Adult Outcomes of Pediatric Recurrent Abdominal Pain: Do They Just Grow Out of It?

Abstract

ABSTRACT. Objective. To determine whether medically unexplained recurrent abdominal pain (RAP) in childhood predicts abdominal pain, irritable bowel syndrome (IBS), other somatic complaints, and psychiatric symptoms and disorders in young adulthood.Methods. A sample of 28 young adults evaluated for RAP between the ages of 6 and 17 years were compared with 28 individually matched former childhood participants in a study of tonsillectomy and adenoidectomy. RAP caseness was established by structured retrospective chart review requiring agreement by 2 independent reviewers. Standardized assessments of abdominal pain, IBS, other somatic symptoms, psychopathology, perceived health, and history of maltreatment were performed an average of 11.1 years after the index visit.Results. Former RAP patients were significantly more likely than controls to endorse anxiety symptoms and disorders, hypochondriacal beliefs, greater perceived susceptibility to physical impairment, poorer social functioning, current treatment with psychoactive medication, and generalized anxiety in first degree relatives. There were trends suggesting associations between childhood RAP and lifetime psychiatric disorder, depression, migraine, and family history of depression, but group differences on abdominal pain, IBS, other somatic symptoms, and history of maltreatment were not statistically significant.Conclusions. There is a strong and relatively specific association between childhood RAP and anxiety in young adulthood. Affected children may be at special risk to perceive physical symptoms as threatening, and should be evaluated for psychiatric disorder on initial presentation. Pediatrics 2001;108(1). URL: http://www. pediatrics.org/cgi/content/full/108/1/e1; abdominal pain, pain, anxiety, depression, colonic diseases, functional.ABBREVIATIONS. RAP, recurrent abdominal pain; FGD, functional gastrointestinal disorder; IBS, irritable bowel syndrome; DSM, Diagnostic and Statistical Manual of Mental Disorders; SCID-NP, Structured Clinical Interview for DSM-IV, Non-patient Version; BSI, brief symptom inventory; NS, not significant. R ecurrent abdominal pain (RAP) has been most consistently defined in the pediatric literature as at least 3 episodes of abdominal pain occurring during a period of at least 3 months that are severe enough to affect the activities of the child. 1,2 RAP is common, affecting between 7% to 25% of school-aged children and adolescents, 1,3-11 and may be responsible for 2% to 4% of pediatric office visits. 12 RAP becomes more prevalent with increasing age into adolescence 1,5,7,10 and is more common in girls, 4,13 with an equal gender ratio in early childhood, 11,14 but greater female symptom reporting in late childhood and adolescence. 1,9,10 Specific structural, infectious, inflammatory, or laboratory abnormalities are unusual in RAP, particularly in the absence of "red flags" such as weight loss, gastrointestinal bleeding, pain awakening the child at night, systemic symptoms such as fever, or laboratory evidence of anemia or inf...

Chronic Abdominal Pain in Children

“…A recent study compared 28 young adults evaluated for functional abdominal pain between the ages of 6 and 17 years with 28 matched former childhood participants of a study of tonsillectomy and adenoidectomy (controls). 7 An average of 11 years after the target visit, a structured psychiatric diagnostic interview was administered to identify psychiatric disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition 54 criteria. Compared with controls, those with persistent abdominal pain were significantly more likely to meet criteria for a lifetime or current history of anxiety disorder.…”

“…[4][5][6] The long-term outcome of this condition has not been determined, but preliminary data indicate that young adults with a history of recurrent abdominal pain that began in childhood who are treated by a subspecialist are significantly more likely than their peers without recurrent abdominal pain to have lifelong psychiatric problems and migraine headaches. 7 Despite the high prevalence and effects of this condition, no evidence-based guidelines for its evaluation and treatment exist.…”

Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial

“…Frequent AP is associated with substantial disabilities in quality of life and daily functioning [59], particularly in attending school [29,38]. A part of children with AP is at risk of symptom persistence till adulthood [5,21,24,53]. Children with AP are found to score higher in questionnaires assessing psychopathological symptoms especially internalizing disturbances such as anxiety and other somatic complaints [14,17,52].…”

Challenges of Caring for Children with Functional Gastrointestinal Disorders

“…7 Adults with a history of FGIDs as children have more psychiatric disorders and higher use of psychiatric medications. 8 The low proportion of children with abdominal pain who consult their pediatricians in combination with the insurmountable inability to care for all children with abdominal pain at the doctor's office calls for creative solutions.…”