2. Definition& Epidemiology
Episodes of pain occurring at least monthly
for 3 consecutive months with severity that
interrupts routine functioning.
RAP affects about 10% of school-age
children.
An organic cause is found in about 10% of
cases, however, with new advances in
technology the percentage of patients with
unexplained pain is decreasing.
3. RAP
Periumbilical abdominal pain is the most
common pain location.
Epigastric pain is associated with symptoms
of nonulcer dyspepsia.
Pain below the umbilicus is often
accompanied by symptoms of irritable bowel
syndrome.Rome II.doc
4. RAP Diagnosis
A wide range of potential organic causes must be
considered before establishing a diagnosis of
Functional pain. Among the most common cause are
chronic constipation parasitic infection (Giardia),
GER, IBD, and lactose intolerance.
The characteristic presentation of children with RAP
includes: onset later than 6 years of age, midline
paroxysmal pain most often periumbilical but also
localized to the epigastric or suprapubic area. The
pain interrupts normal activity.
5. RAP Diagnosis
Symptoms suggestive of organic etiology: fever, age
less than 6 years, weight loss, joint symptoms, or
abnormal growth. Organic pain is usually localized
away from the umbilicus and may wake the patient
from sleep. Vomiting, diarrhea, and blood in stools
are suggestive of organic etiology.
Children with RAP have a normal physical
examination whereas those with organic etiology
may have clinical findings suggestive of the
underlying cause.
6. RAP Evaluation
The laboratory, radiologic or endoscopic evaluation
of children with chronic abdominal pain should be
individualized, depending on the findings suggested
by a detailed history and physical examination.
A CBC, sedimentation rate, stool test and urinalysis
are reasonable screening studies. If indicated an
ultrasound examination of the abdomen can give
information about kidneys, gall bladder, and
pancreas.
7. RAP treatment
The family and the child with functional RAP may
worry about the inability to identify an organic cause
and may be resistant to a diagnosis of nonorganic
disease. After a thorough history and physical
examination, the most important component of
treatment is reassurance of the child and the family
members.
The parents should be instructed to avoid reinforcing
the symptoms with secondary gain.
Children with RAP should return to regular activities.
Medications are generally unhelpful. Close follow up.
