Chronic and Recurrent Abdominal Pain

Education Gap

The past 20 years have witnessed a transition in clinical understanding of childhood bellyaches. The recently published third iteration of pediatric Rome criteria provides updated and accurate criteria for symptom-based diagnosis of chronic and recurrent abdominal pain. In many cases, primary care clinicians can make symptom-based diagnoses and initiate treatment on the first visit.

Objectives

After completing this article, readers should be able to:

1. Make symptom-based diagnoses of functional abdominal pain disorders.

2. List a variety of treatment options for children with functional abdominal pain.

3. Recognize warning signs that discriminate disease from functional abdominal pain.

4. Understand how psychosocial factors play a role in disability associated with functional abdominal pain.

Epidemiology

By definition, chronic or recurrent abdominal pain must occur at least 4 times each month for at least 2 months. Abdominal pain complaints begin as soon as a child can provide an accurate pain history, usually around age 7 years but occasionally younger. Before that age, children have difficulty separating emotional distress from physical pain. The differential diagnosis of child and adolescent abdominal pain is unrelated to age.

One in 10 children visits a clinician because of chronic or recurrent abdominal pain. (1) How can a clinician screen quickly for disease? The first consideration is the duration of each episode. If the pain lasts less than 5 minutes, even if it occurs many times daily, the pain is unlikely to be worrisome. Abdominal pains lasting just a few minutes may be abdominal wall muscle cramps or high-amplitude-propagating colon contractions. High-amplitude-propagating contractions are waves of muscle contraction starting in the ascending colon, with pressures greater than 60 mm Hg, that move colonic contents through the colon to …