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Recurrent abdominal pain of gastro-intestinal origin
I Mavromichalis1, T Zaramboukas, P I Richman
1Second Paediatric Department, Aristotelian University of Thessaloniki, AHEPA General Hospital, Greece.
Insights
Recurrent abdominal pain in children often has a gastrointestinal origin, with most patients showing inflammation. This study challenges the psychogenic cause assumption for unexplained pain.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Recurrent abdominal pain (RAP) is a common pediatric complaint.
- The etiology of RAP is often unclear, with a psychogenic origin frequently assumed.
- Gastrointestinal inflammation may be an underdiagnosed cause of RAP.
Purpose of the Study:
- To investigate the gastrointestinal (GI) origin of recurrent abdominal pain in children.
- To determine the prevalence of upper GI inflammatory lesions in children with RAP.
- To explore the association between Helicobacter pylori and RAP.
Main Methods:
- Endoscopic biopsies of the esophagus, stomach, and duodenum were performed on 71 children with RAP.
- Histopathological examination of biopsies identified inflammatory lesions and H. pylori colonization.
- Data were analyzed to correlate GI findings with the presence of RAP.
Main Results:
- 66 out of 71 children (93%) exhibited inflammatory lesions, including esophagitis, gastritis (cardiac, body, antral), and duodenitis.
- A gastric ulcer was found in one patient.
- Helicobacter pylori colonization was identified in 5 children, with associated gastritis in 4.
Conclusions:
- The study provides strong evidence for a gastrointestinal origin of RAP in children.
- Findings challenge the assumption that unexplained RAP is primarily psychogenic.
- While H. pylori was present, a direct association with RAP was not established in this cohort.
Abstract:
A consecutive series of 71 children (mean age 8.6 years) with recurrent abdominal pain underwent endoscopic oesophageal, gastric and duodenal biopsy in order to determine whether the pain was of gastro-intestinal origin. Of these 71 children, 27 (38%) showed oesophagitis, 14 (20%) cardiac gastritis, 29 (41%) body gastritis, 38 (54%) antral gastritis, and 29 (41%) duodenitis. Thus, 66 of the 71 children studied had an inflammatory lesion explaining their complaints. One of the patients had a gastric ulcer. Helicobacter pylori colonisation was found in 5 of the children: One had H. pylori associated antral and body gastritis and 4 H. pylori associated antral gastritis only. Body gastritis without H. pylori was present in three of these four children. Our data do not support the widespread assumption that recurrent abdominal pain for which no medical cause can be found, is psychogenic; neither do they establish an association between H. pylori antral gastritis and recurrent abdominal pain. However, our data provide strong evidence that there is a gastro-intestinal origin of these patients' complaints.