Abstract
Chronic abdominal pain (CAP) in children and adolescents remains one of the pathogenetically ambiguous disorders and a great trouble to their caretakers as well as patients. Although the symptom does not usually lead to a crucial problem, the parents may be terribly worried, the child may be in distress, and the practitioner may be concerned about ordering tests to confirm a serious occult disease. Systemized diagnostic approaches are needed to overcome this unique difficulty. The presence of red flag symptoms or signs is a general indication to pursue diagnostic testing for organic etiologies of CAP on the basis of specific symptoms in an individual case. Functional abdominal pain can be normally diagnosed when there are no red flag symptoms or signs. According to the Rome III criteria for pediatric functional gastrointestinal disorders, functional disorders of CAP can be classified into functional dyspepsia, irritable bowel syndrome, abdominal migraine, and chronic functional abdominal pain syndrome. Cyclic vomiting syndrome and pathologic aerophagia are also major functional causes of CAP. Modern concepts of the pathogenesis of functional abdominal pain include brain-gut interaction, visceral hypersensitivity, autonomic dysfunction, and psychosocial factors. In addition, psychiatric disorders, presented with red flag symptoms or signs, may induce the CAP in children and adolescents. We introduce practical and systemized diagnostic approaches by illustrating clinical cases of CAP in children and adolescents.
Figures and Tables
Table 1
Differential diagnosis of organic etiologies in childhood chronic abdominal pain based on age and prevalence
![jkma-52-271-i001](/upload/SynapseData/ArticleImage/0119jkma/jkma-52-271-i001.jpg)
*Acid peptic disease; gastroesophageal reflux disease, esophagitis, gastritis, H. pylori-associated. Abbreviations: RAP; recurrent abdominal pain, PAN; polyarteritis nodosa, SMA; superior mesenteric artery syndrome, SLE; systemic lupus erythematosis, MVO; mesenteric vein obstruction, AIP; acute intermittent por-phyria. Adapted from reference 2.
Table 2
Rome III functional gastrointestinal disorders in child and adolescent
![jkma-52-271-i002](/upload/SynapseData/ArticleImage/0119jkma/jkma-52-271-i002.jpg)
*Boldface indicates discussion in this article. Adopted from (5).
References
1. Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr. 1996. 129:220–226.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
2. Kohli R, Li BU. Differential diagnosis of recurrent abdominal pain: New considerations. Pediatr Ann. 2004. 33:113–122.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
3. Boey CCM, Goh KL. Psychosocial factors and childhood recurrent abdominal pain. J Gastroenterol Hepatol. 2002. 17:1250–1253.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
4. Apley J, Naish N. Recurrent abdominal pains: a field survey of 100 school children. Arch Dis Child. 1958. 50:429–436.
5. Di Lorenzo C, Colletti RB, Lehmann HP, Boyle JT, Gerson WT, Hyams JS, Squires RH Jr, Walker LS, Kanda PT. Chronic abdominal pain in children: a clinical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005. 40:245–248.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
6. Kolts RL, Nelson RS, Park R, Heikenen J. Exploratory laparoscopy for recurrent right lower quadrant pain in a pediatric population. Pediatr Surg Int. 2006. 22:247–249.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
7. Park MH, Choi WJ, Hwang JB. Topical tacrolimus resulting in a marked resolution of perianal Crohn's disease. Korean J Pediatr Gastroenterol Nutr. 2005. 8:70–75.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
8. Zinkin NT, Peppercorn MA. Abdominal epilepsy. Best Pract Res Clin Gastroenterol. 2005. 19:263–274.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
9. Song JY, Kim JS, Hwang JB. A case of abdomonal epilepsy presenting with recurrent abdominal pain. Korean J Pediatr Gastroenterol Nutr. 2007. 10:202–205.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
10. Hong SP, Shin HJ, Kim YH, Choe BK, Choi WJ, Kim AS, Hwang JB. A case of PFAPA syndrome mimicking cyclic vomiting syndrome. Korean J Pediatr Gastroenterol Nutr. 2006. 9:85–91.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
11. Yang HR. New approach to chronic recurrent abdominal pain in children. Korean J Pediatr. 2006. 49:129–135.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
12. Raquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS. Childhood functional gastrointestinal disorders: child/adlescent. Gastroenterology. 2006. 130:1527–1537.
13. Hwang JB, Oh HJ, Choi KH. Long term follow-up of cyclic vomiting syndrome. Korean J Pediatr Gastroenterol Nutr. 2000. 3:75–83.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
14. Hwang JB, Choi WJ, Kim JS, Lee SY, Jung CH, Lee YH, Kam S. Clinical features of pathologic childhood aerophagia: early recognition and essential diagnostic criteria. J Pediatr Gastroenterol Nutr. 2005. 41:612–616.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
15. von Baeyer CL. Understanding and managing children's recurrent pain in primary care: A biopsychosocial perspective. Paediatr Child Health. 2007. 12:121–125.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
16. Raymer D, Weininger O, Hamilton JR. Psychological problems in children with abdominal pain. Lancet. 1984. 1:439–440.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
17. Robinson JO, Alverez JH, Dodge JA. Life events and family history in children with recurrent abdominal pain. J Psychosom Res. 1990. 34:171–181.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)