Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

Abstract

ObjectiveTo (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting with abdominal pain, and (iv) evaluate whether children with GPFAP fulfill diagnostic criteria for functional abdominal pain (FAP) as described in current literature: chronic abdominal pain (CAP) and the Rome III criteria (PRC-III) for abdominal pain-related functional gastrointestinal disorders (FGID).DesignCross-sectional study.SettingGeneral practices in the Netherlands.Subjects305 children aged 4–17 years consulting for abdominal pain.Main outcome measuresGPFAP, CAP, FGIDs.Results89.2% of children were diagnosed with GPFAP. Headaches and bloating were positively associated with GPFAP whereas fever and > 3 red flag symptoms were inversely associated. Additional diagnostic tests were performed in 26.8% of children. Less than 50% of all children with GPFAP fulfilled criteria for CAP and FGIDs; in 47.9% of patients the duration of symptoms at presentation was less than three months.ConclusionsIn almost 90% of children included in this study the GP suspected no organic cause for the abdominal pain. GPs diagnose FAP in children without alarm symptoms and order diagnostic testing in one out of four children presenting with abdominal pain. No difference was found in GPs’ management between children with a diagnosis of GPFAP and other diagnoses. Only about half of the children with a GP diagnosis of FAP fulfilled time-criteria of FAP as defined in the literature.

Combining Rome III criteria with alarm symptoms provides high specificity but low sensitivity for functional gastrointestinal disorders in children

“…We found that three of the eight alarm symptoms we explored, namely heredity, defecation at night and bloody stools, were significantly more common in OGID than in FGID. Previous studies on paediatric alarm symptoms have been contradictory (), and the 2005 technical report from North American Society for Pediatric Gastroenterology, Hepatology and Nutrition rated alarm signs as evidence quality D .…”

“…There is expert consensus and a long tradition on the use of alarm symptoms to rule out organic disease . Studies on the paediatric Rome III criteria in combination with alarm symptoms are scarce and, to our knowledge, there has only been one validation study .…”

Недостатність Травлення Та Шляхи Його Корекції У Дітей Раннього Віку З Харчовою Непереносимістю

“…Досить час-то затяжний або рецидивуючий перебіг гастро-інтестинальних захворювань кишечника у дітей призводить до розвитку недостатності травлення, глибоких метаболічних порушень, затримки фі-зичного та психомоторного розвитку, формування полідефіцитних станів, зниження якості життя ди-тини [15,24]. Функціональні захворювання є пре-диктором формування хронічної патології ШКТ у подальші періоди життя, що визначає необхідність удосконалення методів їх лікування.…”

Functional abdominal pain: an integrative review study from a biopsychosocial view

“…Warschburger et al 35 Transversal 5 Schurman et al 39 Transversal 5 Lozinsky et al 12 Clinical trial 1 Spee et al 15 Transversal 2, 3…”