Functional Recurrent Abdominal Pain Research Articles

Recurrent Abdominal Pain in School Age Children

Abstract Background Abdominal pain defined as any type of pain or discomfort that occurs in any area from the lower chest to the groin. Abdominal pain is symptom of a wide variety of mild to serious diseases, disorders, conditions. Abdominal pain can result from infection, malignancy, inflammation, obstruction and other abnormal processes. Aim of the Work To define the causes of recurrent abdominal pain among a sample of school age children. Subjects and Methods This cross sectional study was carried out to evaluate those children who presented to the Pediatric Outpatient Clinic, Children Hospital, Ain Shams University because of recurrent abdominal pain they were diagnosed in the pediatric Gastroenterology unit between June 2016 and July 2017. History taking included full analysis of abdominal pain, associated gastrointestinal symptoms and associated systemic manifestations. Examination included anthropometric measurements, general and local abdominal examination. Routine investigations included complete blood counts, urine analysis and culture, microscopic stool examination and pelviabdominal US. Other specific investigations were selected according to clinical manifestations to reach an organic cause. After reaching the definitive diagnosis, patients were classified into 2 groups organic causes and functional abdominal pain. Results During the study period, 100 children presented with recurrent abdominal pain. Results revealed that only 28% of the recurrent abdominal pain causes were attributed to organic factors; the most commonly encountered organic causes of recurrent abdominal pain were urinary tract infection (12%) while 72% of children presented with functional recurrent abdominal pain. The most common causes of function recurrent abdominal pain in our study was irritable bowel syndrome. Conclusion Most of the cases of RAP among school age children are due to functional abdominal pain (72%).

Long-term Outcome of Children with Recurrent Abdominal Pain

We report on long-term follow-up [mean (SD) duration, 44.7 (4.3) mo] of 48 out of 132 children with recurrent abdominal pain, who were a part of an earlier study at our hospital. 31 (64.5%) children still experienced pain; 26 (54.1%) reported their pain to be better than before, 4 children reported it to be same as before, and one child reported it worse than before. 17 out of 31 children had pain fitting into one of the categories of functional gastrointestinal disorders in the Rome III criteria; most commonly functional abdominal pain (n=6) and functional constipation (n=3). In majority of children with functional recurrent abdominal pain, pain may persist over the next 3-4 years, but shows slight improvement in frequency and severity.

Sa2003 Increased Duodenal Intra Epithelial Lymphocytes (IELs) are Associated With Recurrent Abdominal Pain and Parasite Infection but Not Helicobacter pylori in a Paediatric Chilean Cohort

Introduction Functional Recurrent Abdominal Pain (RAP) is a paediatric functional gastrointestinal disorder with poorly investigated pathophysiology. Proposed aetiology varies and the diagnosis is characterised by Rome III criteria. Some studies consider Helicobacter pylori to be a cause of RAP, while others disagree. The aim of this study was to investigate upper gastrointestinal pathology in a cohort of 123 children in Chile with respect to RAP, H pylori infection and other concurrent infection. Methods This blinded retrospective and IRB-approved study analysed biopsies taken from the gastric antrum and body and the duodenum in 123 Chilean children referred to endoscopy (with informed parental consent). Histopathology was evaluated against a clinical database which included symptoms, symptom duration and endoscopy findings. Rome III criteria were used to assign RAP to the relevant cases. All patients had stool microbiology and parasitology. H pylori infection was assessed by serology and histology. In the duodenum, routine histopathology and also eosinophil counts (in 5HPF ×40 magnification), were performed by microscopy. IELs/100 enterocytes were counted. Independently those patients with IELs >25 had serology performed for coeliac disease. Results Overall 105 patients were diagnosed with RAP and 12 patients were able to act as controls, having no symptoms of RAP or concurrent infection. The Rome III diagnosis of RAP was significantly associated with higher IEL counts (>20 in 74 patients) compared to controls (p=0.04). Furthermore, a higher IEL count was also positively associated with parasitic infection (nine with parasites) (p=0.02). Of 16 patients with lymphocytic duodenosis, (>25 IELs per 100 enterocytes) only three were infected by H pylori . One had coeliac disease with positive serology. Antral nodularity was observed in association with lymphoid follicles (p≤0.01) and H pylori infection (p H pylori but infection was not significantly associated with RAP (p=0.55) or parasite infection, as concurrent infection was present in only 2 patients (p=0.24). Conclusion From this study, low grade inflammation, manifest by increased IELs, may be associated with RAP and also parasitic infection. H pylori is not associated with parasite infection. However, as eosinophilia was not significantly associated with the condition further investigation is required to elucidate the potential involvement of innate immunity, including mast cells. Furthermore, there is no association between H pylori infection and RAP. Funded by EU CONTENT Project (INCO-CT-2006-032136), CONICYT/BM (RUE #29) and Fondecyt #1100654 (Chile). Competing interests None declared.

A randomised controlled trial of written self-disclosure for functional recurrent abdominal pain in youth

Written self-disclosure (WSD) has rarely been evaluated as an intervention for paediatric diseases. To test the efficacy of WSD for youths aged 11–18 years with a diagnosis of functional recurrent abdominal pain (RAP), 63 were randomly assigned to receive standard medical care (SMC) alone or WSD in addition to SMC. WSD was administered in three 20-min sessions, one in the clinic and two by phone in the home. Measures of self-reported pain frequency, somatisation severity and quality of life (QOL) were completed at baseline and 3- and 6-month follow-up points. Blind review of electronic medical records provided data on clinic visit and phone consultation utilisation for the 6 months prior to and following baseline. Practice of WSD in addition to SMC was associated with significantly fewer activity-limiting gastrointestinal pain experiences (d = 0.61) and reduced health care utilisation (d = 0.59) 6 months later compared to SMC alone. There were no significant effects for somatisation severity or QOL in 6 months. WSD may be a useful treatment adjunct for reducing pain frequency and resulting health care utilisation in a portion of youths with functional RAP.

Treatment of Chronic Recurrent Abdominal Pain: Laparoscopy or Hypnosis?

Functional chronic recurrent abdominal pain (FCRAP) is long lasting, intermittent, or constant pain affecting 15-30% of children ages 4-18 and presents a diagnostic and treatment challenge to the physician. The predictive value of diagnostic tests is questionable, and studies of the treatment of chronic abdominal pain show inconclusive evidence regarding diet regimens as well as medical and surgical treatments. However, there is evidence that cognitive-behavioral therapy may be useful in improving pain and disability outcome. Increasing the understanding of the neural-pain pathways and research in cognitive modulation of pain led to the application of behavioral strategies in children with FCRAP with variable success. However, the use of hypnotherapy in children with recurrent abdominal pain is not common. During the last 3 years, we have implemented hypnosis as the preferred treatment for patients with FCRAP. In the current study, we aimed to summarize our experience with hypnosis for the treatment of FCRAP in children. Twenty patients who met the criteria for FCRAP were candidates for hypnosis. Hypnosis or imagery was offered to the families, of whom 3 refused. Seventeen patients underwent just one single session of hypnosis. A possible nonorganic etiology for the abdominal pain was revealed in all cases. In 14 adolescents, all clinical symptoms resolved. Hypnosis was not effective in 3 cases, in whom secondary gain was probably responsible for their symptoms. No side effects have been noted during and after the study. Follow-up was available for a period of 4-24 months. Although effective in the management of acute pain and distress in pediatric cancer patients, the use of hypnotherapy in children with FCRAP is not a common practice. The current study highly supports the use of hypnosis as a part of the biobehavioral approach for this dilemma.

Changes in the Prevalence of Biopsy-proven Helicobacter pylori Infection in Korean Children with Functional Recurrent Abdominal Pain Over the Last 18 Years

Changes in the Prevalence of Biopsy-proven <i>Helicobacter pylori</i> Infection in Korean Children with Functional Recurrent Abdominal Pain Over the Last 18 Years

Gastric myoelectrical and motor abnormalities in children and adolescents with functional recurrent abdominal pain

Recurrent abdominal pain is common among children and adolescents. The majority of the affected patients have no apparent cause for their symptoms. This study evaluated gastric myoelectrical activity and motility abnormalities in children and adolescents with functional recurrent abdominal pain. Forty-two children with functional recurrent abdominal pain [19 (45.2%) males, mean 8 years, SD 3 years, 19 functional abdominal pain, 9 irritable bowel syndrome, 9 functional dyspepsia, 1 abdominal migraine, 1 aerophagia and 3 non-specific abdominal pain according to Rome III criteria] and 20 healthy children [10 (50%) males, mean 9 years, SD 2.7 years] from the same geographical area underwent electrogastrography (EGG), and ultrasonographic assessment of gastric emptying rate and antral motility. Average gastric emptying rate, amplitude of antral contractions and antral motility index were lower in patients (46.5%, 74.3% and 6.5 respectively) compared to controls (66.17%, 89% and 8.3 respectively) (P < 0.001). Gastric emptying rate had a negative correlation with scores obtained for severity of symptoms (r = -0.63, P < 0.0001). Postprandial dominant frequency instability co-efficient (post-DFIC) was higher in patients than in controls (27.83% vs 18.3%, P = 0.0087), and correlated with the symptom score (r = 0.26, P = 0.045). Gastric emptying and antral motility were significantly impaired in patients, indicating a possible role for gastric motility disturbances in the pathogenesis of childhood functional recurrent abdominal pain. Further studies, including therapeutic trials, are needed to confirm this association and for recommendation of prokinetic drugs in its management.

The Functional Recurrent Abdominal Pain (RAP) in Children May be the Precursor of Adult Migraine

The Functional Recurrent Abdominal Pain (RAP) in Children May be the Precursor of Adult Migraine

Citalopram Treatment of Pediatric Recurrent Abdominal Pain and Comorbid Internalizing Disorders: An Exploratory Study

To assess the potential efficacy, tolerability, and safety of citalopram in the treatment of functional pediatric recurrent abdominal pain and comorbid internalizing disorders. Twenty-five clinically referred children and adolescents with recurrent abdominal pain aged 7 to 18 years, inclusive, participated in a 12-week, flexible-dose, open-label trial of citalopram. Primary outcome measure was the Clinical Global Impression Scale-Improvement, with responders defined by ratings of 1 (very much improved) or 2 (much improved). Secondary measures included self- and parent reports of abdominal pain, anxiety, depression, other somatic symptoms, and functional impairment. Side effects were assessed using a standardized checklist. Data were analyzed using an intent-to-treat format and the last observation carried forward procedure. Twenty-one subjects (84%) were classified as responders (Clinical Global Impression Scale-Improvement score < or =2). Citalopram was generally well tolerated. Four subjects withdrew prematurely, one due to reported visual side effects. Ratings of abdominal pain, anxiety, depression, other somatic symptoms, and functional impairment all improved significantly over the course of the study compared with baseline. Citalopram is a promising treatment for functional pediatric recurrent abdominal pain and deserves additional study with a randomized, placebo-controlled clinical trial.

Recurrent abdominal pain, anxiety, and depression in primary care

. Campo JV, Bridge J, Ehmann M, Altman S, Luca A, Birmaher B, Di Lorenzo C, Iyengar S &amp; Brent D. ( 2004 ) Pediatrics , 113 , 817 – 824 . ObjectiveThe prevalence of psychiatric disorder in children and adolescents with functional recurrent abdominal pain (RAP) is unknown. Our aim was to determine whether RAP is associated with psychiatric symptoms and disorders, anxious temperament and functional impairment in paediatric primary care.MethodsChildren and adolescents who were 8–15 years of age, inclusive, and presented with RAP (n = 42) or for routine care in the absence of recurrent pain (n = 38) were identified by a screening procedure in paediatric primary care office waiting rooms and recruited to participate in a case–control study. Outcome measures were psychiatric diagnoses generated by standardized psychiatric interview administered blind to subject status and self, parent and clinician ratings of child psychiatric symptoms, temperamental traits and functional status.ResultsRAP patients were significantly more likely to receive a diagnosis of a psychiatric disorder, with a categorical anxiety disorder in 33 (79%) and a depressive disorder in 18 patients (43%), and higher levels of anxiety and depressive symptoms, temperamental harm avoidance and functional impairment than control subjects. Anxiety disorders [mean age of onset: 6.25 (standard deviation: 2.17) years] were significantly more likely to precede RAP [mean age of onset: 9.17 (standard deviation: 2.75) years] in patients with associated anxiety.ConclusionsYouths who present with RAP in primary care deserve careful assessment for anxiety and depressive disorders. Future studies should examine treatments that are proved to be efficacious for paediatric anxiety and/or depressive disorders as potential interventions for RAP. Longitudinal, family and psychobiological studies are needed to illuminate the nature of observed associations among RAP, anxiety and depression.

Sleep patterns in children and adolescents with functional recurrent abdominal pain: objective versus subjective assessment

To document objective sleep patterns of children and adolescents with functional recurrent abdominal pain (RAP), and to compare them with subjective sleep assessments and sleep patterns of healthy controls. Subjective sleep reports and sleep habit assessments were obtained from 25 adolescents with functional RAP and from 15 age- and gender-matched healthy volunteers, and were compared with continuous movement monitoring using the Actigraph for 7 consecutive days. Abdominal pain before falling asleep was a unanimous complaint in the RAP group, with 29% reporting awakening from sleep by the pain. Only 25% of RAP patients assessed their sleep quality as good, compared with 87% of the control group. Objective sleep patterns measurements of the RAP patients were similar to those of the control group as well as to measurements observed in a large population of school-aged children and adolescents. This study of a small group of children and adolescents with functional RAP provides objective evidence that their sleep patterns do not differ from those of normal peers, despite their subjective complaints.

Sleep patterns in children and adolescents with functional recurrent abdominal pain: objective versus subjective assessment

Sleep patterns in children and adolescents with functional recurrent abdominal pain: objective versus subjective assessment

Recurrent abdominal pain, anxiety, and depression in primary care.

The prevalence of psychiatric disorder in children and adolescents with functional recurrent abdominal pain (RAP) is unknown. Our aim was to determine whether RAP is associated with psychiatric symptoms and disorders, anxious temperament, and functional impairment in pediatric primary care. Children and adolescents who were 8 to 15 years of age, inclusive, and presented with RAP (N = 42) or for routine care in the absence of recurrent pain (N = 38) were identified by a screening procedure in pediatric primary care office waiting rooms and recruited to participate in a case-control study. Outcome measures were psychiatric diagnoses generated by standardized psychiatric interview administered blind to subject status and self, parent, and clinician ratings of child psychiatric symptoms, temperamental traits, and functional status. RAP patients were significantly more likely to receive a diagnosis of a psychiatric disorder, with a categorical anxiety disorder in 33 (79%) and a depressive disorder in 18 patients (43%), and higher levels of anxiety and depressive symptoms, temperamental harm avoidance, and functional impairment than control subjects. Anxiety disorders (mean age of onset: 6.25 [standard deviation: 2.17] years) were significantly more likely to precede RAP (mean age of onset: 9.17 [standard deviation: 2.75] years) in patients with associated anxiety. Youths who present with RAP in primary care deserve careful assessment for anxiety and depressive disorders. Future studies should examine treatments that are proved to be efficacious for pediatric anxiety and/or depressive disorders as potential interventions for RAP. Longitudinal, family, and psychobiological studies are needed to illuminate the nature of observed associations among RAP, anxiety, and depression.

Peptic ulcer

OBJECTIVE: To present a current review about pathogenesis, pathophysiology, diagnosis, and treatment of peptic ulcer disease in children, based on the reviewed publications and the author personal experience. METHODS: We revised the most relevant articles about peptic ulcer in children, published from the last 20 years. RESULTS: The gastroduodenal peptic ulcer is very common in adults, mostly in the developing countries. Although it is less frequent in children, the optical fibroendoscopy has improved the number of diagnosed cases. The peptic ulcer is classified as its etiology in primary and secondary. The secondary peptic ulcer is related to a subjacent disease or use of drugs, while the primary ulcer happens in the absence of underlying systemic diseases The primary duodenal ulcer is the most common presentation, and there are strong evidences of the H. pylori association in the etiology. Clinical presentation changes with age and ulcer type. Secondary ulcers are mostly acute and sometimes dramatic, while the primary ones have a chronic evolution mostly similar to patients with functional recurrent abdominal pain, but the presence of epigastric pain, feeding-related pain, vomiting, bleeding, familiar history for peptic ulcer, nocturnal pain, and male gender are strongly related to peptic ulcer. The acid antisecretory agents have great efficacy on relieving symptoms and solving ulcerate lesion, although the H. pylori eradication itself prevents primary duodenal ulcer recurrence. CONCLUSIONS: The primary peptic ulcer involve many factors in Its etiopathogenesis, being H. pylori the most important of them Although there isn t yet a ideal therapeutic course. The antibiotics play an important role in peptic ulcer and the H. pylori research must be done for na accurate diagnosis and treatment.

Salivary and gastric fluid secretory immunoglobulin A and free secretory component concentrations in children with Helicobacter pylori-positive gastritis.

The concentrations of secretory IgA (sIgA) in the saliva and the concentrations of free secretory components (FSC) both in the saliva and gastric fluid of patients with Helicobacter pylori HP-positive gastritis and of a control group with functional recurrent abdominal pain (RAP) were measured in order to determine whether there is a deficiency of these non-specific local defence factors in children with HP infection. Eighteen patients with HP-positive gastritis and 12 children with RAP were included in the study and sIgA and FSC concentrations were analysed using the radial immunodiffusion technique. In contrast to our initial hypothesis, the concentrations of FSC in saliva and gastric fluid and sIgA in saliva of patients with HP infection showed no significant difference when compared with children who do not have an organic disease and HP infection. It is suggested that these local defence factors are not involved in the pathogenesis of HP-positive gastritis.

Levels of Peptidoleukotriene E4 Are Elevated in Active Crohn's Disease

Summary: Proinflammatory mediators, including leukotriene (LT) B4, are elevated in the intestinal mucosa in active chronic inflammatory bowel diseases (IBD). LTE4 is the major peptidoleukotriene metabolite and it is stable in urine. The aim of this study was to measure LTE4 levels in the urine of 27 children with Crohn's disease and 27 control subjects including 12 children with functional recurrent abdominal pain and 15 unaffected siblings of IBD patients. LTE4 levels were measured in urine using high‐performance liquid chromatography separation and radioimmunoassay with specific antibody. The Pediatric Crohn's Disease Activity Index and physician global assessment were used to categorize patient groups. C‐reactive protein, orosomucoid, and erythrocyte sedimentation rate were employed as laboratory markers of mucosal inflammation. Urinary LTE4 levels were elevated in the 13 children with active Crohn's disease (160.5 ± 59.4 pg/ml; mean ± SEM) compared with both levels in the 14 patients with inactive disease (67.1 ± 18.1 pg/ml; p &lt; 0.05) and controls (45.0 ± 10.9 pg/ml; p &lt; 0.05). We conclude that measurement of urinary LTE4 is a useful test for monitoring the activation of peptidoleukotrienes in patients with Crohn's disease. It provides a noninva‐sive, objective adjunct for assessment of disease activity and could be employed in future trials examining the role of the leukotriene inhibitors in the medical therapy of IBD.

Levels of peptidoleukotriene E4 are elevated in active Crohn's disease.

Proinflammatory mediators, including leukotriene (LT) B4, are elevated in the intestinal mucosa in active chronic inflammatory bowel diseases (IBD). LTE4 is the major peptidoleukotriene metabolite and it is stable in urine. The aim of this study was to measure LTE4 levels in the urine of 27 children with Crohn's disease and 27 control subjects including 12 children with functional recurrent abdominal pain and 15 unaffected siblings of IBD patients. LTE4 levels were measured in urine using high-performance liquid chromatography separation and radioimmunoassay with specific antibody. The Pediatric Crohn's Disease Activity Index and physician global assessment were used to categorize patient groups. C-reactive protein, orosomucoid, and erythrocyte sedimentation rate were employed as laboratory markers of mucosal inflammation. Urinary LTE4 levels were elevated in the 13 children with active Crohn's disease (160.5 +/- 59.4 pg/ml; mean +/- SEM) compared with both levels in the 14 patients with inactive disease (67.1 +/- 18.1 pg/ml; p < 0.05) and controls (45.0 +/- 10.9 pg/ml; p < 0.05). We conclude that measurement of urinary LTE4 is a useful test for monitoring the activation of peptidoleukotrienes in patients with Crohn's disease. It provides a noninvasive, objective adjunct for assessment of disease activity and could be employed in future trials examining the role of the leukotriene inhibitors in the medical therapy of IBD.

The “Psychosomatic Family” Model: An Empirical and Theoretical Analysis

Evolution of the Family Systems Paradigm has been constrained by the dichotomy between theory building and empirical research. This article integrates these two domains by presenting a theoretical analysis of the "psychosomatic family" model as it informs and is informed by an empirical research project. Forty families of children with Crohn's disease (CD), ulcerative colitis (UC), and functional recurrent abdominal pain syndrome (RAP) were rated during standard, videotaped family interaction tasks, lunch, and interview. Laboratory scores of disease activity were associated with triangulation, marital dysfunction, and total "psychosomatic family" scores. Disease activity was not significantly correlated with enmeshment, overprotection, rigidity, conflict avoidance, or poor conflict resolution. Thus, the marital/triangulation and enmeshment/overprotection/conflict clusters may be subcomplexes of the "psychosomatic family" complex. CD, UC, and RAP groups differed in the relations among particular family patterns and disease activity. A heuristic family-psycho-somatic model is presented to facilitate future research.