Children with Recurrent Abdominal Pain: How Do They Grow Up?

Apley, John; Hale, Barbara N.

doi:10.1136/bmj.3.5870.7

Cited by 187 publications

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“…Prospective studies have shown that many children with abdominal pain continue to complain of somatic symptoms and disability years after their initial evaluation (Apley and Hale, 1973;Christensen and Mortensen, 1975;Magni et al, 1987;Stickler and Murphy, 1979;Walker et al, 1995Walker et al, , 1998. For any patient population, however, the average longitudinal trajectory rarely describes all individuals.…”

Section: Introductionmentioning

confidence: 99%

“…Some children with persistent abdominal pain also report a variety of additional symptoms including headaches, fatigue, dizziness, and nonspecific somatic complaints (Oster, 1972), suggesting the possibility of a somatization disorder (Ernst et al, 1984;Walker et al, 1991). Moreover, abdominal pain and associated somatic symptoms can have a considerable impact on children's daily functioning both academically and socially (Claar et al, 1999).Prospective studies have shown that many children with abdominal pain continue to complain of somatic symptoms and disability years after their initial evaluation (Apley and Hale, 1973;Christensen and Mortensen, 1975;Magni et al, 1987;Stickler and Murphy, 1979;Walker et al, 1995Walker et al, , 1998. For any patient population, however, the average longitudinal trajectory rarely describes all individuals.…”

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Trajectories of Symptoms and Impairment for Pediatric Patients With Functional Abdominal Pain: A 5-Year Longitudinal Study

Mulvaney

Lambert

Garber

et al. 2006

Journal of the American Academy of Child & Adolescent Psych

162

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Objective-This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominal pain not associated with identifiable organic disease. Method-TheChildren's Somatization Inventory and the Functional Disability Inventory were administered four times over 5 years to 132 patients (6-18 years old) seen in a pediatric gastroenterology clinic. Individual trajectories were empirically grouped and correlates of trajectory group membership at baseline were evaluated.Results-A model with three unique trajectories was found to adequately fit both symptom and impairment data. Two trajectories indicated relatively long-term improvement and one indicated continued high levels of symptoms and impairment. At baseline, the long-term risk group did not have the most severe pain but had significantly more anxiety, depression, lower perceived selfworth, and more negative life events.Conclusions-These results indicate that several distinct trajectories of relatively long-term outcomes may exist in children with functional abdominal pain. One trajectory indicated longterm risk for a high level of symptoms and impairment. Psychosocial correlates of long-term risk for physical symptoms and impairment, such as child-reported stress and internalizing symptoms, may be useful for treatment planning. Keywordsfunctional abdominal pain; somatic symptoms; impairment; trajectories; longitudinal; children Abdominal pain is one of the most common reasons for referral to pediatric primary care and gastroenterology clinics (Starfield et al., 1980). Recurrent episodes of pain over a period of several months or longer may affect as many as 10% to 24% of children and adolescents Hyams et al., 1996;Oster, 1972 pain in children is functional-without objective evidence of organic disease (Boyle, 1997;Walker et al., 2004). Some children with persistent abdominal pain also report a variety of additional symptoms including headaches, fatigue, dizziness, and nonspecific somatic complaints (Oster, 1972), suggesting the possibility of a somatization disorder (Ernst et al., 1984;Walker et al., 1991). Moreover, abdominal pain and associated somatic symptoms can have a considerable impact on children's daily functioning both academically and socially (Claar et al., 1999).Prospective studies have shown that many children with abdominal pain continue to complain of somatic symptoms and disability years after their initial evaluation (Apley and Hale, 1973;Christensen and Mortensen, 1975;Magni et al., 1987;Stickler and Murphy, 1979;Walker et al., 1995Walker et al., , 1998. For any patient population, however, the average longitudinal trajectory rarely describes all individuals. To date, subgroups of change have not been delineated for pediatric abdominal pain and the relationship between initial status and trajectories of change across time has not been investigated. Characterization of unique patterns of change is important because it may identify profiles of long-term risk that facilitate tailoring interventions fo...

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Trajectories of Symptoms and Impairment for Pediatric Patients With Functional Abdominal Pain: A 5-Year Longitudinal Study

Mulvaney

Lambert

Garber

et al. 2006

Journal of the American Academy of Child & Adolescent Psych

162

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“…26 Implications of pediatric RAP across the lifespan are not well understood. Early follow-up studies reported persistence of recurrent abdominal pain into adulthood for one third to one half of affected children, 24,27,28 but are limited by the lack of standardized assessments and formal diagnostic criteria, and none used any formal assessment of psychopathology. In more recent studies using standardized assessments and control groups, former RAP patients reported significantly greater abdominal pain, other somatic symptoms, functional impairment, health service use, and internalizing psychiatric symptoms in comparison to controls at 5-year follow-up, and females with a history of RAP were significantly more likely to meet diagnostic criteria for IBS.…”

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confidence: 99%

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

et al. 2001

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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...

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“…Pediatrics 2013;132:475-482 AUTHORS: Grace D. Shelby, PhD, a Kezia C. Shirkey, PhD, Dr Shelby conducted psychiatric diagnostic interviews, drafted the initial manuscript, conducted data analyses, and reviewed and revised the manuscript; Dr Shirkey and Ms Sherman conducted psychiatric diagnostic interviews and critically reviewed the manuscript; Dr Beck supervised and conducted psychiatric diagnostic interviews, conducted data analysis, and critically reviewed the manuscript; Dr Haman supervised psychiatric diagnostic interviews, conducted data analysis, and critically reviewed the manuscript; Ms Shears coordinated data collection and critically reviewed the manuscript; Dr Horst reviewed medical records, conducted data analysis, and critically reviewed the manuscript; Dr Smith contributed to conceptualizing and designing the study, supervised data analysis and critically reviewed the manuscript; Dr Garber contributed to conceptualizing and designing the study, provided oversight of psychiatric diagnostic interviewing, and critically reviewed the manuscript; Dr Walker contributed to conceptualizing and designing the study, supervised research activities, oversaw writing of the manuscript, and critically reviewed and revised the manuscript; and all authors approved the final manuscript as submitted. Chronic or recurrent abdominal pain affects 8% to 25% of school-age youth, [1][2][3] is associated with frequent school absences, [4][5][6] and accounts for 2% to 4% of pediatric clinic visits. 7 Many patients, however, have no evidence of structural or biochemical abnormalities underlying their pain, and hence are considered to have medically unexplained or "functional" abdominal pain (FAP).…”

Section: Discussionmentioning

confidence: 99%

Functional Abdominal Pain in Childhood and Long-term Vulnerability to Anxiety Disorders

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: At the time of their pediatric medical evaluation, patients with functional abdominal pain (FAP) have higher levels of emotional symptoms compared with youth without FAP. No controlled prospective study has evaluated psychiatric outcomes for FAP patients in adulthood. WHAT THIS STUDY ADDS:This prospective study showed that pediatric FAP was associated with high risk of anxiety disorders in adolescence and young adulthood. Risk was highest if abdominal pain persisted, but was significantly higher than in controls even if pain resolved. abstract BACKGROUND: Cross-sectional studies link functional abdominal pain (FAP) to anxiety and depression in childhood, but no prospective study has evaluated psychiatric status in adulthood or its relation to pain persistence.METHODS: Pediatric patients with FAP (n = 332) and control subjects (n = 147) were tracked prospectively and evaluated for psychiatric disorders and functional gastrointestinal disorders (FGIDs) at followup in adolescence and young adulthood (mean age = 20.01 years). Participants were classified according to presence (FGID-POS) or absence (FGID-NEG) of FGIDs at follow-up.RESULTS: Lifetime and current risk of anxiety disorders was higher in FAP than controls (lifetime: 51% vs 20%; current: 30% vs 12%). Controlling for gender and age, the odds ratio was 4.9 (confidence interval = 2.83-7.43) for lifetime anxiety disorder and 3.57 (confidence interval = 2.00-6.36) for current anxiety disorder at follow-up for FAP versus controls. Lifetime risk of depressive disorder was significantly higher in FAP versus controls (40% vs. 16%); current risk did not differ. In most cases, initial onset of anxiety disorders was before pediatric FAP evaluation; onset of depressive disorders was subsequent to FAP evaluation. Within the FAP group, risk of current anxiety disorders at follow-up was significantly higher for FGID-POS versus FGID-NEG (40% vs 24%), and both were higher than controls (12%); current depressive disorders did not differ across FGID-POS, FGID-NEG, and controls. CONCLUSIONS:

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Children with Recurrent Abdominal Pain: How Do They Grow Up?

Cited by 187 publications

References 3 publications

Trajectories of Symptoms and Impairment for Pediatric Patients With Functional Abdominal Pain: A 5-Year Longitudinal Study

Trajectories of Symptoms and Impairment for Pediatric Patients With Functional Abdominal Pain: A 5-Year Longitudinal Study

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

Functional Abdominal Pain in Childhood and Long-term Vulnerability to Anxiety Disorders

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