recurrent abdominal pain and intestinal obstruction after traditional open abdominal surgery. We sought to determine the true incidence of adhesion formation after laparotomy and laparoscopy in children. Patients and Methods: We examined the clinical data of 55 children operated on laparoscopically in our department from 1996 to 1998. All of these children had already undergone surgery: 27 had had laparoscopy and 28 a laparotomy. Results: Of the 27 postlaparoscopy patients, only 5 (18%) presented adhesions, whereas 24 of the 28 patients (85%) who had undergone laparotomy were found to have adhesions. In this latter group, seven presented with recurrent abdominal pain, which was the indication for the second procedure. One of these patients had a partial intestinal obstruction. In the remaining 47 patients, the laparoscopy was not occasioned by abdominal pain or obstruction. Conclusions: These preliminary results and ...

An unusual cause of recurrent abdominal pain

Abdominal pain is a common complaint with diverse etiologies. We describe an unusual case of recurrent abdominal pain in an adult due to lead poisoning, a condition usually associated with childhood. A previously healthy 42-yr-old man presented with 2 days of severe crampy abdominal pain and a 1-month history of constipation. Physical examination was remarkable for diffuse abdominal pain but peritoneal signs were not present. Blood tests were remarkable for hematocrit of 33 and mean cell volume of 78, with ovalocytes and basophilic stippling on blood smear. Abdominal x-ray showed stool throughout the colon and a nonspecific bowel gas pattern. The patient was treated with intravenous fluids and enemas, and his symptoms resolved within 2 days. Repeat history taking revealed he had been stripping paint from an old Victorian house in the preceding few months. He was discharged after a blood lead level was obtained. Before his clinic appointment he was readmitted 2 days later with recurrent abdominal pain. His blood lead level was elevated at 110 μg/dl (toxic range). After consultation with the Occupational Health and Safety Administration and local poison control service, he was treated with intravenous calcium edetate disodium and intramuscular dimercaprol. He was asymptomatic at discharge, with a level of 56 μg/dl. Two weeks later, a repeat level was elevated at 72 μg/dl, for which he received a 3-wk course of oral dimercaptosuccimer. Subsequent levels were unremarkable, and the patient remains asymptomatic. Abdominal pain secondary to lead poisoning in adults is uncommon. This case highlights the importance of taking a detailed occupational history and appropriately using “routine” blood tests to diagnose a rare condition that presented with a common complaint.

Evaluation of 13CO 2 breath tests for the detection of fructose malabsorption

Breath hydrogen (H 2) studies have made clear that small intestinal absorption of fructose is limited, especially in toddlers. Malabsorption of fructose may be a cause of recurrent abdominal pain and chronic nonspecific diarrhea (toddler's diarrhea). Fructose absorption is facilitated by equimolar doses of glucose and, as we have found, amino acids (especially L-alanine); the mechanism underlying this effect remains unclear. To study fructose absorption in a more direct way, we combined breath H 2 studies with breath 13CO 2 studies. Gastric emptying was studied by using L-glycine-1- 13C in 4 children from 12.1 to 16.0 years of age. After 25 gm of fructose and 27.5 gm of glucose, when given together, gastric emptying was significantly ( p < 0.05) slower than with either sugar alone. In a second series of experiments, 5 children from 12.0 to 15.9 years of age were tested with 25 gm of fructose, alone and with equimolar doses of glucose and L-alanine, and 4 younger children from 3.1 to 6.1 years of age were tested with 2 gm/kg (max 37.5 gm) fructose, alone or with an equimolar dose of L-alanine. All fructose solutions were enriched with 15 mg of D-fructose- 13C-6. In all 9 children, fructose was malabsorbed as judged by breath H 2 increases ≥ 20 ppm, and the addition of glucose or L-alanine resulted in significantly lower breath H 2 increases ( p <- 0.005 for glucose, p <- 0.001 for alanine). In contrast, the addition of alanine or glucose did not change the pattern of breath 13CO 2 excretion in the 5 older children, whereas in the 4 younger children (with relatively higher doses), L-alanine addition resulted in significantly lower increases in breath 13CO 2. In the latter group, for each time point, breath H 2 and 13CO 2 concentrations after fructose were compared with those after fructose plus L-alanine; in 20 out of 24 points, both H 2 and 13CO 2 were higher after fructose. These results suggest that 13CO 2 not only originated from the oxidation of absorbed substrate but also, at least in part, from colonic bacterial metabolism. For the detection or fructose malabsorption—as opposed to, for instance, lactose—the 13CO 2 breath test seems to be of limited value.

The clinical significance of disaccharide maldigestion

The prevalence of lactose maldigestion is lowest in Scandinavia and Northwest Europe (3-8%) and close to 100% in most of Southeast Asia. In Europe the frequency increases in the southern and eastern directions, reaching 70% in southern Italy and Turkey. There is also a high prevalence of lactose maldigestion in the people of Africa with the exception of cattle-raising nomads. Lactose maldigestion causes uncharacteristic abdominal symptoms such as bloating, borborygmus, colic, flatulence, and diarrhea. The degree of discomfort depends on the amount of lactose consumed, but also on an individual sensitivity to lactose. The symptoms of irritable bowel syndrome (IBS) and lactose maldigestion are similar. Consequently, most investigations indicate an increased frequency of lactose maldigestion in patients suffering from IBS. Recurrent abdominal pain (RAP) in children corresponds to IBS in adults. Lactose maldigestion is a frequent cause of RAP in regions with a high prevalence of lactose maldigestion in early childhood. Diffuse small-intestinal damage in celiac disease or kwashiorkor leads to a proportional decrease of all disaccharidase activities, with the most pronounced being decrease of lactase. The consumption of milk may then cause abdominal discomfort and increased diarrhea. Several investigations have indicated an increased frequency of lactose maldigestion in patients with osteoporosis. A connection between lactose maldigestion and decreased absorption of calcium has not been proven, however. The increased tendency toward osteoporosis is more likely caused by a lower calcium intake because of milk intolerance. Milk and dairy products with reduced lactose content are better tolerated by patients with lactose maldigestion.(ABSTRACT TRUNCATED AT 250 WORDS)

The humoral immune response to Helicobacter pylori infection in children with recurrent abdominal pain

The systemic humoral immune response to Helicobacter pylori antigens was investigated in 36 children with recurrent abdominal pain (RAP). H. pylori was cultured and Helicobacter-like organisms (HLO) were seen in six children, three of whom had active and two inactive chronic gastritis. None of these children had endoscopic abnormalities. All sex children had increased IgG antibodies to heat-stable H. pylori antigens which were of the IgG1 and IgG3 subclasses. Using six other IgG tests, four of which were commercially available, two to five H. pylori-positive children were found seropositive. Five of six H. pylori-negative children with inactive chronic gastritis and no endoscopic abnormalities had increased IgM antibody levels in addition to increased or borderline increased IgG antibody levels to H. pylori, indicating activity in a chronic H. pylori infection. Five children without H. pylori and with no morphological changes, but with gastritis or duodenitis by endoscopy, had significantly lower IgG and IgA antibody levels compared to other groups. Six of nineteen children without H. pylori, and with no morphological or endoscopic changes had increased IgG and IgM antibody levels to H. pylori. All H. pylori-negative children were seronegative by the four commercial kits. Overall, 12 (33%) of 36 children with RAP were either H. pylori positive by culture and microscopy or had increased IgG antibody levels to H. pylori, which is significantly different from the 10-14% seropositive rate of asymptomatic children. H. pylori may therefore be a cause of RAP in one quarter to one third of the children with RAP in whom other etiologies of RAP are excluded. Further studies on a large number of children are needed for an extended evaluation of the humoral immune response to H. pylori and for further examination of commercial kits which seem to give a high number of false-negative results.

Diagnostic value of ultrasound in children with recurrent abdominal pain

In order to investigate the diagnostic value of ultrasound in children with recurrent abdominal pain and to estimate the clinical relevance of rare organic causes of abdominal pain in these patients, we prospectively examined 93 children aged between 5.5 and 12 years by means of abdominal ultrasound. In 3 patients (3.2%) an anatomic abnormality was detected, which could not account for the abdominal pain. We conclude that many organic abnormalities, that could be diagnosed by ultrasound, are clinically irrelevant as a cause of recurrent abdominal pain in children and therefore ultrasound does not significantly contribute to the diagnosis. However, ultrasound can still play a role in the work-up of children with recurrent abdominal pain in avoiding unnecessary radiologic X-ray procedures.