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Recurrent abdominal pain in children revisited: irritable bowel syndrome and psychosomatic aspects. A prospective
E A Nygaard1, K Størdal, B S Bentsen
1Department of Pediatrics, Ostfold Central Hospital, Fredrikstad, Norway. egilnyg@online.no
Insights
Recurrent abdominal pain (RAP) in children often meets irritable bowel syndrome (IBS) criteria, regardless of organic findings. Psychological factors, assessed by the Child Behaviour Checklist (CBCL), showed no significant differences between groups.
Area of Science:
- Pediatric Gastroenterology
- Child Psychology
Background:
- Recurrent abdominal pain (RAP) in children is common.
- Historically, organic causes were found in <10% of RAP cases.
- Advancements in medical technology and knowledge have expanded investigation methods.
Purpose of the Study:
- To investigate organic abnormalities in children with RAP.
- To determine the proportion of children meeting irritable bowel syndrome (IBS) criteria.
- To evaluate emotional and behavioral disturbances using the Child Behaviour Checklist (CBCL).
Main Methods:
- 44 children with RAP underwent an investigation program.
- Irritable Bowel Syndrome (IBS) criteria were applied irrespective of organic findings.
- The Child Behaviour Checklist (CBCL) assessed emotional and behavioral disturbances.
Main Results:
- 50% of children without organic disease met IBS criteria.
- 39% of children with organic findings met IBS criteria (P=0.68).
- CBCL scores were within the normal range for most children (32/36).
Conclusions:
- A high proportion of children with RAP meet IBS criteria, necessitating exclusion of organic abnormalities first.
- No significant differences in emotional or behavioral disturbances were found between organic and non-organic groups via CBCL.
Background:
Since Apley, more than 40 years ago, concluded that less than 10% of cases with recurrent abdominal pain (RAP) are of organic origin, medical technology has improved, the knowledge has expanded and new methods of investigation have been developed. The lack of organic findings in many children with RAP has led to the conclusion that psychological factors are important.
Methods:
Forty-four children with RAP underwent an investigation programme to find organic abnormalities that might explain the symptoms. Current criteria for irritable bowel syndrome (IBS) in children were used to find out what proportion fulfilled these criteria, irrespective of the organic findings on clinical investigation. A standardized questionnaire, the CBCL (Child Behaviour Checklist), was used to evaluate emotional and behavioural disturbances in children referred for RAP.
Results:
Thirteen out of 26 (50%) children with no signs of organic disease fulfilled the IBS criteria as opposed to 7 out of 18 (39%) children in the group with organic findings (P = 0.68). The total score for the CBCL was in the normal range for 32 out of 36 of the children.
Conclusions:
We found a high proportion of children fulfilling the IBS criteria in both groups, thus organic abnormalities have to be excluded before making the IBS diagnosis. The results of the CBCL forms did not show any difference between children with organic versus those with non-organic abnormalities, both groups within the normal range.
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