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Abdominal pain is a common complaint in pediatric population, often resulting in unscheduled office or emergency room visits. This symptom can be acute, recurrent, or chronic.

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Acute abdominal pain generally refers to pain that has been present for <24 hours. When the presentation is acute, the challenge for the evaluating physician is to differentiate potentially life-threatening and serious medical conditions from benign self-limited ones. The frequency of surgical intervention in patients presenting with acute abdominal pain is around 1%,1 but the possibility of overlooking a serious organic etiology is a cause of concern to evaluating physicians and families.

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Children are considered to have recurrent or chronic abdominal pain if they have experienced at least three bouts of abdominal pain, severe enough to affect activities, over a period of at least 3 months. Though this definition was initially used by Apley and Nash2 as the entry criteria for their descriptive study, it later became a term to describe all children with abdominal pain without known organic etiology. Recurrent abdominal pain (RAP) should be used as a description rather than as a diagnosis. RAP may occur in functional abdominal pain (FAP; see below), but this pattern of discomfort can also occur with organic disease.3Functional gastrointestinal disorders (FGID) include a combination of chronic and/or recurrent symptoms not explained by known biochemical or structural abnormalities. According to Rome III criteria, symptoms must occur at least once per week for at least 2 months before making a diagnosis of FGID.4 In a study of 227 patients with recurrent and chronic abdominal pain, only 76 (33%) were found to have well-defined organic etiologies.5

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Abdominal pain accounts for 2–4% of all pediatric office visits.6 In a study by Hyams et al., 13% of middle-school students and 17% of high-school students experienced weekly abdominal pain. In that study, approximately 8% students saw their physician for abdominal pain evaluation in the previous year.7 In Apley and Nash original study involving 1000 children in primary and secondary schools, 10.8% of children had RAP, with a female preponderance (female to male ratio of 1.3:1).2 In that survey, the age distribution was also examined. Ten to 12% of males aged 5–10 years had RAP, followed by decline in prevalence and a later peak at age 14 years. Females showed a sharp rise in prevalence after age 8 years and by age 9 years 25% of this group experienced RAP. The long-term outcome of patients with FGID is not known, but studies indicate patients with history of chronic abdominal pain that began in childhood and treated by a subspecialist are more likely to have lifelong psychiatric problems and migraine headaches.3 Genetic factors and early life events may have a role in the pathogenesis of chronic abdominal pain.

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Family History

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There is a higher prevalence of alcoholism, psychiatric disorders, somatization disorders, migraine, and chronic pain symptoms among family members. Familial clustering is often seen in patients with FGID. Subjects with FGID, in a study by Locke et al., had an increased risk of reporting a first-degree relative with abdominal pain and/or bowel distrurbance.8 Possible explanations ...

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