Recurrent abdominal pain: a psychogenic disorder?

Abstract

The mean age of the children in the study was 11 years 3 months and the range was 6 years 5 months-16 years 5 months. Each of the children in the recurrent abdominal pain group met the criteria outlined by Apley,4 which included at least three attacks of pain occurring over a period longer than 3 months, with no known organic cause, and severe enough to affect the child's participation in his normal activities. They underwent a thorough physical examination and rectal examination including immediate microscopy of stools for ova and parasites, with no positive results. Laboratory investigations included blood count and in most cases urine analysis and culture. All test results were within normal limits. In addition, all the children with recurrent abdominal pain were followed up for at least 18 months and none developed an organic pathology that would account for their pain. A structured interview was conducted with each child and at least one parent to provide comparison information between children with recurrent abdominal pain and control children with no history of abdominal pain. The Quay-Peterson behaviour checklist6 was completed independently by each of the child's parents and the child's teacher. The Poznanski depression scale7 was completed by the interviewer and the Birleson self report scale8 was completed by the child. Each parent independently completed the Locke-Wallace marital adjustment scale.9 Sociodemographic measures were taken for each child's family along with a measure of the amount of life stress each child had experienced, and a family history of pain. A complete medical and pain history was also determined for each child. In addition, 25 of the children with recurrent abdominal 388 copyright.

Chronic Abdominal Pain in Children

“…24,25,34 Finally, a few studies have examined broad areas of family functioning. These studies found no difference between patients with abdominal pain and other patient groups or controls on measures of parent marital satisfaction 47,48 or family cohesion and conflict. 48 In 1 study, children with recurrent episodes of abdominal pain reported greater parental encouragement of illness behavior than did children without abdominal pain.…”

“…In a study comparing 30 patients with abdominal pain with 30 patients with acute minor illness or injury, no significant differences were found between the patient groups when depression was assessed by interview or a child self-report measure. 47 Another study comparing 19 patients with functional abdominal pain with 19 patients with an organic etiology of abdominal pain found no significant differences between the groups on the Child Behavior Checklist completed by the mother or on the Rutter B2 Behavioral Scale completed by the teacher. 50 Similarly, no significant differences were found between patients with and without organic findings in 2 studies that included pediatric patients whose abdominal pain ranged in duration from 1 month to several years.…”

“…One study 47 compared 30 pediatric patients with recurrent episodes of abdominal pain with 30 patients referred for acute minor illness or injury. Life-event change in the previous year did not differ significantly between the 2 groups.…”

The prevalence of Helicobacter pylori serum antibodies in children with recurrent abdominal pain

“…Unequivocal somatic causes have scarcely been reported [2,13] and psychogenic mechanisms were considered to be the main cause of these patients' complaints [10]. The role played by psychogenic factors in RAP has been difficult to establish convincingly [17] and resulted in renewed interest in possible somatic causes. The discovery of Helicobacter pylori and its establishment as an important organism in gastrointestinal disease in adults prompted studies on the role of H. pylori in the paediatric age group.…”

Dietl's crisis: an under-recognized clinical entity in the pediatric population

“…The etiology is often thought to be psychogenic with an underlying organic cause present in less than 10% of such patients (2). Management focuses on constipation avoidance and identification of relevant psychosocial issues.…”