Chronic Recurrent Abdominal Pain

Brian A. McFerron; Shamaila Waseem

doi:10.1542/pir.33-11-509

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Brian A. McFerron, MD*
Shamaila Waseem, MD*

^*Division of Pediatric Gastroenterology/Hepatology and Nutrition, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.

Author Disclosure
Drs McFerron and Waseem have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

CBT:: cognitive behavioral therapy
FGID:: functional gastrointestinal disorder
GI:: gastrointestinal
IBS:: irritable bowel syndrome

Educational Gap

Chronic abdominal pain in childhood accounts for 2% to 4% of office visits to primary care clinicians and 50% to pediatric gastroenterologists. Differentiation among organic gastrointestinal, organic non-gastrointestinal, and functional gastrointestinal disorders can be difficult, but specific criteria are available.

Objectives

After completing this article, readers should be able to:

Develop a differential diagnosis of chronic abdominal pain in children.
Be aware of alarming signs and symptoms that could indicate organic disease.
Differentiate the four abdominal pain–associated functional gastrointestinal disorders in children as outlined by the Rome III criteria.
Discuss the role of acid peptic disorders as it pertains to chronic abdominal pain in children.
Discuss the role of lactase deficiency as it pertains to chronic abdominal pain in children.
Determine when referral to a pediatric specialist is warranted.

Introduction

Chronic abdominal pain in childhood is encountered frequently by primary care physicians, subspecialists, and surgical specialists alike. This symptom accounts for 2% to 4% of office visits to primary care clinicians and 50% of office visits to pediatric gastroenterologists. (1)(2) Chronic abdominal pain is defined by the American Academy of Pediatrics’ 2005 clinical report as “long-lasting intermittent or constant abdominal pain that is functional or organic.” (3) Chronic abdominal pain in children ignites significant anxiety in both patients and their families. In addition, the economic impact on health care is substantial. Furthermore, the short- and long-term effects on school attendance, academic performance, and peer interaction cannot be understated. The exact prevalence of chronic abdominal pain is not known. However, it has been suggested that 13% to 17% of the pediatric population experience chronic abdominal pain. (1) Of note, there are …