Recurrent Abdominal Pain Syndrome Research Articles

The possibilities of cytoreductive operations in recurrent abdominal pain syndrome in cancer patients, occurring under the mask of acute pancreatitis

Among the diseases of urgent pathology, the leading place belongs to acute pancreatitis, which is inferior to such nosologies as acute appendicitis and acute cholecystitis. Moreover, the lion’s share is occupied by light forms, which make up 85%. The aim of the work is to demonstrate a clinical case of recurrent abdominal syndrome occurring under the mask of acute pancreatitis in a patient with oncopathology identified using a diagnostic algorithm used in outpatient practice. Material and methods. Patient F., 60 years old, repeatedly sought medical help in a network of polyclinics and hospitals providing emergency specialized medical care with recurrent abdominal syndrome. Results and discussion. Against the background of conservative treatment, the patient had a short-term positive dynamics characteristic of a mild form of acute pancreatitis. After taking the patient to the dispensary and conducting an in-depth diagnostic examination according to the algorithm developed by our group of researchers, cancer of the stomach stump T2N0M0 was detected. Conclusion. Patients with recurrent abdominal pain syndrome need dispensary observation on an outpatient basis to identify other pathology occurring under the guise of acute pancreatitis and to conduct adequate treatment.

A personalized approach to recurrent abdominal pain syndrome based on clinical and laboratory algorithms

To optimize the diagnosis of abdominal pain syndrome occurring under the «mask» of acute pancreatitis via algorithms for clinical and laboratory examination. We have retrospectively and prospectively analyzed patients with abdominal pain syndrome. We selected all patients with acute pancreatitis who repeatedly applied with abdominal pain syndrome to polyclinics and hospitals between 2017 and 2021. A personalized algorithm for patients with abdominal pain syndrome occurring under the «mask» of acute pancreatitis has been developed. This algorithm underlies an information system for decision-making support. An optimal diagnostic algorithm is needed in reception departments of hospitals and polyclinics. This one depends on equipment of hospitals and needs to be constantly improved. When refusing hospitalization and discharging patients with recurrent pain syndromes, physicians should orient the doctors of general network to use more informative methods. Indeed, the last ones may be unavailable in reception departments and various districts due to technical, qualification and organizational shortcomings. Advanced clinical and laboratory diagnostic methods based on the above-described algorithm are necessary for recurrent abdominal pain syndrome occurring under the «mask» of acute pancreatitis.

Application of a diagnostic algorithm for differential diagnosis in a patient with recurrent abdominal pain

Introduction Among the diseases of urgent pathology the leading place belongs to acute pancreatitis, which is second only to acute appendicitis and acute cholecystitis. Moreover, a significant share is occupied by mild forms, which account for 85%. In the Clinical Recommendations for Acute pancreatitis in the section “Prevention and dispensary monitoring”, the authors recommend regular dispensary monitoring by a gastroenterologist and a surgeon. However, this nosology according to the Order of the Ministry of Health of the Russian Federation from 03.15.2022 No 168N is not included in the dispensary observation. In this regard, patients remain without proper attention of doctors when they are discharged from hospitals, or when they refuse hospitalization after examination in the emergency room.The aim of the work – is to present the result of applying the diagnostic algorithm of differential diagnosis of diseases and detection of gastrointestinal tract pathology on the clinical example of a patient with recurrent abdominal pain syndrome.Materials and methods The analysis of medical records of a 59-year-old patient who repeatedly applied to the network of polyclinics and hospitals providing emergency specialized medical care for recurrent abdominal syndrome was carried out.Results and discussion In this clinical observation of recurrent abdominal syndrome in a patient, the biliary mask of acute pancreatitis was revealed. In outpatient conditions using the developed diagnostic algorithm, choledocholithiasis, juxtapapillary diverticulum of the duodenum and hernia of the esophageal aperture of the diaphragm were detected. The diagnosis made it possible to perform the treatment competently and lead to the patient's recovery. Thanks to the dispensary observation and additional methods of investigation according to the developed algorithm, the following were detected: juxtapapillary diverticulum of the duodenum, which may not be visualized at video esophagogastroduodenoscopy with direct optics, as well as ductal stones, which are not always visualized at transabdominal ultrasound and are detected at endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography. Difficulties may arise in the diagnosis of gastrointestinal diseases due to the variability of the clinical course and polymorphism of symptoms in this category of patients. Such a course of diseases causes difficulties at the stage of patients' admission to the emergency room of clinics, can lead to diagnostic errors that lead to incorrect treatment tactics.Conclusion The application of an algorithm based on the assessment of clinical criteria in conjunction with instrumental imaging methods and laboratory tests allowed to optimize the diagnostic process and facilitated the choice of optimal therapy and surgical tactics for the treatment of the patient with recurrent abdominal pain syndrome.

ЭНТЕРОПАТИИ С НАРУШЕНИЕМ МЕМБРАННОГО ПИЩЕВАРЕНИЯ И СИНДРОМ РАЗДРАЖЕННОГО КИШЕЧНИКА – СОЧЕТАННАЯ ПАТОЛОГИЯ

The article describes the clinical manifestations and their causes in the pathology of the small intestine in patients who complain of excessive bloating, recurrent abdominal pain syndrome, stool disorders with a tendency to relaxation. Such patients repeatedly return to the doctor. The evidence of a decrease in the activity of disaccharidases in this cohort of patients is presented. The emphasis is placed on the need to study the nutritional history, to identify products that provoke a violation of membrane digestion. The classification of carbohydrates with indication of products containing them is given. The essence of repeated and persistent clinical manifestations due to impaired membrane digestion and absorption of carbohydrates in the small intestine is explained, which leads to their appearance in the large intestine in different volumes, which is accompanied by the splitting of carbohydrates with the formation of gases. On the one hand, this is a normal process, but when it gets out of control, the patient gets to the doctor. The essence of a carbohydrate–restricted diet is described - this is the low FODMAP diet and its decoding. The products containing oligosaccharides are indicated, which are capable of being cleaved by the enzyme alpha-galactosidase, which is absent in the human body, but is present in the microflora of the large intestine. Advice is given on limiting the intake of such products, both in terms of the frequency of intake and the volume of portions containing them, in order to avoid excessive amounts of intestinal gases, the development of a clinically painful condition. A thorough study of the nutritional history and the necessary correction of eating behavior is the main idea of this article, dedicated to the same type of clinical picture with varying degrees of manifestations of its symptoms.

Le syndrome de la rate baladeuse : cas clinique

IntroductionWandering spleen is a rare condition that occurs when there is an acquired or congenital hypelaxity of the suspensory ligaments of the spleen, resulting in its migration to any abdominal or pelvic position. Case reportA 43-year-old woman presented with symptoms of acute abdominal pain. At physical examination, a splenomegaly was found in the left hypochondria, thereafter followed by a secondary migration of the lump to a periumbilical location. Computed tomography revealed a wandering spleen with vascular pedicle torsion. Splenopexia was perfomed. ConclusionA wandering spleen is most frequently observed in children and young women. This rare diagnosis should be considered facing a recurrent abdominal pain syndrome, a splenomegaly accompanied with pain, or a pelvic lump. A wandering spleen may lead to torsion of the vascular pedicle of the spleen, a chronic volvulus with portal hypertension, or even a splenic infarction. The diagnosis is performed by computed tomography. Wandering spleen is treated surgically, by splenopexy or splenectomy.

The role of esophageal multichannel intraluminal impedance monitoring for 24 hours in diagnosis of aerophagia

Objective To investigate the clinical characteristics of aerophagia in children, and to evaluate the effect of 24 hours esophageal multichannel intraluminal impedance monitoring in diagnosis of aerophagia. Methods The clinical data of 30 children with aerophagia hospitalized in Department of Digestive Disease, Nanjing Children's Hospital Affiliated to Nanjing Medical University from July 2005 to June 2013 were reviewed.The 24 hours esophageal multichannel intraluminal impedance monitoring was performed in 8 cases of aerophagia.The treatment of these patients normally included psychological counseling, dietary adjustment, Iactulose, Domperidone and vitamins, while Simethicone was given to the patients if normal treatment was invalid. Results Of the 30 patients, aged 2 to 13 years, averaged(8.6±4.5) years, the chief complaints were abdominal distention in 30 cases(100.00%), visible or audible air swallowing in 28 cases(93.33%), repetitive belching in 27 cases(90.00%), reduced appetite in 25 cases(83.33%), constipation in 22 cases(73.33%), psychological stresses in 15 cases(50.00%), recurrent abdominal pain syndrome in 10 cases(33.33%), chronic diarrhea in 3 cases(10.00%) and acute abdominal pain in 3 cases(10.00%). Among the 30 patients, 24 hours esophageal multichannel intraluminal impedance monitoring was performed in 8 cases, averaging 149.63(47-553)times of air swallowing were recorded.In the 30 patients, 24 cases(80.00%) were relieved after being treated with psychological counseling, dietary adjustment, lactulose, domperidone and vitamins, and only 6 cases(20.00%) were invalid for normal treatment but well responeded to Simethicone. Conclusions Aerophagia is a kind of functional gastrointestinal disorders in children.Abdominal distention, air swallowing, repetitive belching, reduced appetite, constipation and pain are common symptoms.It can be cured through psychological counseling management, diet modification, laxatives, propulsives and vitamins.24 hours esophageal multichannel intraluminal impedance monitoring is a useful technology in the diagnosis of aerophagia children. Key words: Aerophagia; Functional gastrointestinal disorder; Multichannel intraluminal impedance; Child

Early Minimal Change Chronic Pancreatitis” Or “Imaging Negative Chronic Pancreatitis

We report five cases of or minimal change pancreatitis in our outpatient department. Minimal Change Pancreatitis is an entity that is very unfamiliar in majority of the practicing physician & surgeons. It is often called as early chronic pancreatitis. All these terms are often used synonymously. It is a syndrome consisting of phase of inflammation of pancreas which is manifested by less easily identifiable clinical features like chronic or recurrent abdominal pain syndrome with normal abdominal imaging studies e.g. USG (Ultrasonography), CT (Computed Tomography),MRI(Magnetic Resonance Imaging)/MRCP(Magnetic Resonance Cholangio Pancreatography).

Recurrent Abdominal Pain Syndrome in a Cohort of Sri Lankan Children and Adolescents

Recurrent abdominal pain (RAP) is a common problem among children and adolescents. The epidemiology of RAP among Sri Lankan children is unknown. A self-administered parental questionnaire was distributed to 810 randomly selected school children, aged 5-15 years, and 734 (90.6%) were returned. RAP was diagnosed using Apley criteria. Children who fulfilled the criteria were interviewed. Seventy-seven had RAP (10.5%). Of them, 45 (58.4%) had periumbilical pain. The severity was mild to moderate in 45 (58.4%) and severe in 32 (41.6%). Common associated symptoms were headache (42.9%), anorexia (35.1%), lethargy (23.4%) and joint pain (23.4%). Health care consultation among affected children was 70.1%. RAP was significantly higher in those who were exposed to stressful life events and who had a family history of RAP (p < 0.0001). RAP was not associated with school academic performance and participation in sports (p > 0.05). According to our results, the epidemiology and clinical profile of RAP in Sri Lankan children appears to be similar to that in other parts of the world, except for health care consultation, which is higher than previously reported.

Prospective peer‐review audit of paediatric upper gastrointestinal endoscopy

To describe the findings of paediatric upper gastrointestinal endoscopy (UGE) and to reduce the rate of normal findings in children undergoing diagnostic UGE. Upper gastrointestinal endoscopy were performed at a single tertiary referral children's hospital over a 3-year period by four endoscopists. Patients were subgrouped into diagnostic categories (recurrent abdominal pain syndrome (RAP), oesophagitis, coeliac disease and enteropathy/inflammatory bowel disease) and endoscopists recorded their clinical diagnosis as above before each procedure. Endoscopic and biopsy findings were compared with clinical diagnosis. After the first year of audit each endoscopist was appraised of their practice and strategies implemented to reduce the normal UGE. In years 2 and 3 all endoscopists were audited by their peers on a monthly basis. A total of 1172 UGE were performed over a 3-year period. Ninety per cent were diagnostic procedures, of which 48% were normal, 16% identified oesophagitis, 11% coeliac disease, 6% gastritis, 3%Helicobacter pylori and 1% peptic ulcer disease. Peer-review audit significantly reduced the number of normal findings in coeliac disease, RAP and overall (P < 0.01) but not in the groups with presumed oesophagitis or investigation of enteropathy/inflammatory bowel disease. A high proportion of patients undergoing UGE have normal procedures. Peer-review audit can reduce the number of normal procedures particularly in RAP and in the diagnosis of coeliac disease.

Clinical Features of Pathologic Childhood Aerophagia: Early Recognition and Essential Diagnostic Criteria

This study investigated the early recognition and diagnosis of pathologic childhood aerophagia to avoid unnecessary diagnostic approaches and serious complications. Between 1995 and 2003, data from 42 consecutive patients with pathologic childhood aerophagia, aged 2 to 16 years, were reviewed. An esophageal air sign was defined as an abnormal air shadow on the proximal esophagus adjacent to the trachea on a full-inflated chest radiograph. Of the 42 patients, the chief complaints were abdominal distention (52.4%), recurrent abdominal pain syndrome (21.4%), chronic diarrhea (11.9%), acute abdominal pain (7.1%) and others (7.2%). Mean symptom duration before diagnosis was 10.6 months (range, 1 to 60 months), and it exceeded 12 months for 16 (38.1%) patients. The clinical features common to all patients were abdominal distention that increased progressively during the day, increased flatus on sleep, increased bowel sound on auscultation and an air-distended stomach with increased gas in the small and large bowel by radiography. Visible or audible air swallowing (26.2%) and repetitive belching (9.5%) were also noted. Esophageal air sign was observed in 76.2% of the patients and in 9.7% of the controls (P=0.0001). The subgroups of pathologic childhood aerophagia divided by underlying associations were pathologic childhood aerophagia without severe mental retardation (76.2%), which consisted of psychological stresses and uncertain condition, and pathologic childhood aerophagia with severe mental retardation (23.8%). The common manifestations of pathologic childhood aerophagia may be its essential diagnostic criteria, and esophageal air sign may be useful for the early recognition of pathologic childhood aerophagia. Our observations show that the diagnostic clinical profiles suggested by Rome II criteria should be detailed and made clearer if they are to serve as diagnostic criteria for pathologic childhood aerophagia.

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.

The impact of the September 11, 2001 terrorist attacks and aftermath on the incidence of recurrent abdominal pain syndrome in children.

The impact of the September 11, 2001 terrorist attacks and aftermath on the incidence of recurrent abdominal pain syndrome in children.

Paramesocolic hernias: consequences of delayed diagnosis. Report of three new cases

Background If internal hernias account for less than 1% of the causes of intestinal obstruction, the paraduodenal or paramesocolic hernias (PMH) represent 50% of the 500 published as of the year 2000. Despite their congenital character, they are diagnosed more frequently in adulthood, with a mean age of 38 years at diagnosis. In the last few years, diagnoses are being made earlier. With the goal of increased early diagnosis and decreased mortality associated with these internal hernias, the authors report on 3 young patients with PMH. Methods Three cases of paramesocolic hernias are reported, 2 right (RPMH) and 1 left (LPMH). They all had a history of symptoms of recurrent abdominal pain of variable frequency and intensity but of sufficient importance to justify previous diagnostic studies. The 2 patients with RPMH, a 3-year-old boy and a 17-year-old woman, presented symptoms of intestinal obstruction and had necrosis of the small intestine leading to short-bowel syndrome. The LPMH patient, a 13-year-old boy, suffered recurrent abdominal pain from the age of 3. Gastroesophageal reflux was diagnosed, and surgery was performed at the age of 4 years. A laparoscopy at 13 years of age found no pathology. A new upper gastrointestinal tract series found retroperitoneal and paraduodenal jejunum incarceration, partially obstructing the duodenum. During surgery, the adhered jejunal section was restored intraperitoneally, and the open Treitz arch was closed. The authors have not found the anatomic characteristics of this case in the literature. Conclusions Delays and errors in PMH diagnosis may result in irreparable damage. Differential diagnosis workups of patients with recurrent abdominal pain syndrome should always include PMH.

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.

Upper gastrointestinal disease, Helicobacter pylori and recurrent abdominal pain

Roma E, Panayiotou J, Kafritsa Y, Van‐Vliet C, Gianoulia A, Constantopoulos A. Upper gastrointestinal disease, Helicobacter pylori and recurrent abdominal pain. Acta Pædiatr 1999; 88: 598‐601. Stockholm. ISSN 0803‐5253Over a 5‐y period, 396 children complaining of recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy in order to identify any underlying organic pathology and determine the prevalence of Helicobacter pylori (H. pylori) infection. Histologically confirmed mucosal inflammation was found in 338 out of 396 children (85.4%); in 113 of 396 patients (28.5%), H. pylori was identified on the gastric mucosa. Significant discriminating factors between H. pylori positive and negative children with RAP included age (mean age for positive 11 y vs. 8.1 y for negative, p &lt; 0.01) and gender (male gender predominance in the H. pylori positive, p &lt; 0.001). No significant difference was found between H. pylori positive and negative groups regarding incidence and character of the presenting symptoms. All H. pylori positive children (100%) had abnormal histology compared with 225 out of 283 negative ones (79.5%). Histologically confirmed gastritis was the most prominent finding in H. pylori positive children compared with H. pylori negative (98.2% vs. 19%, p &lt; 0.001). Conversely, oesophagitis was more common in H. pylori negative children (47.7% vs. 27.4%, p &lt; 0.001). The incidence of peptic ulcer was higher in H. pylori infected patients than in the H. pylori negative group (5.3% vs. 1%, p &lt; 0.05). Our data suggest that gastrointestinal pathology is more common than previously thought in children with RAP, while H. pylori infection is a relatively important factor in the etiology of upper gastrointestinal inflammation in RAP syndrome. □Helicobacter pylori, recurrent abdominal pain, upper gastrointestinal endoscopy

Upper Gastrointestinal Endoscopy in Recurrent Abdominal Pain of Childhood

SummaryOver a 2.5‐year period, 82 consecutive children complaining of recurrent abdominal pain underwent upper gastrointestinal endoscopy. Gastroscopy confirmed pathology in 48 of the children (58.5%). Four of the children, who also had undergone gastroscopy, had other diagnoses (lactose malabsorption, hydronephrosis, yersinosis), and 30 of the children (36.6%) retained the initial diagnosis of recurrent abdominal pain syndrome. Gastritis was found in 48 of the children, 18 of whom (37.5%) had positive test results for Helicobacter pylori, based on histology and/or culture. Of 16 H. pylori‐positive children tested, 12 (75%) also had an elevated concentration of IgG‐class antibodies to H. pylori in their sera. Three of the children had duodenal ulcer disease, all of whom were H. pylori positive. Esophagitis was found in eight of the children with gastritis, all of whom were found to have gastroesophageal reflux. Our data suggest that among the children with recurrent abdominal pain syndrome, organic pathology is more common than was previously thought. Altogether 22% of the children with recurrent abdominal pain syndrome were infected with H. pylori.

Upper Gastrointestinal Endoscopy in Recurrent Abdominal Pain of Childhood

Over a 2.5-year period, 82 consecutive children complaining of recurrent abdominal pain underwent upper gastrointestinal endoscopy. Gastroscopy confirmed pathology in 48 of the children (58.5%). Four of the children, who also had undergone gastroscopy, had other diagnoses (lactose malabsorption, hydronephrosis, yersiniosis), and 30 of the children (36.6%) retained the initial diagnosis of recurrent abdominal pain syndrome. Gastritis was found in 48 of the children, 18 of whom (37.5%) had positive test results for Helicobacter pylori, based on histology and/or culture. Of 16 H. pylori-positive children tested, 12 (75%) also had an elevated concentration of IgG-class antibodies to H. pylori in their sera. Three of the children had duodenal ulcer disease, all of whom were H. pylori positive. Esophagitis was found in eight of the children with gastritis, all of whom were found to have gastroesophageal reflux. Our data suggest that among the children with recurrent abdominal pain syndrome, organic pathology is more common than was previously thought. Altogether 22% of the children with recurrent abdominal pain syndrome were infected with H. pylori.

Pediatric Pain: Interacting Behavioral and Physical Factors

Pain in infants, children, and adolescents warrants study from a developmental, behavioral, and physiological perspective because maturation of physical, emotional, and cognitive systems influences the way in which pain is experienced and expressed. Pediatric pain is an underdeveloped area ripe for study within the realm of developmental and behavioral pediatrics, as noted by documentation of its undertreatment in children. The focus of this paper is to present issues relevant to the study of pain in children, using the example of the recurrent abdominal pain syndrome to illustrate points regarding epidemiology, assessment, and intervention. It is the opinion of these authors that pediatric pain must be understood from a developmental perspective in both clinical and nonclinical populations of children. Multidisciplinary approaches to research in pain aids in understanding the development of nociceptive transmission and inhibitory systems, the development of pain expression, and the influence of context on pain experience and behavior. The goal of research in pediatric pain is to understand these systems within a developmental context so that preventive and therapeutic intervention strategies can be developed to reduce children's distress and pain-related disability.

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.

Potential biobehavioral mechanisms of recurrent abdominal pain in children

To explain why otherwise healthy children experience recurrent episodes of abdominal pain (the recurrent abdominal pain syndrome, or RAP), it has been hypothesized that the child with RAP demonstrates: (1) a deficit in autonomic nervous system recovery to stress, and/or (2) an enhanced behavioral and subjective response to pain. To evaluate the validity of these assumptions, children with RAP (9–14 years) and hospital and healthy controls matched for age, sex, ethnicity and SES were exposed to a cold pressor stimulus (0 ± 1°C). Autonomic (peripheral vasomotor and heart rate), somatic (forearm EMG), subjective (pain intensity and distress), and behavioral (facial expression) responses were recorded during baseline, stressor and recovery periods. At all 4 levels of observation, the cold pressor stimulus resulted in significant autonomic, somatic, subjective and behavioral arousal. However, no significant differential response across the 3 groups was noted for any measure and, in particular, no recovery deficit in autonomic arousal was demonstrated. These findings do not support the assumption of a differential response to an acute laboratory induced stress in children with RAP compared to control children.