Introduction ..• Abdominal pain is one of the most common reasons for a parent to bring his or her child to medical attention.• Abdominal pain is classified into : ▫ Acute ▫ Chronic
Introduction ..• Acute abdominal pain : ▫ In response to tissue injury ▫ Less than 12 weeks ▫ Accompanied by signs of sympathetic arousal• Chronic abdominal pain : ▫ Beyond 12 weeks, or beyond normal period for healing ▫ Rarely associated with sympathetic arousal
Definition ..• It’s defined as episodes of pain occurring at least monthly for 3 consecutive months with a severity that interrupts routine functioning.• It’s called also non-organic or recurrent abdominal pain
Epidemiology ..• It’s one of the most common symptoms of children worldwide.• It occurs most commonly between age 4 and 14 years ( ≈ 15 % ).
Risk factors ..• Anxiety• Family factor• physically or emotionally traumatic experiences• preceding gastrointestinal infections
Causes ..• Recent studies seem that the causes of RAP are multifactorial.• Abnormalities in the nervous system that create an oversensitivity to physiological stimuli. It’s may be associated with visceral hyperalgesia—a decreased threshold for pain in response to changes in the body.
Causes ..• Psychological factors do not cause functional abdominal pain, but they can make the pain experience worse.• The trigger for functional abdominal pain varies from one patient to another, and may transform over time even in the same patient.
Clinical presentation ..• The patient came to your clinic complaining of para-umbilical pain, sudden or progressive in onset, colicky in nature, may be constant, increasing or decreasing in course, may associated with dyspepsia, nausea, vomiting, early satiety, not related with meals, may be relieved with changing of bowel movement ( constipation, diarrhea )• NB : abdominal pain relieved with changing of bowel movement → classical IBS.
Diagnosis ..• There are wide range of organic causes of RAP e.g. chronic constipation, parasitic infection, GERD, IBD, and lactase deficiency.• Children with RAP have normal physical examination.• Further investigations are unnecessary if history and clinical examination lead to a diagnosis of functional abdominal pain.
Diagnosis ..• CBC, ESR, urinalysis, stool examination, anti- tissue transglutaminase IgA (tTGAs), plain AXR, abdominal US, endoscopy, testing for H.pylori.• If negative, that support RAP.• It’s preferred to look for : ▫ Autonomic nervous system abnormalities. ▫ Intestinal motility abnormalities.
Treatment ..• Reassurance.• Return to regular activities.• Medications are generally unhelpful or, at best, offer transient placebo effect.• Biofeedback, guided imagery, and relaxation techniques have been useful in some children with functional pain.• Close follow-up.
Summary ..• RAP is one of most common complaint in children.• RAP affect school-age group.• RAP is multifactorial disease.• Should exclude the organic causes.• RAP isn’t life-threatening diseases.• Reassurance.
References ..1. Kliegman R, Stanton B, Behrman R, Jenson H. Nelson Textbook of Pediatrics. 18th edition. 2007. Saunders Elseveir.2. Berger MY, Gieteling MJ, Benninga MA; Chronic abdominal pain in children. BMJ. 2007 May 12;334(7601):997-1002.3. Seema Khan, MD, Childrens National Medical Center, Washington, DC – Published August 2006. Updated December 2012.4. Adapted in part from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Guidelines on Functional Abdominal Pain (Boston Childrens Hospital website)5. Nader N. Youssef, MD, and Jeffrey S. Hyams, MD. Functional Abdominal Pain in Children. Case Study and Commentary. JCOM May 2008 Vol. 15, No. 5.