++
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.
++
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.
++
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
++
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.
++
There is a higher prevalence of alcoholism, psychiatric disorders,
somatization disorders, migraine, and chronic ...