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Prevalence, characteristics, and management of childhood functional abdominal pain in general practice
Leo A A Spee1, Yvonne Lisman-Van Leeuwen, Marc A Benninga
1Department of General Practice, Erasmus MC University Medical Centre , Rotterdam , the Netherlands.
Insights
General practitioners (GPs) frequently diagnose functional abdominal pain (FAP) in children, but nearly half do not meet formal diagnostic criteria. This highlights a need for standardized diagnostic approaches for pediatric functional abdominal pain.
Area of Science:
- Pediatric Gastroenterology
- General Practice
- Functional Gastrointestinal Disorders
Background:
- Functional abdominal pain (FAP) is a common reason for pediatric consultations.
- Accurate diagnosis by general practitioners (GPs) is crucial for appropriate management.
- Understanding diagnostic patterns and adherence to criteria is essential for improving care.
Purpose of the Study:
- To determine the proportion of children diagnosed with GP-diagnosed functional abdominal pain (GPFAP).
- To assess associations between patient/disease characteristics and GPFAP.
- To describe GP diagnostic management and evaluate if GPFAP diagnoses meet FAP criteria (chronic abdominal pain and Rome III criteria).
Main Methods:
- Cross-sectional study conducted in general practices in the Netherlands.
- Involved 305 children aged 4-17 years presenting with abdominal pain.
- Outcome measures included GPFAP, chronic abdominal pain (CAP), and functional gastrointestinal disorders (FGIDs).
Main Results:
- 89.2% of children received a GPFAP diagnosis.
- Headaches and bloating were associated with GPFAP; fever and red flag symptoms were inversely associated.
- Diagnostic tests were used in 26.8% of cases, and less than 50% of GPFAP patients met CAP/FGID criteria, with 47.9% having symptoms < 3 months.
Conclusions:
- GPs rarely suspect organic causes for pediatric abdominal pain, diagnosing FAP in nearly 90% of cases.
- Diagnostic testing is employed in about a quarter of children with abdominal pain.
- A significant proportion of children diagnosed with FAP by GPs do not meet established literature criteria for chronicity.
Objective:
To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting with abdominal pain, and (iv) evaluate whether children with GPFAP fulfill diagnostic criteria for functional abdominal pain (FAP) as described in current literature: chronic abdominal pain (CAP) and the Rome III criteria (PRC-III) for abdominal pain-related functional gastrointestinal disorders (FGID).
Design:
Cross-sectional study.
Setting:
General practices in the Netherlands.
Subjects:
305 children aged 4-17 years consulting for abdominal pain.
Main Outcome Measures:
GPFAP, CAP, FGIDs.
Results:
89.2% of children were diagnosed with GPFAP. Headaches and bloating were positively associated with GPFAP whereas fever and > 3 red flag symptoms were inversely associated. Additional diagnostic tests were performed in 26.8% of children. Less than 50% of all children with GPFAP fulfilled criteria for CAP and FGIDs; in 47.9% of patients the duration of symptoms at presentation was less than three months.
Conclusions:
In almost 90% of children included in this study the GP suspected no organic cause for the abdominal pain. GPs diagnose FAP in children without alarm symptoms and order diagnostic testing in one out of four children presenting with abdominal pain. No difference was found in GPs' management between children with a diagnosis of GPFAP and other diagnoses. Only about half of the children with a GP diagnosis of FAP fulfilled time-criteria of FAP as defined in the literature.
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