II. Definition

  1. Pain occurs at least once/month for at least 3 months
  2. Ages 5 - 16 years (peaks at age 9 years)
  3. Affects activity, school attendance

III. Epidemiology

  1. Prevelance
    1. School age children: 10-15%
    2. Pre-teen and teenage children: 20%

IV. Pathophysiology

  1. Autonomic Dysfunction with altered intestinal motility
  2. Hyperalgesia and altered sensory pathways

V. Causes

  1. Functional Abdominal Pain in most cases
    1. Dyspepsia
    2. Irritable Bowel Syndrome
    3. Abdominal Migraine
    4. Functional Constipation
    5. Cyclical Vomiting
    6. Adolescent Rumination Syndrome
  2. Organic cause in 3-8% of cases (see differential diagnosis below)
    1. See Abdominal Pain Causes

VI. Risk Factors

  1. School Phobia (and related stresses) closely associated
  2. Parents (especially mothers) often have Anxiety Disorder or Major Depression

VII. Associated Conditions

VIII. Symptoms

  1. Nonspecific recurrent Abdominal Pain
    1. Typically periumbilical or epigastric, ill-defined pain
    2. Not related to meals
    3. Not related to movement or activity
  2. Nausea or Vomiting may be present depending on type
  3. No Dysuria

IX. Signs

  1. Well appearing child
  2. Exam is often normal or mild abdominal tenderness
  3. Normal growth curves (or Body Mass Index for age)

X. Signs: Red flags

  1. Pain location distant from Umbilicus
  2. Pain that awakens child at night
  3. Erythrocyte Sedimentation Rate (ESR) or C-Reactive Protein (C-RP) elevated
  4. Weight loss
  5. Blood in stool

XI. Labs (Limited and focused work-up)

XII. Imaging

  1. Flat and upright abdominal XRay (KUB)
  2. Consider RUQ Ultrasound
  3. Consider pelvic Ultrasound

XIII. Differential Diagnosis

  1. Crohn's Disease
  2. Peptic Ulcer Disease
  3. Carbohydrate intolerance
  4. Appendiceal colic
  5. Nephrolithiasis (Ureteropelvic junction obstruction)
  6. Giardia
  7. Blastocystis hominis
  8. Hereditary Pancreatitis
  9. Abdominal Migraine
  10. Epilepsy
  11. Gynecologic disorder
  12. Psychiatric disorder or abuse
    1. Major Depression
    2. Generalized Anxiety Disorder
    3. Sexual Abuse
    4. Physical abuse
    5. Conversion reaction

XIV. Management

  1. Avoid Medications
    1. Peppermint Oil capsule three times daily has been used
  2. Emphasize the patient's response to pain
  3. Involve the parents
  4. Reassure that the problem is NOT life threatening
  5. Be realistic and frank
    1. Problem may persist for extended period of time
  6. Treat suspected Constipation aggressively
    1. Mineral Oil
    2. Lactulose
    3. Fleet Enema
  7. Promote full activity and a sense of health
  8. Encourage a well balanced diet
  9. Encourage adequate hydration
  10. Encourage adequate fiber intake
  11. Maintain school attendance

XV. Course

  1. Usually resolves by age 20 years
  2. Irritable Bowel Syndrome may develop

XVI. Prognosis

  1. These children often get lower grades than peers

XVII. References

  1. Thiessen (2002) Pediatr Rev 23(2):39-46 [PubMed]
  2. Claudius in Majoewsky (2012) EM:RAP-C3 2(3): 3

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Functional abdominal pain (C1609533)

Concepts Sign or Symptom (T184)
Dutch functionele buikpijn
French Douleur abdominale fonctionnelle
German funktionelle Bauchschmerzen
Italian Dolore addominale funzionale
Portuguese Dor abdominal funcional
Spanish Dolor abdominal funcional
Japanese 機能性腹痛, キノウセイフクツウ
Czech Funkční břišní bolest
Hungarian Funkcionális hasfájás
English Functional abdominal pain

Ontology: Recurrent abdominal pain (C2585575)

Concepts Sign or Symptom (T184)
SnomedCT 439469002
English Recurrent abdominal pain (finding), Recurrent abdominal pain, Recurrent abdominal pains
Spanish dolor abdominal recurrente (hallazgo), dolor abdominal recurrente