Recurrent abdominal pain in children attending pediatrics OPD
Keywords:
Abdominal pain, Children, Functional gastrointestinal disorder
Abstract
Background: Recurrent abdominal pain is one of the commonest gastrointestinal complaints in children, affecting approximately 10% of school-aged children and adolescents. There is no consensus with regards to etiology, investigation, and management of this common problem. This article addresses some of the issues related to epidemiology, etiology, management, and prognosis of recurrent abdominal pain.
Material and Methods: This was a hospital-based study conducted on 120 children patients with RAP. Patients of the age group of 4 to 14 years attending the pediatric OPD of Indian Institute of Medical Science and Research and Noor Hospital, from January 2019 to November 2019 were included in the study. Children age less than 4 years and more than 13 years not meeting the criteria of RAP were excluded from the study. Children with organic causes of RAP have been treated according to the corresponding reason.
Results: Out of 120 patients of RAP, sex distribution is unequal with male predominance (64.1%). Although in this study, age group was in the following order by decreasing 7-10 years old (43.3%), followed by 4-6 years old (36.3%) and 11-14 years old (20%).
Conclusions: Organic disorder is still the commoner causes of RAP in our part of the world. Most children with recurrent abdominal pain have functional gastrointestinal diseases and detailed history, examination and basic stool, urine and hematological investigations are sufficient to exclude organic pathology in them. The key step in the management of RAP is to first investigate for the organic cause based on the symptoms and then treat.
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References
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8. Thiessen PN. Recurrent abdominal pain. Pediatr Rev. 2002;23(2):39-46. doi: https://doi.org/10.1542/pir.23-2-39.
9. Liebman WM. Recurrent abdominal pain in children: lactose and sucrose intolerance, a prospective study. Pediatr. 1979;64(1):43-45.
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12. Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr 1996;129(2):220-226. doi: https://doi.org/10.1016/s0022-3476(96)70246-9.
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19. Rasul CH, Khan MAD. Recurrent abdominal pain in school children in Bangladesh. J Ceylon Coll Phys. 2000;33:110-114.
20. Mavromichalis I, Zaramboukas T, Richman PL, Slaving G. Recurrent abdominal pain of gastrointestinal origin. Eur J Pediatr. 1992;151:560-563. Available at https://www.indianpediatrics.net/sep2002/sep-830-834.htm
21. Kumar M, Yashha SK, Khanduri A, Prashad KN, Ayyagari A, Panday R. Endoscopic, histologic and microbiological evaluation of upper abdominal pain with special reference to H. pylori infection. Indian Pediatr. 1996;33(11):905-909.
22. Walker LS, Lipani TA, Greene JW, Caines K, Stutts J, Polk DB, et al. Recurrent abdominal pain: symptom subtypes based on the Rome II criteria for pediatric functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2004;38(2):187-191. doi: https://doi.org/10.1097/00005176-200402000-00016.
23. Huang RC, Plamer LJ, Forbes DA. Prevalence and pattern of childhood abdominal pain in an Australian general practice. J Paediatr Child Health. 2000;36(4):349-353. doi: https://doi.org/10.1046/j.1440-1754.2000.00513.x.
24. Devanarayana NM, de Silva DGH, de Silva HJ. Recurrent abdominal pain syndrome in a cohort of Sri Lankan children and adolescents. J Trop Pediatr. 2008;54(3):178-183. doi: https://doi.org/10.1093/tropej/fmm114.
25. Boey CCM, Goh KL. Stressful life events and recurrent abdominal pain in children in a rural district in Malaysia. Eur J Gastroenterol Hepatol. 2001;13(4):401-404. doi: https://doi.org/10.1097/00042737-200104000-00017.
26. Campo JV, Bridge J, Ehmann M, Altman S, Lucas A, Birmaher B, et al. Recurrent abdominal pain, anxiety, and depression in primary care. Pediatri. 2004;113(4):817-824. doi: https://doi.org/10.1542/peds.113.4.817
27. Di Lorenzo C, Youssef NN, Sigurdsson L, Scharff L, Griffiths J, Wald A. Visceral hyperalgesia in children with functional abdominal pain. J Pediatr. 2001;139(6):838-843. doi: https://doi.org/10.1067/mpd.2001.118883.
28. Pace F, Zuin G, Di Gianomo S, Molteni P, Casini V, Fontana M, et al. Family history of irritable bowel syndrome is the major determinant of persistent abdominal complaints in young adults with a history of pediatric recurrent abdominal pain. World J Gastroenterol. 2006;12(24):3874-3877. doi: https://dx.doi.org/10.3748%2Fwjg.v12.i24.3874.
29. Paul SP, Barnard P, Bigwood C, Candy DC. Challenges in management of irritable bowel syndrome in children. Indian Pediatr. 2013;50(12):1137-1143. Available at https://www.indianpediatrics.net/dec2013/dec-1137-1143.htm.
30. Giorgio V, D’Andrea V, Coccia P, Filoni S, Rendeli C, Fundarò C. Efficacy of rifaximin for SIBO treatment in IBS children. Pediatr Res. 2010;68(S1):144. doi: https://doi.org/10.1203/00006450-201011001-00280.
31. Gelfand AA. Migraine and childhood periodic syndromes in children and adolescents. Curr Opin Neurol. 2013;26(3):262-268. doi: https://doi.org/10.1097/wco.0b013e32836085c7
32. Lagman-Bartolome AM, Lay C. Pediatric migraine variants. Curr Neurol Neurosci Rep. 2015;15(6):34. doi: https://doi.org/10.1007/s11910-015-0551-3.
33. S Huertas-Ceballos A, Logan S, Bennett C, Macarthur C. Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev. 2008;1:CD003017. doi: https://doi.org/10.1002/14651858.cd003017.pub2.
34. Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G. Antidepressants for the treatment of abdominal painrelated functional gastrointestinal disorders in children and adolescents. Cochrane Database Syst Rev. 2011;7:CD008013. doi: https://doi.org/10.1002/14651858.CD008013.pub2.
35. Pourmoghaddas Z, Saneian H, Roohafza H, Gholamrezaei A. Mebeverine for pediatric functional abdominal pain: a randomized, placebo-controlled trial. Biomed Res Int. 2014;2014:191026. doi: https://doi.org/10.1155/2014/191026.
36. Huertas‐Ceballos AA, Logan S, Bennett C, Macarthur C. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane database of systematic reviews. 2008(1): CD003019. doi: https://doi.org/10.1002/14651858.cd003019.pub3.
37. Saps M, Di Lorenzo C. Pharmacotherapy for functional gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr. 2009;48(2):S101-S103. doi: https://doi.org/10.1097/mpg.0b013e3181a15f49.
38. Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G. Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents. Cochrane Database Syst Rev. 2011;(7):CD008013. doi: https://doi.org/10.1002/14651858.cd008013.pub2.
39. Roohafza H, Pourmoghaddas Z, Saneian H, Gholamrezaei A. Citalopram for pediatric functional abdominal pain: a randomized, placebo-controlled trial. Neurogastroenterol Motil. 2014;26(11):1642-1650. doi: https://doi.org/10.1111/nmo.12444.
40. Chiou E, Nurko S. Functional abdominal pain and irritable bowel syndrome in children and adolescents. Therapy. 2011;8(3):315-331. doi: https://doi.org/10.2217/thy.11.7
41. Sadeghian M, Farahmand F, Fallahi GH, Abbasi A. Cyproheptadine for the treatment of functional abdominal pain in childhood. Minerva Pediatr. 2008;60(6):1367-1374.
42. See MC, Birnbaum AH, Schechter CB, Goldenberg MM, Benkov KJ. Double-blind, placebo-controlled trial of famotidine in children with abdominal pain and dyspepsia. Dig Dis Sci. 2001;46(5):985-992. doi: https://doi.org/10.1023/A:1010793408132.
2. Bansal D, Patwari AK, Malhotra VL, Malhotra V, Anand VK. Helicobacter pylori infection in recurrent abdominal pain. Indian Pediatr. 1998; 35: 329-335. Available at http://medind.nic.in/ibv/t98/i4/ibvt98i4p329.pdf.
3. Macarthur C, Saunders N, Feldman W, Ipp M, Winders-Lee P, Roberts S, et al. Helicobacter pylori and childhood recurrent abdominal pain: Community based case-control study. BMJ. 1999;319(7213):822-823.
4. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1000 school children. Arch Dis Child. 1958;33(168):165-170. doi: https://dx.doi.org/10.1136%2Fadc.33.168.165.
5. Boey CC, Goh KL. Recurrent abdominal pain and consulting behaviour among children in a rural community in Malaysia. Dig Liver Dis. 2001;33(2):140-144. doi: https://doi.org/10.1016/s1590-8658(01)80069-4.
6. Kokkonen J, Haapalahti M, Tikkanen S, Karttunene R, Savilahtl E. Gastrointestinal complaints and diagnosis in children: a populationbased study. Acta Pediatr. 2004;93(2):880-886. doi: https://doi.org/10.1111/j.1651-2227.2004.tb02684.x.
7. Pearl RH, Irish MS, Caty MG, Glick PL. The approach to common abdominal diagnosis in infants and children. Part II. Pediatr Clin North Am. 1998;45(6):1287-1326. doi: https://doi.org/10.1016/s0031-3955(05)70092-4.
8. Thiessen PN. Recurrent abdominal pain. Pediatr Rev. 2002;23(2):39-46. doi: https://doi.org/10.1542/pir.23-2-39.
9. Liebman WM. Recurrent abdominal pain in children: lactose and sucrose intolerance, a prospective study. Pediatr. 1979;64(1):43-45.
10. Wald A, Chandra R, Fisher SE, Gartner JC, Zitelli B. Lactose malabsorption in recurrent abdominal pain in childhood. J Pediatr. 1982;100(1):65-68. doi: https://doi.org/10.1016/S0022-3476(82)80236-9.
11. Boey CC. Lactose deficiency among Malaysian children with recurrent abdominal pain. J Paediatr Child Health. 2001;37(2):157-160. doi: https://doi.org/10.1046/j.1440-1754.2001.00622.x.
12. Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr 1996;129(2):220-226. doi: https://doi.org/10.1016/s0022-3476(96)70246-9.
13. Nurko S, Zimmerman LA. Evaluation and treatment of constipation in children and adolescents. Am Fam Physician. 2014;90(2):82-90. Available at https://www.aafp.org/afp/2014/0715/p82.html.
14. Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138(1):125-128. doi: https://doi.org/10.1067/mpd.2001.109606.
15. Boey CC, Yap SB. An epidemiological survey of recurrent abdominal pain in a rural Malay school. J Paediatr Child Health. 1999;35(3):303-305. doi: https://doi.org/10.1046/j.1440-1754.1999.00366.x.
16. Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, et al. Childhood functional gastrointestinal disorders. Gut 1999;45(2):1160-1168. doi: http://dx.doi.org/10.1136/gut.45.2008.ii60.
17. Boey CC, Yap S, Goh KL. The prevalence of recurrent abdominal pain in 11- to 16-year-old Malaysian schoolchildren. J Paediatr Child Health. 2000;36(2):114-116. doi: https://doi.org/10.1046/j.1440-1754.2000.00465.x.
18. Boey CC, Goh KL. Predictors of recurrent abdominal pain among 9 to 15-year-old urban school-children in Malaysia. Acta Paediatr. 2001;90(3):353-355. doi: https://doi.org/10.1111/j.1651-2227.2001.tb00318.x.
19. Rasul CH, Khan MAD. Recurrent abdominal pain in school children in Bangladesh. J Ceylon Coll Phys. 2000;33:110-114.
20. Mavromichalis I, Zaramboukas T, Richman PL, Slaving G. Recurrent abdominal pain of gastrointestinal origin. Eur J Pediatr. 1992;151:560-563. Available at https://www.indianpediatrics.net/sep2002/sep-830-834.htm
21. Kumar M, Yashha SK, Khanduri A, Prashad KN, Ayyagari A, Panday R. Endoscopic, histologic and microbiological evaluation of upper abdominal pain with special reference to H. pylori infection. Indian Pediatr. 1996;33(11):905-909.
22. Walker LS, Lipani TA, Greene JW, Caines K, Stutts J, Polk DB, et al. Recurrent abdominal pain: symptom subtypes based on the Rome II criteria for pediatric functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr. 2004;38(2):187-191. doi: https://doi.org/10.1097/00005176-200402000-00016.
23. Huang RC, Plamer LJ, Forbes DA. Prevalence and pattern of childhood abdominal pain in an Australian general practice. J Paediatr Child Health. 2000;36(4):349-353. doi: https://doi.org/10.1046/j.1440-1754.2000.00513.x.
24. Devanarayana NM, de Silva DGH, de Silva HJ. Recurrent abdominal pain syndrome in a cohort of Sri Lankan children and adolescents. J Trop Pediatr. 2008;54(3):178-183. doi: https://doi.org/10.1093/tropej/fmm114.
25. Boey CCM, Goh KL. Stressful life events and recurrent abdominal pain in children in a rural district in Malaysia. Eur J Gastroenterol Hepatol. 2001;13(4):401-404. doi: https://doi.org/10.1097/00042737-200104000-00017.
26. Campo JV, Bridge J, Ehmann M, Altman S, Lucas A, Birmaher B, et al. Recurrent abdominal pain, anxiety, and depression in primary care. Pediatri. 2004;113(4):817-824. doi: https://doi.org/10.1542/peds.113.4.817
27. Di Lorenzo C, Youssef NN, Sigurdsson L, Scharff L, Griffiths J, Wald A. Visceral hyperalgesia in children with functional abdominal pain. J Pediatr. 2001;139(6):838-843. doi: https://doi.org/10.1067/mpd.2001.118883.
28. Pace F, Zuin G, Di Gianomo S, Molteni P, Casini V, Fontana M, et al. Family history of irritable bowel syndrome is the major determinant of persistent abdominal complaints in young adults with a history of pediatric recurrent abdominal pain. World J Gastroenterol. 2006;12(24):3874-3877. doi: https://dx.doi.org/10.3748%2Fwjg.v12.i24.3874.
29. Paul SP, Barnard P, Bigwood C, Candy DC. Challenges in management of irritable bowel syndrome in children. Indian Pediatr. 2013;50(12):1137-1143. Available at https://www.indianpediatrics.net/dec2013/dec-1137-1143.htm.
30. Giorgio V, D’Andrea V, Coccia P, Filoni S, Rendeli C, Fundarò C. Efficacy of rifaximin for SIBO treatment in IBS children. Pediatr Res. 2010;68(S1):144. doi: https://doi.org/10.1203/00006450-201011001-00280.
31. Gelfand AA. Migraine and childhood periodic syndromes in children and adolescents. Curr Opin Neurol. 2013;26(3):262-268. doi: https://doi.org/10.1097/wco.0b013e32836085c7
32. Lagman-Bartolome AM, Lay C. Pediatric migraine variants. Curr Neurol Neurosci Rep. 2015;15(6):34. doi: https://doi.org/10.1007/s11910-015-0551-3.
33. S Huertas-Ceballos A, Logan S, Bennett C, Macarthur C. Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev. 2008;1:CD003017. doi: https://doi.org/10.1002/14651858.cd003017.pub2.
34. Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G. Antidepressants for the treatment of abdominal painrelated functional gastrointestinal disorders in children and adolescents. Cochrane Database Syst Rev. 2011;7:CD008013. doi: https://doi.org/10.1002/14651858.CD008013.pub2.
35. Pourmoghaddas Z, Saneian H, Roohafza H, Gholamrezaei A. Mebeverine for pediatric functional abdominal pain: a randomized, placebo-controlled trial. Biomed Res Int. 2014;2014:191026. doi: https://doi.org/10.1155/2014/191026.
36. Huertas‐Ceballos AA, Logan S, Bennett C, Macarthur C. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane database of systematic reviews. 2008(1): CD003019. doi: https://doi.org/10.1002/14651858.cd003019.pub3.
37. Saps M, Di Lorenzo C. Pharmacotherapy for functional gastrointestinal disorders in children. J Pediatr Gastroenterol Nutr. 2009;48(2):S101-S103. doi: https://doi.org/10.1097/mpg.0b013e3181a15f49.
38. Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G. Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents. Cochrane Database Syst Rev. 2011;(7):CD008013. doi: https://doi.org/10.1002/14651858.cd008013.pub2.
39. Roohafza H, Pourmoghaddas Z, Saneian H, Gholamrezaei A. Citalopram for pediatric functional abdominal pain: a randomized, placebo-controlled trial. Neurogastroenterol Motil. 2014;26(11):1642-1650. doi: https://doi.org/10.1111/nmo.12444.
40. Chiou E, Nurko S. Functional abdominal pain and irritable bowel syndrome in children and adolescents. Therapy. 2011;8(3):315-331. doi: https://doi.org/10.2217/thy.11.7
41. Sadeghian M, Farahmand F, Fallahi GH, Abbasi A. Cyproheptadine for the treatment of functional abdominal pain in childhood. Minerva Pediatr. 2008;60(6):1367-1374.
42. See MC, Birnbaum AH, Schechter CB, Goldenberg MM, Benkov KJ. Double-blind, placebo-controlled trial of famotidine in children with abdominal pain and dyspepsia. Dig Dis Sci. 2001;46(5):985-992. doi: https://doi.org/10.1023/A:1010793408132.
CITATION
DOI: 10.17511/ijpr.2020.i03.01
Published: 2020-03-31
How to Cite
Bansal, S., & Une, D. L. (2020). Recurrent abdominal pain in children attending pediatrics OPD. Pediatric Review: International Journal of Pediatric Research, 7(3), 114-121. https://doi.org/10.17511/ijpr.2020.i03.01
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