Diagnostic Approaches to Chronic Abdominal Pain in Children

Jae Hong Park

doi:10.5223/kjpgn.2011.14.1.26

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Park: Diagnostic Approaches to Chronic Abdominal Pain in Children

Review Article

Korean Journal of Pediatric Gastroenterology and Nutrition

Korean Journal of Pediatric Gastroenterology and Nutrition 2011; 14(1): 26-32.

Published online: 31 March 2011

DOI: https://doi.org/10.5223/kjpgn.2011.14.1.26

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 (jhongpark@pusan.ac.kr)

Received 27 February 2011 Revised 15 March 2011 Accepted 17 March 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

Figures and Tables

Table 1

Currently Used Definitions to Describe Childhood Abdominal Pain

IBS: irritable bowel syndrome.

Table 2

Initial Approach to Treating Children with Recurring Abdominal Pain

CBC: complete blood count, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, ALT: alanine aminotransferase, TTG/IgA: tissue transglutaminase, IgA, UA: urine analysis, DDx: differential diagnosis, GERD: gastroesophageal reflux disease, PPI: proton pump inhibitor, GI: gastrointestinal, IBS: irritable bowel syndrome.

Table 3

Findings That Suggest Recurrent Abdominal Pain due to Organic Disease

Table 4

Rome III Functional Gastrointestinal Disorders in Children and Adolescents

From Rasquin A. et al. Childhood functional gastrointestinal disorders: child/adolescent.

Table 5

Functional Gastrointestinal Disorders (FGID)

From Kohli R and Li BU. Differential dagnosis of recurrent abdominal pain: new considerations. FRAP: functional recurrent abdominal pain, IBS: irritable bowel syndrome.

Table 6

Differential Diagnosis of RAP Based on the Presenting Symptoms Complex

From Kohli R and Li BU. Differential diagnosis of recurrent abdominal pain: new considerations.

Table 7

Alarm Symptoms for Organic Causes of RAP

From Kohli R and Li BU. Differential diagnosis of recurrent abdominal pain: new considerations. GI: gastrointestinal, IBD: inflammatory bowel disease, ESR: erythrocyte sedimentation rate, SLE: systemic lupus erythematosus.

Table 8

Findings and Testing

Noe JD and Li BU. Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing. RLQ: right lower quadrant, CBC: complete blood count, ALT: alanine aminotransferase, GGT: gamma glutamyl transpeptidase, CRP: C-reactive protein, UA: urine analysis, UGI: upper gastrointestinal, GB: gallbladder, IBD: inflammatory bowel disease, UTI: urinary tract infection, SMA: superior mesenteric artery.

Table 9

Key Diagnostic Features

Noe JD and Li BU. Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing. RUQ: right upper quadrant, RLQ: right lower quadrant, LLQ: left lower quadrant, IBD: inflammatory bowel disease.

Table 10

Pediatric Gastroenterology Referral

GI: gastrointestinal, RAP: recurrent abdominal pain, IDA: iron deficiency anemia, ESR: erythrocyte sedimentation rate, IBD: inflammatory bowel disease.

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