Recurrent Abdominal Pain In Children Research Articles

One hundred cases of recurrent abdominal pain in children: diagnostic procedures and criteria for a psychosomatic diagnosis.

To highlight the diagnostic difficulties involved in elucidating the aetiology of recurrent abdominal pain and to evaluate the use of special premises and criteria for the diagnosis of psychosomatic pain. The study included 100 consecutive cases of recurrent abdominal pain in 6 to 15 y-old children who were evaluated at a special paediatric clinic for recurrent abdominal pain and who were followed for at least one year. The investigation included a semi-structured questionnaire, laboratory investigations based on clinical data and diagnoses based on defined criteria. Three premises and seven criteria, based on the assumption that chronic negative stress can cause recurrent pain, were used for the diagnosis of psychosomatic pain. When the presented premises and criteria were employed for the diagnosis of psychosomatic pain, nearly half of the cases (48%) of recurrent abdominal pain could be explained. An organic or possibly organic diagnosis was found in 25% of the cases. Fourteen children had a possible psychosomatic diagnosis and in 9 cases no known diagnosis could be reached. The presented premises and criteria for the diagnosis of psychosomatic pain can be helpful when diagnosing recurrent abdominal pain, but further validation is needed. According to these criteria, a psychosomatic diagnosis was common in this series, accounting for nearly half of the cases. A medical diagnosis was evident in a quarter of the cases.

Intragastric Maldistribution of a Liquid Meal in Children with Recurrent Abdominal Pain Assessed by Three-Dimensional Ultrasonography

Background: Using two-dimensional (2D) ultrasonography, we previously found indications of impaired adaptive relaxation of the proximal stomach in children with recurrent abdominal pain (RAP). In the present study, we applied a new three-dimensional (3D) ultrasonographic method to investigate intragastric volumes and distribution of a liquid meal in another group of children with RAP. Methods: Twenty patients with RAP (age 10-15 years) and 20 healthy subjects (age 11-15 years) underwent ultrasonographic measurements of the stomach. A position sensor was used based on magnetic scanhead tracking for acquisition of 3D images after a liquid meal. The children scored abdominal symptoms before and after the meal. Results: Expressed as a fraction of ingested volume, the patients had a smaller volume of the proximal stomach and a larger antral volume at 2 r min postprandially compared to healthy subjects ( P r = r 0.03 and P r = r 0.001, respectively). The patients also showed a decreased proximal to distal gastric volume ratio at 2 r min postprandially ( P r = r 0.001). Patients experienced more pain in response to the meal than healthy subjects ( P r = r 0.04), but there was no correlation between pain and proximal or distal gastric volumes. Conclusions: RAP in children may be associated with an early intragastric maldistribution of a meal.

Systematic review of treatments for recurrent abdominal pain.

To conduct a systematic review of evaluated treatments for recurrent abdominal pain (RAP) in children. Online bibliographic databases were searched for the terms "recurrent abdominal pain," "functional abdominal pain," "children," or "alternative therapies" in articles classified as randomized controlled trials. The abstracts or full text of 57 relevant articles were examined; 10 of these met inclusion criteria. Inclusion criteria required that the study involve children aged 5 to 18 years, subjects have a diagnosis of RAP, and that subjects were allocated randomly to treatment or control groups. The methodology and findings of these articles were evaluated critically, and data were extracted from each article regarding study methods, specific interventions, outcomes measured, and results. Studies that evaluated famotidine, pizotifen, cognitive-behavioral therapy, biofeedback, and peppermint oil enteric-coated capsules showed a decrease in measured pain outcomes for those who received the interventions when compared with others in control groups. The studies that evaluated dietary interventions had conflicting results, in the case of fiber, or showed no efficacy, in the case of lactose avoidance. Evidence for efficacy of treatment of RAP in children was found for therapies that used famotidine, pizotifen, cognitive-behavioral therapy, biofeedback, and peppermint oil enteric-coated capsules. The effects of dietary fiber were less conclusive, and the use of a lactose-free diet showed no improvement. There seemed to be greater improvement when therapy (famotidine, pizotifen, peppermint oil) was targeted to the specific functional gastrointestinal disorder (dyspepsia, abdominal migraine, irritable bowel syndrome). The behavioral interventions seemed to have a general positive effect on children with nonspecific RAP. Many of these therapies have not been used widely as standard treatment for children with RAP. Although the mechanism of action for each effective therapy is not fully understood, each is believed to be safe for use in RAP.

Psychosocial factors and childhood recurrent abdominal pain.

Recurrent abdominal pain in children is not a single condition but a description of a wide spectrum of clinical manifestations, some of which fit into a definite pattern, such as the irritable bowel syndrome, while others do not. Organic disorders may be present, but in the majority of children they cannot be detected. Although children with recurrent abdominal pain do not generally have psychological or psychiatric illness, there is a growing body of evidence to suggest that psychosocial stress plays an important role in this condition. This review will look into some of this evidence. The precise pathophysiology that results in abdominal pain is still not clearly understood, but the current belief is that visceral hypersensitivity or hyperalgesia and changes in the brain-gut axis linking the central and enteric nervous systems are important mechanisms.

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

Office-based research: A new era and new opportunities

Office-based research: A new era and new opportunities

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 …

Psychosocial aspects of assessment and treatment of irritable bowel syndrome in adults and recurrent abdominal pain in children.

This article presents a selective review of psychosocial research on irritable bowel syndrome (IBS) in adults and on a possible developmental precursor, recurrent abdominal pain (RAP), in children. For IBS the authors provide a summary of epidemiology, of the psychological and psychiatric disturbances frequently found among IBS patients, and of the possible role of early abuse in IBS. A review of the psychosocial treatments for IBS finds strong evidence to support the efficacy of hypnotherapy, cognitive therapy, and brief psychodynamic psychotherapy. The research relating RAP to IBS is briefly reviewed, as is the research on its psychological treatment. Cognitive-behavioral therapy that combines operant elements and stress management has the strongest support as a treatment for RAP.

Psychosocial aspects of assessment and treatment of irritable bowel syndrome in adults and recurrent abdominal pain in children.

Psychosocial aspects of assessment and treatment of irritable bowel syndrome in adults and recurrent abdominal pain in children.

EARLY GASTROINTESTINAL SYMPTOMS and SUBSEQUENT RECURRENT ABDOMINAL PAIN OF CHILDHOOD

Introduction Little is known of the precursors and natural history of childhood recurrent abdominal pain (RAP) and its relationship to early gastrointestinal (GI) function. This study determines the prevalence of common GI problems in childhood and assesses the relationship of RAP at age eight to prior GI function and symptoms. Methods The Raine Study enrolled 2979 women by the eighteenth week of pregnancy in a prospective cohort that has been followed to age eight with extensive data collection every 1 to 2 years. The prevalence of GI symptoms and problems in this population was determined and the relationship of these to the reporting of RAP at age eight was analysed. Results Two thousand eight hundred and sixty infants were assessed at birth, and 2162 of 2620 potentially still available were followed to year 8. One hundred and forty-two children (6.6%) experienced RAP at age eight (9.3% of girls, 5.3% of boys, P = 0.009). Only 16% of these children experienced pain more frequently than several times per week. The occurrence of GI symptoms and function at various ages up to eight have been defined. Seventy five percent of children at all ages defaecated between twice a day and once every second day. The proportion with infrequent defaecation increased with age. Ten per cent of 5-year old had been treated for constipation and 12% had difficulties with faecal soiling. The risk of RAP for early GI symptoms is shown in the table. Symptom/feature Prevalence (%) Odds ratio 95% CI * P < 0.05, ** P < 0.001. Infantile colic 28.7 4.23 3.6–5.0* GOReflux 0–4 months 29 1.23 0.84–1.80 GOReflux 5–12 months 12.8 1.16 0.70–1.91 Frequent stools year 1 17.2 0.70 0.42–1.17 Frequent stools year 2 5.9 1.0 0.43–2.34 Infrequent stools year 2 1.6 4.19 1.57–11.16* Infrequent stools year 8 2.9 4.12 2.17–7.8** Soiling year 5 11.8 1.38 0.28–6.79 Conclusions 1 RAP at age 8 is associated with infrequent defaecation at ages 2 and 8. 2 RAP at age 8 is associated with infantile colic This may reflect underlying sensitivity to gastrointestinal distension and contraction. or reflect parental anxiety. 3 RAP is not associated with frequent stools, GOReflux or with disorders of defaecation.

Helicobacter pylori infection in recurrent abdominal pain in children--a prospective study.

A total of 40 children was recruited to assess the role of Helicobacter pylori infection in children with recurrent abdominal pain syndrome. Among 40 children, seven (17.5%) cases were confirmed to have H. pylori infection. All H. pylori-positive patients had active chronic gastritis histologic findings (p < 0.0001); however, the majority of the H. pylori-negative patients had minimal to mild gastritis histologic findings (p = 0.001). Grossly, chronic gastritis picture was present in all children infected with H. pylori and antral nodular gastropathy present in 43%. 71% of H. pylori-positive patients had elevated anti-H. pylori IgG titer; however, 15% in H. pylori-negative patients (p = 0.006). Serum H. pylori assay had a sensitivity of 71% and specificity of 85%; however, sensitivity and specificity of rapid urease test were 86% and 100% respectively. Antral nodularity is a specific, peculiar endoscopic finding of children infected with H. pylori (p = 0.004). Although the present study suggests that H. pylori-related chronic gastritis may play an etiological role in a subgroup of children with RAP syndrome, but the routine screening of H. pylori infection in children with RAP is not recommended, since no compelling data support the significant association between H. pylori infection and RAP syndrome.

The significance of life-events as contributing factors in childhood recurrent abdominal pain in an urban community in Malaysia

This study aimed to look at the link between childhood recurrent abdominal pain (RAP) and the presence of recent life-events in an urban community in Malaysia. School children aged from 9 to 15 years in the city of Petaling Jaya were randomly selected to fill in a questionnaire and to be interviewed. The prevalence of RAP among 1488 school children studied was 9.6% (95% confidence interval (CI), 8.18–11.25). Higher prevalences of RAP were found in children who had experienced the following life-events in the previous year: loss of a family member through death ( P<.001), hospitalisation of a family member ( P<.001), the child's own hospitalisation ( P=.001), change of address ( P<.001), change in occupation of an immediate family member ( P<.001), failure in a major school examination ( P<.001), bullying at school ( P=.001). Following logistic regression analysis, five life-events remain significant: hospitalisation of a family member ( P=.038), the child's own hospitalisation ( P=.034), change in occupation of an immediate family member ( P=.049), examination failure ( P=.001) and bullying at school ( P=.028). This study strongly suggests that recent stressful life-events are important risk-factors for RAP.

Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it?

To determine whether medically unexplained recurrent abdominal pain (RAP) in childhood predicts abdominal pain, irritable bowel syndrome (IBS), other somatic complaints, and psychiatric symptoms and disorders in young adulthood. A sample of 28 young adults evaluated for RAP between the ages of 6 and 17 years were compared with 28 individually matched former childhood participants in a study of tonsillectomy and adenoidectomy. RAP caseness was established by structured retrospective chart review requiring agreement by 2 independent reviewers. Standardized assessments of abdominal pain, IBS, other somatic symptoms, psychopathology, perceived health, and history of maltreatment were performed an average of 11.1 years after the index visit. Former RAP patients were significantly more likely than controls to endorse anxiety symptoms and disorders, hypochondriacal beliefs, greater perceived susceptibility to physical impairment, poorer social functioning, current treatment with psychoactive medication, and generalized anxiety in first degree relatives. There were trends suggesting associations between childhood RAP and lifetime psychiatric disorder, depression, migraine, and family history of depression, but group differences on abdominal pain, IBS, other somatic symptoms, and history of maltreatment were not statistically significant. There is a strong and relatively specific association between childhood RAP and anxiety in young adulthood. Affected children may be at special risk to perceive physical symptoms as threatening, and should be evaluated for psychiatric disorder on initial presentation.

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.

Organic abnormalities in recurrent abdominal pain in children

Organic abnormalities in recurrent abdominal pain in children

Organic abnormalities in recurrent abdominal pain in children

Organic abnormalities in recurrent abdominal pain in children

Organic abnormalities in recurrent abdominal pain in children

Using an investigation protocol, the aim of this study was to determine the frequency of organic abnormalities in children with recurrent abdominal pain, as new diagnostic approaches may reveal a higher prevalence of organic disease in this group than has been found in most studies. Included in the study were 44 children (mean age 8.3 y; 2-15) with more than three bouts of abdominal pain severe enough to affect the daily activities of the child and lasting more than 3 mo. The investigation covered a detailed medical story, a physical examination, blood, urine and stool samples. The somatic investigation was completed by abdominal X-ray and ultrasound, lactose-breath-hydrogen test and 24-h pH monitoring in the lower oesophagus. A Child Behaviour Checklist was completed to assess psychosocial aspects of the illness. The blood, urine and stool samples were normal, and abdominal ultrasound did not give any results related to the symptoms. Constipation was diagnosed in 7 patients (16%); 9 patients (21%) had gastro-oesophageal reflux and oesophagitis was found in another 3 children. One child had nodular antral gastritis with colonization by Helicobacter pylori, and three children had pathological lactose-breath-hydrogen tests. Twenty-four children (55%) did not have any signs of organic disease. The total score for the CBCL was in the normal range in 89%. Our observations indicate a higher proportion of organic abnormalities in recurrent abdominal pain than has been found in most previously reported studies, though a multicausal approach seems important.

Stressful life events and recurrent abdominal pain in children in a rural district in Malaysia.

The purpose of this study was to look at the correlation between recurrent abdominal pain and the presence of recent stressful life events among schoolchildren in a rural district in Malaysia. This is a cross-sectional study of schoolchildren aged 9-15 years based in Kuala Langat, a rural district located in the south-west of the Malaysian state of Selangor. Schoolchildren were selected randomly and given questionnaires to fill in. This was followed by interview with the children on the same day by one of the authors (CCMB) to ensure consistency of response. Recurrent abdominal pain was defined as 'at least three episodes of abdominal pain, severe enough to affect their activities over a period longer than three months' [1]. The children were also asked to answer either 'yes' or 'no' to whether they had experienced various life events in the previous year. A sample of 1462 schoolchildren (722 boys and 740 girls) aged between 9 and 15 years were included in the study. There were 768 Malays, 393 Chinese and 301 Indians. Of these 1462 children, 161 (11.0%) had recurrent abdominal pain. On performing multiple logistic regression analysis, two life events were significantly associated with recurrent abdominal pain: death of a family member (P = 0.008; odds ratio 0.61, 95% CI 0.43-0.88) and a change in occupation of an immediate family member (P = 0.003; odds ratio 0.53, 95% CI 0.35-0.81). This study suggests that recurrent abdominal pain in children is associated with recent stressful life events in the children's lives.

Current controversies associated with Helicobacter Pylori infection in the pediatric population

Helicobacter pylori is a human bacterial gastric pathogen, fulfilling each of Koch's postulates for causal inference for ulceration in children and adults. In addition many reports purport to show that the organism causes a variety of extra-intestinal manifestations in children. This review of the English language literature provides evidence that H. pylori is likely a cause of unexplained iron deficiency (sideropenic) anemia in children, even in the absence of gastrointestinal bleeding. Much stronger evidence is required however, before H. pylori infection can be considered as an etiologic agent in recurrent abdominal pain of childhood, unexplained short stature, protracted diarrhea in pre-schoolers and sudden infant death syndrome.