Recurrent Abdominal Pain In Children Research Articles

Recurrent abdominal pain in children: A Sri Lankan perspective

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Helicobacter pylori Infection and Childhood

Pediatric-based Helicobacterpylori research continues to contribute significantly to our understanding of both clinical and pathophysiological aspects of this infection. Here, we review the published pediatric H.pylori literature from April 2009-March 2010. Analysis of pediatric H.pylori strains continues to suggest that cagA(+) and cagPAI competent strains are less prevalent than in adult isolates. Studies from the Middle East report a high H.pylori prevalence and intrafamilial transmission. Data continue to show a lack of association between H.pylori and recurrent abdominal pain of childhood, gastroesophageal reflux disease, and growth retardation. Recent probiotic trials have not shown a benefit on H.pylori eradication in children, while sequential therapy remains an attractive therapeutic eradication strategy in children, which requires validation in different geographic regions.

Complementary, Holistic, and Integrative Medicine: Recurrent Abdominal Pain

1. David Gottsegen, MD* 1. *Department of Pediatrics, Tufts University School of Medicine, Baystate Medical Center, Springfield, Mass. Recurrent or chronic abdominal pain is a common and often perplexing condition, affecting between 15% and 35% of the pediatric population worldwide. Apley (1) first defined recurrent abdominal pain (RAP) in 1958 as at least three episodes of abdominal pain sufficient to disrupt a child's daily activities over the previous 3 months. At the time of Apley's study, only 5% of cases were found to have an organic cause. With newer diagnostic methods, up to one third of cases of RAP may be found to have organic causes. “Red flags” that might indicate specific organic diseases are: a family history of inflammatory bowel disease, fever, weight loss, night awakening, anemia, bloody stools, and localized tenderness. Most children who do not have specific organic disorders have functional RAP. The causes of functional abdominal pain still are poorly understood but are believed to be due to autonomic dysfunction or visceral hypersensitivity to stimuli such as intestinal bowel gas, an acute trigger such as a viral gastroenteritis, an increased central perception of pain, and altered bowel habits such as constipation. Perception of pain is mediated by temperamental, cultural, and psychological factors, such as anxiety or depression, and social stressors, such as learning difficulties and family stress. Functional abdominal pain may be categorized into four specific disorders, as described by the Rome III criteria for functional gastrointestinal (GI) disorders: functional dyspepsia, functional abdominal pain, irritable bowel syndrome (IBS), and abdominal migraine. Postprandial abdominal pain, with feelings of bloating, gas, or heartburn, is classified as dyspepsia and may be associated with gastroesophageal reflux. IBS is characterized by cramping pain with alteration in bowel movements. Episodic abdominal pain …

Misdiagnosis in Fabry Disease

To evaluate the most frequent diagnostic errors in patients with Fabry disease and the types of specialists most often consulted before diagnosis. We evaluated 45 consecutive symptomatic patients with Fabry disease confirmed by enzymatic tests in males and genetic studies in females. We interviewed the patients, their mothers, or both regarding symptoms, age at onset, medical consultations, and recommended treatments. Neuropathic pain was the most frequent initial complaint, and rheumatic fever was the most common diagnosis. Seven patients were treated with penicillin for many years. Ten patients sought medical consultation because of abdominal pain and were diagnosed with food intoxication or nonspecific pain. Six patients sought consultation because of anhidrosis, considered of unclear cause, and angiokeratomas diagnosed as petechiae. Internists and pediatricians were the most frequently consulted specialists. The correct diagnosis was obtained after a mean of 19.7 years. Pediatricians as well as internists commonly misdiagnose Fabry disease. Neuropathic pain, hypohidrosis, and recurrent abdominal pain in childhood or adolescence should include Fabry disease in the differential diagnosis to facilitate earlier diagnosis and treatment of these patients.

Back to Rome (Criteria)

<p>A little more than 5 years ago, the February 2004 issue of <em>Pediatric Annals</em> was guest edited by Dr. B U.K. Li, with the title “Recurrent Abdominal Pain in Children.” I specifically recall learning about the Rome II diagnostic criteria for the symptom-based diagnosis of 13 functional pediatric gastrointestinal disorders from the articles in that issue.</p>

The Cochrane Library and Recurrent Abdominal Pain in Children: An Overview of Reviews

<i>The Cochrane Library</i> and Recurrent Abdominal Pain in Children: An Overview of Reviews

Prognosis of Chronic or Recurrent Abdominal Pain in Children

Chronic abdominal pain (CAP) or recurrent abdominal pain is common in childhood and is rarely associated with organic disease. With modern diagnostic technology, new organic abnormalities are found in children with CAP. Thus far a causal relation between these abnormalities and CAP has not been established. The additional prognostic value of extensive testing of children with CAP is a subject of debate. To investigate how often abdominal pain persists in children with CAP and to investigate whether medical tests such as laboratory tests, imaging, and endoscopy have additional prognostic value to history taking and clinical examination. A systematic search was conducted in MEDLINE, EMBASE, and PsycINFO for prospective cohort studies published from 1960 until October 2005. The most common medical key words for CAP were used in our search strategy. The methodological quality of studies was determined. Clinical heterogeneity between studies was analyzed. The percentages of children with abdominal pain after follow-up were pooled. The search yielded 2620 citations, of which 18 studies met the inclusion criteria. In total, 1331 children were followed up for 5 years (median, range 1-29 years). In total, 29.1% (95% CI 28.1-30.2) of patients with CAP had abdominal pain after follow-up. The prognosis of CAP diagnosed clinically was similar to that diagnosed after additional medical testing. CAP persisted in 29.1% (95% CI 28.1-30.2) of children. In the absence of alarming symptoms, additional diagnostic testing did not influence the prognosis of CAP.

Diagnostic algorithm for recurrent abdominal pain in children

Children who suffer from recurrent abdominal pain are a very heterogeneous group of patients. The organic, psychological and functional causes of this disorder overlap, making both the diagnosis and the treatment more difficult. The contribution of Rome criteria is in defining symptoms that helps in diagnosing functional disorders and thus lessen the number of unnecessary diagnostic procedures. The purpose of this algorithm is to help physicians diagnose and treat children with recurrent abdominal pain.

S1144 Parental Employment and Marital Status: Indicators of Coping Style in Childhood Recurrent Abdominal Pain

S1144 Parental Employment and Marital Status: Indicators of Coping Style in Childhood Recurrent Abdominal Pain

Recurrent Abdominal Pain Among Children Attending Government and Private Schools in Delhi

Recurrent abdominal pain (RAP) in school children is a common problem. The studies from Southeast Asian countries and India have largely been hospital based. The prevalence of RAP in a school population has never been undertaken in India. To study the prevalence of recurrent abdominal pain in the school going children in the age group of 7 -14 years. The parents of children from 10 schools (government and private) in Delhi were administered a predesigned questionnaire. A total of 1350 questionnaires were administered from Nov 04 to Sep 05. The questionnaire was based on the criteria used by Apley to define recurrent abdominal pain in children. 500 completed questionnaires, each from government and private schools were analyzed for the purpose of study. The prevalence of recurrent abdominal pain (RAP) was found to be 14.6%. There was a higher prevalence among girls (18.9%), than in boys (11.5%) and the difference was statistically significant. The prevalence among theprivate school children was higher (15.8%) than in government schools (13.4%). The maximum number of children with RAP was in the age group of 10-12 years (54.1%). The most common location for pain abdomen was periumblical (71.9%). 82% of children reported a diurnal variation in symptoms. Only 24.1% of children with RAP required hospitalization for the same in the preceding year. The results show that 14 out of every 100 children in urban Indian schools have complaints of recurrent abdominal pain. Girls are more affected than boys and despite the chronicity of symptoms no medical consultation is sought for these children. RAP is commonest in the age group of 10-12 years.

Sphincter of Oddi dysfunction in children with recurrent abdominal pain: 5‐year follow‐up after endoscopic sphincterotomy

Sphincter of Oddi (SO) dysfunction has not been reported as a cause of recurrent abdominal pain (RAP) in children. We present a 5-year follow-up of a group of children with RAP and manometry proven SO dysfunction. Retrospective chart review of children who underwent SO manometry and endoscopic sphincterotomy (ES) for recurrent abdominal pain. Long-term follow-up was obtained by telephone survey. Eleven of the 12 children had abdominal pain; one had reproducible postprandial discomfort. Five children localized the pain to the upper abdomen. The same number of children had associated nausea or vomiting. On hepatobiliary scintigraphy study, three children had SO dysfunction type curve, four had low ejection fraction and nine had reproduction of symptoms on cholecystokinin (CCK) infusion. SO manometry revealed elevated pressure in 11 children. The remaining child had paradoxical contraction of the SO. On short-term follow-up, eight children had resolution of symptoms after ES, three did not respond and one had recurrence of symptom in 6 months. Children symptomatic for less than 1 year were more likely to respond to ES (P < 0.01). All children with upper abdominal pain with nausea and/or vomiting, postprandial pain and SO type scintiscan curve responded to ES. On long-term follow-up, seven of the eight responders to ES remained symptom free, one recurred with irritable bowel syndrome-like symptoms. One child with recurrent symptoms had resolution after cholecystectomy and another non-responder improved after an appendectomy. SO dysfunction is an uncommon but treatable cause of RAP in children. Awareness of this condition may help a segment of children with RAP.

Hypnotherapy for Children With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Controlled Trial

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult IBS patients. We undertook a randomized controlled trial and compared clinical effectiveness of HT with standard medical therapy (SMT) in children with FAP or IBS. Fifty-three pediatric patients, age 8-18 years, with FAP (n = 31) or IBS (n = 22), were randomized to either HT or SMT. Hypnotherapy consisted of 6 sessions over a 3-month period. Patients in the SMT group received standard medical care and 6 sessions of supportive therapy. Pain intensity, pain frequency, and associated symptoms were scored in weekly standardized abdominal pain diaries at baseline, during therapy, and 6 and 12 months after therapy. Pain scores decreased significantly in both groups: from baseline to 1 year follow-up, pain intensity scores decreased in the HT group from 13.5 to 1.3 and in the SMT group from 14.1 to 8.0. Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from 14.4 to 9.3 in the SMT group. Hypnotherapy was highly superior, with a significantly greater reduction in pain scores compared with SMT (P < .001). At 1 year follow-up, successful treatment was accomplished in 85% of the HT group and 25% of the SMT group (P < .001). Gut-directed HT is highly effective in the treatment of children with longstanding FAP or IBS.

The effectiveness of two relaxation‐based techniques for the treatment of recurrent abdominal pain in children

The effectiveness of two relaxation‐based techniques for the treatment of recurrent abdominal pain in children

School Nurse Knowledge and Perceptions of Recurrent Abdominal Pain: Opportunity for Therapeutic Alliance?

Recurrent abdominal pain of childhood affects up to 15% of school-age children, who face significant psychosocial consequences, including school absence. Because assessment of recurrent abdominal pain is frequently made at the school nurse level, a questionnaire was sent to 425 school nurses to evaluate perceptions about recurrent abdominal pain. Among the responses, 47.1% believed children were taking or seeking attention; 3.6% considered it a serious disease, 77.9% stated that affected children should see a physician, 51.5% believed they should relax, and 25.0% believed they needed medicine. Results indicated that school nurses were unclear on epidemiologic and etiologic features of recurrent abdominal pain and had negative views that may inadvertently contribute to the anxiety felt by affected children. Education of school nurses and communication from physicians may advance strategies designed to reduce the fiscal and social costs associated with this common childhood condition.

Recurrent abdominal pain in school children: effect of obesity and diet

To study the epidemiology and some of the risk factors of childhood recurrent abdominal pain (RAP) in school age children. We used a questionnaire concerning socioeconomic parameters, intensity, frequency, duration, nature of RAP and anthropometric measures. We used several criteria to identify RAP and the Wong-Baker FACES scale for pain intensity and calculated the gender/age-specific body mass index (BMI) Z-score using NCHS standards. Obesity was defined as a BMI>or=95th percentile for age and gender. A total of 925 children mean age of 9.5 years completed and returned the questionnaires. The prevalence of RAP was 24%; 22% among boys versus 26% among girls (p=0.28) and reached its peak among children aged 7-9 (29%) years. Children with BMI>or=95% percentile reported more RAP compared to those not obese (33.3% vs. 22.5%) (OR=1.8, p=0.01). There was an inverse correlation between fruit consumption and RAP prevalence with 20% among children reporting more than three serving of fruit per week compared to 40% of those who did not consume any fruits (p<0.002). Logistic regression analysis confirmed BMI>or=95th percentile and low consumption of fruits are significant risk factors for RAP. There is a significant association between RAP and obesity and both conditions are prevalent among children in this population. Understanding more about the co-morbidity between RAP and obesity could have important implications on RAP management and treatment.

Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial

BackgroundBecause of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique.Methods22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with ≤ 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline.ResultsAt baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04). There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05), and two (82% vs. 45%, P < 0.01) months and significantly greater decrease in days with missed activities at one (85% vs. 15%, P = 0.02) and two (95% vs. 77%. P = 0.05) months. During the two months of follow-up, more children who had learned guided imagery met the threshold of ≤ 4 day of pain each month and no missed activities (RR = 7.3, 95%CI [1.1,48.6]) than children who learned only the breathing exercises.ConclusionThe therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP.

HEALTHCARE UTILIZATION OF CHILDREN WITH RECURRENT ABDOMINAL PAIN AFTER COMPLETING BIOFEEDBACK TREATMENT

Background: Childhood recurrent abdominal pain (RAP) is associated with increased healthcare utilization. Therapeutic biofeedback (BF) attempts to achieve behavior modification toward pain and has been used in the treatment of RAP. A decrease in healthcare utilization would serve as a valid endpoint, marking efficacy of this therapeutic intervention in RAP. Objective: To determine healthcare utilization of children with RAP after completing biofeedback. Methods: A database of a large health maintenance organization was queried to identify all children from 2003-2005 who were diagnosed with RAP by a pediatric gastroenterologist and who then completed BF treatment. The data were collected over the 2-year period prior to BF treatment and 1-year post treatment. Outcome measures used included: total number of health care visits, prescriptions, emergency room visits, and diagnostic evaluations. Results: 39 children (55% female, aged 13.4 years, range 8 to 19 years) had been diagnosed with RAP and undergone BF treatments (4.9 sessions, range 1-12). Healthcare utilization was significantly reduced for all outcome measures (see Table).Table: Healthcare UtilizationConclusions: In this cohort of children with RAP who were treated with biofeedback, there was a marked decrease in healthcare utilization. Biofeedback should be considered as a cost-effective first-line therapy for childhood RAP. Long-term studies need to be performed to see if this positive outcome effect persists into adulthood.

A New Biobehavioral Treatment Approach for Recurrent Abdominal Pain

Purpose: Childhood recurrent abdominal pain (RAP) has been hypothesized to be associated with a deficit in autonomic nervous system (ANS) recovery to stress and an enhanced subjective response to pain. Respiratory sinus arrhythmia, which is positively correlated with heart rate variability, has been shown to be an indicator of ANS functioning. Therapeutic heart rate variability biofeedback (BF) attempts to achieve behavior modification toward pain and has been used in the treatment of RAP. A decrease in pain frequency and intensity along with an improvement in ANS functioning would serve as valid endpoints, marking efficacy of this therapeutic intervention in RAP. The objective of this study is to determine pain intensity, pain frequency, and ANS functioning of children with RAP after completing BF. Methods: Children diagnosed with RAP were referred for BF by pediatric gastroenterologists. The children were seen by doctoral interns for an average of 6 weekly sessions. The data was collected prior to BF treatment and post treatment. Outcome measures used included: pain intensity (visual analogue scale, 1 to 10), pain frequency (episodes per week), and ANS functioning as measured by peak to valley differences in respiratory sinus arrhythmia (RSA). Results: 64 children (70% female, aged 7 to 18 years) had been diagnosed with RAP and undergone BF treatments (6 sessions, range 1–12). Pain intensity and frequency were significantly reduced. RSA was significantly increased (see table).Table: Pain Levels and RSAConclusions: In this cohort of children with RAP who were treated with BF, there was a marked decrease in pain intensity and frequency after completing BF in a pediatric medical setting. BF should be considered as a cost effective first line therapy for childhood RAP. Long-term studies need to be performed to see if this positive outcome effect persists into adulthood.

A Prospective Study for the Association of Helicobacter pylori Infection to a Multidimensional Measure for Recurrent Abdominal Pain in Children

There is a controversial association between Helicobacter pylori infection and recurrent abdominal pain (RAP) in childhood and inconsistent information on specific symptomatology of the infection. To examine the prevalence of H. pylori infection among children with RAP compared to asymptomatic children. Two prospective studies were conducted. The first study enrolled 223 children diagnosed with RAP from two pediatric gastroenterology clinics in Houston, Texas. Children were qualified if they were identified by their physician as having RAP. A new multidimensional measure for RAP (MM-RAP) consisting of four scales (pain intensity scale, symptoms scale, disability scale, and satisfaction scale) was administered to each child/parent. The second study enrolled 330 asymptomatic children from the same community who did not have any upper gastrointestinal symptoms. Symptomatic and asymptomatic children underwent (13)C-urea breath testing. In the first study, the prevalence of H. pylori in children with RAP was 11% and fell with age from 20% at age < or = 5 years to 7% for children > 10 years (OR = 2.7, 95% CI = 0.7-11.2). There was no association between the mother's educational level and H. pylori prevalence; (12% among children whose mothers completed college versus 11% among those who had elementary school, p = .8). No relationship was found between H. pylori and mean scores of the RAP scales. In the second study, the prevalence of H. pylori in asymptomatic children was 17% and increased with age from 11% for children < or = 5 years to 40% for children > 10 years (OR = 5.4, 95% CI = 2.0-13.8). The mother's educational level was inversely correlated with H. pylori (OR = 3.0, 95% CI = 2.2-6.1, p < .01). The epidemiologic patterns of H. pylori infection differed significantly between symptomatic and asymptomatic children. Younger children suffering from RAP are more likely to be infected with H. pylori than older children with the same complaint, suggesting that early acquisition may manifest in symptoms that lead to clinic visits.

The Primary Care Physician??s Approach to Functional Abdominal Pain in Childhood

Recurrent abdominal pain in children was defined initially by Apley and updated recently by Rome II criteria. The intent of the Rome II criteria is to provide greater insight into functional disorders of the gastrointestinal tract. Because markers for these disorders are lacking, diagnostic evaluations may vary. In this investigation, the individual approach of the primary care physician to the child with functional abdominal pain (as defined by Rome II criteria) is explored both in a hypothetical and clinical setting. A clinical vignette and survey involving the evaluation of a school-aged child with prototypical functional abdominal pain was distributed to area primary care physicians (n=201 completed). The actual physician approach for functional abdominal pain was determined through chart review of children referred to gastroenterology clinic (n=103). Physicians favored limited organ-specific testing, with urinalysis, preferred most. Physicians with extreme anticipation of a positive yield requested more testing than their nonanticipatory counterparts (5.7+/-2.2 vs. 2.0+/-2.0, P<0.001). Ultrasound was the only diagnostic test requested with greater frequency in actual subjects than hypothetical (31% vs. 18%, P<0.005). In accordance with published guidelines, physicians requested minimal testing for functional abdominal pain. Increased ultrasound requests in the clinic setting may be more reflective of the need for reassurance rather than seeking an organic etiology.