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Key Features

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  • Approximately 2–4% of all pediatric office visits occur because of unexplained, recurrent abdominal pain

  • Up to 17% of adolescents have been reported to have recurrent abdominal pain

  • Based on the Rome III criteria, the term "recurrent abdominal pain" has been discarded for the more meaningful terms that fall into the categories of "abdominal pain-related functional gastrointestinal (GI) disorders," which encompasses four entities

    • Functional dyspepsia (characterized by epigastric pain)

    • Irritable bowel syndrome (characterized by altered form and frequency of stools and improvement with defecation)

    • Abdominal migraines

    • Childhood functional abdominal pain

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Clinical Findings

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  • Children with functional abdominal pain experience recurrent attacks of abdominal pain or discomfort at least once per week for at least 2 months

  • According to the Rome III criteria, the classification of the abdominal pain depends on the characteristics of the pain such as

    • Location of pain

      • Usually localized to periumbilical area

      • May also be more generalized

    • Association with bowel habits

      • Functional abdominal pain usually bears little relationship to bowel habits and physical activity

      • However, some patients have a symptom constellation suggestive of irritable bowel syndrome, including bloating, postprandial pain, lower abdominal discomfort, and erratic stool habits with a sensation of obstipation or incomplete evacuation of stool

    • Associated symptoms

      • Pallor

      • Nausea

      • Vomiting

  • Alarm symptoms that would suggest a more severe organic etiology are absent include

    • Dysphagia

    • Persistent vomiting

    • GI blood loss

    • Associated rashes

    • Joint complaints

  • A thorough physical examination that includes a rectal examination is essential and usually normal

  • Complaints of abdominal tenderness elicited during palpation may be out of proportion to visible signs of distress

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Diagnosis

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  • Complete blood count

  • Erythrocyte sedimentation rate

  • Stool test for occult blood

  • Ultrasound of the abdomen and pelvis may be helpful to detect gallbladder or ovarian pathology in the adolescent female patient

  • If the pain is atypical, further testing suggested by symptoms and family history should be done, including

    • Additional imaging studies

    • Endoscopic analysis

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Treatment

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  • Consists of reassurance based on a thorough history and physical examination and a sympathetic, age-appropriate explanation of the nature of functional pain

  • Therapy for psychosocial stressors, including biofeedback therapy, may be necessary

  • Low-dose amitriptyline may occasionally be helpful in

    • Older patients

    • Patients with what appears to be visceral hyperalgesia

  • Antispasmodic medications

    • Rarely helpful

    • Should be reserved for patients with more typical irritable bowel complaints

  • Targeted therapy based on symptoms may be helpful for irritable bowel syndrome

  • For abdominal migraines, treatments for migraine headaches may help

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