Abdominal Pain

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

Treatment

• 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