Long-term prognosis in children with recurrent abdominal pain.

Abstract

. Long-term prognosis in children with recurrent abdominal pain. The present study is a follow-up of 34 cases admitted to a paediatric department with recurrent abdominal pain (RAP) in 1942 and 1943. 45 persons without a history of RAP were selected at random and included as controls. Using a questionnaire, there was a higher incidence of gastrointestinal symptoms among persons with a history of RAP during childhood than among controls (P < 0 05). 18 of the original 34 cases who still had symptoms were re-examined; 11 had a clinical picture consistent with a diagnosis of irritable colon, 5 had a picture compatible with both irritable colon and peptic ulcer/gastritis, and 2 had duodenal ulcer.Abdominal pains occurred no more frequentlyamong children ofparents who had had RAP during childhood than among children of parents without such a history. However, there was a higher incidence of abdominal pain among children of parents who were complaining of abdominal discomfort at the time of the investigation than among children whose parents were without such symptoms (P < 0 005).It has been generally held that the prognosis for children with recurrent abdominal pain (RAP) is good, though this point of view is not supported by the few published follow-up studies. Apley (1959) examined 30 persons who had been in hospital as children with RAP 8-20 years earlier. The patients had received no or inadequate treatment. 9 were free from symptoms. In 9 cases the episodes of abdominal pain had ceased only to be replaced by other symptoms, especially headache. In 12 cases abdominal pains persisted, mostly accompanied by 'nervous' complaints. Among 18 controls, one had severe headache, 4 had occasional slight headache, 3 had occasional abdominal discomfort, and one suffered from nervousness.Apley and Hale (1973) reported a follow-up of 30 persons 10-14 years after they had been referred to a children's hospital on account of RAP and treated with reassurance and explanation. The results were similar to those of the first study except for the following points: the children who responded to treatment recovered more quickly than those described in the first study; relapse did not occur in treated patients; and in the treated group fewer nonabdominal disorders developed.

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

“…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.…”

Systematic Review of Treatments for Recurrent Abdominal Pain

“…4 -6 With this approach, approximately 30% to 40% of children do have resolution of their pain. 7,8 However, the remainder continue to exhibit symptoms and go on to be adults with abdominal pain, anxiety, or other somatic disorders. 9 Pharmaceutical treatments are commonly used in an effort to manage symptoms despite the lack of data supporting their efficacy.…”

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

“…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.…”