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Prognostic factors for persistence of chronic abdominal pain in children
Marieke J Gieteling1, Sita Ma Bierma-Zeinstra, Yvonne Lisman-van Leeuwen
1Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
Insights
Parental gastrointestinal symptoms are a key predictor of persistent chronic abdominal pain (CAP) in children. Evidence does not support psychological factors in children predicting CAP persistence.
Area of Science:
- Pediatric Gastroenterology
- Clinical Epidemiology
Background:
- Chronic abdominal pain (CAP) is a common condition in children.
- Identifying prognostic factors for CAP persistence is crucial for effective management.
Purpose of the Study:
- To systematically review and synthesize evidence on prognostic factors for the persistence of chronic abdominal pain in children.
Main Methods:
- Systematic review of prospective follow-up studies identified through MEDLINE, EMBASE, and PsycINFO.
- Included studies defined pediatric CAP using established criteria (Apley, von Baeyer, Rome committee).
- Best-evidence synthesis was used to summarize evidence for prognostic factors.
Main Results:
- Moderate evidence indicates parental gastrointestinal symptoms predict CAP persistence.
- Strong evidence shows no association between female sex and CAP duration.
- Moderate evidence suggests abdominal pain severity does not predict persistence.
Conclusions:
- Limited prognostic follow-up studies exist for pediatric CAP.
- Physicians should inquire about parental gastrointestinal issues as a risk factor.
- Current evidence does not support psychological factors in children as predictors of CAP persistence.
Objectives:
The aim of the study was to identify prognostic factors for the persistence of chronic abdominal pain (CAP) in children.
Materials And Methods:
For this systematic review, MEDLINE, EMBASE, and PsycINFO were searched up to June 2008 for prospective follow-up studies of pediatric CAP as defined by the criteria of Apley, von Baeyer, or the Rome committee. The outcome measure of interest was persistence of CAP. Persistent CAP was considered only when the abdominal pain of children with CAP persisted during follow-up at the same level of frequency and severity. For each study the risk for bias was assessed. The evidence for prognostic factors was summarized according to a best-evidence synthesis.
Results:
Eight studies, which examined 17 prognostic factors, were included. Moderate evidence was found that having a parent with gastrointestinal symptoms predicts the persistence of CAP. Strong evidence was found for no association between female sex and the duration of CAP, and moderate evidence that the severity of abdominal pain does not predict persistence of CAP. There is conflicting evidence as to whether psychological factors prevent, or have no relation with, persistence of CAP.
Conclusions:
Because there are few prognostic follow-up studies on pediatric CAP, the evidence for prognostic factors is limited. Physicians should ask about parental gastrointestinal problems because this is a risk factor for persistence of CAP in children. The hypothesis that psychological factors of the child predict persistence of CAP is not supported by evidence from the follow-up studies.
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