3. 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
4. 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
9. 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
10. Epidemiology ..
• It’s one of the most common symptoms of
children worldwide.
• It occurs most commonly between age 4 and 14
years ( ≈ 15 % ).
11. Risk factors ..
• Anxiety
• Family factor
• physically or emotionally traumatic experiences
• preceding gastrointestinal infections
12. 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.
13. 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.
14. 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.
15. 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.
16. 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.
18. 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.
19. 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.
20. 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, Children's 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
Children's 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.
