Journal List > Korean J Pediatr Gastroenterol Nutr > v.14(1) > 1043512

Korean J Pediatr Gastroenterol Nutr. 2011 Mar;14(1):26-32. Korean.
Published online March 31, 2011.  https://doi.org/10.5223/kjpgn.2011.14.1.26
Copyright © 2011 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
Diagnostic Approaches to Chronic Abdominal Pain in Children
Jae Hong Park, M.D.
Department of Pediatrics, School of Medicine, Pusan National University, Busan, Korea.

Corresponding author (Email: jhongpark@pusan.ac.kr )
Received February 27, 2011; Revised March 15, 2011; Accepted March 17, 2011.

Abstract

Chronic abdominal pain (CAP) is a common complaint encountered in pediatric clinics and a great concern for patients and their caretakers as well as health care professionals. A constant challenge is detecting individuals with organic diseases or psychosomatic disorders from the majority of patients who have a functional disorder including functional dyspepsia, irritable bowel syndrome, functional abdominal pain, and abdominal migraine. Beginning with a detailed history and physical examination, physicians must determine a differential diagnosis of CAP by applying the symptom-based Rome III criteria to positively identify a functional disorder. These findings should then be further analyzed based on diagnostic clues and red flags that indicate the presence of specific organic diseases and/or the need for further testing. Once a functional diagnosis has been made or an organic disease is suspected, physicians can initiate an empiric therapeutic trial. Since psychological distress accompanies both organic and non-organic abdominal pain in children, a cooperative diagnostic approach involving pediatricians and psychiatrists is recommended.

Keywords: Abdominal pain; Chronic; Diagnosis; Child

Tables


 Table 1
Currently Used Definitions to Describe Childhood Abdominal Pain
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Table 2
Initial Approach to Treating Children with Recurring Abdominal Pain
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Table 3
Findings That Suggest Recurrent Abdominal Pain due to Organic Disease
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Table 4
Rome III Functional Gastrointestinal Disorders in Children and Adolescents
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Table 5
Functional Gastrointestinal Disorders (FGID)
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Table 6
Differential Diagnosis of RAP Based on the Presenting Symptoms Complex
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Table 7
Alarm Symptoms for Organic Causes of RAP
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Table 8
Findings and Testing
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Table 9
Key Diagnostic Features
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Table 10
Pediatric Gastroenterology Referral
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References
1. Starfield B, Hoekelman RA, McCormick M, Benson P, Mendenhall RC, Moynihan C, et al. Who provides health care to children and adolescents in the United States? Pediatrics 1984;74:991–997.
2. 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.
3. Frank L, Kleinman L, Rentz A, Ciesla G, Kim JJ, Zacker C. Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases. Clin Ther 2002;24:675–689.
4. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993;38:1569–1580.
5. Talley NJ, Gabriel SE, Harmsen WS, Zinsmeister AR, Evans RW. Medical costs in community subjects with irritable bowel syndrome. Gastroenterology 1995;109:1736–1741.
6. Campo JV, Di Lorenzo C, Chiappetta L, Bridge J, Colborn DK, Gartner JC Jr, et al. Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it? Pediatrics 2001;108:E1.
7. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1,000 school children. Arch Dis Child 1958;33:165–170.
8. American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain. Chronic abdominal pain in children. Pediatrics 2005;115:812–815.
9. Kohli R, Li BU. Differential diagnosis of recurrent abdominal pain: new considerations. Pediatr Ann 2004;33:113–122.
10. Boey CC, Goh KL. Psychosocial factors and childhood recurrent abdominal pain. J Gastroenterol Hepatol 2002;17:1250–1253.
11. Noe JD, Li BU. Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing. Pediatr Ann 2009;38:259–266.
12. Di Lorenzo C, Colletti RB, Lehmann HP, Boyle JT, Gerson WT, Hyams JS, et al. American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain; NASPGHAN Committee on Abdominal Pain. 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.
13. Hwang JB, Jeong SH. Practical diagnostic approaches to chronic abdominal pain in children and adolescents. J Korean Med Assoc 2009;52:271–284.
14. von Baeyer CL. Understanding and managing children's recurrent pain in primary care: a biopsychosocial perspective. Paediatr Child Health 2007;12:121–125.
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