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Usefulness of complementary test in the study of patients with chronic abdominal pain
María Isabel Jiménez Candel1, Tatiana Salvador Pinto2, Mónica García Peris3
1Sección de Gastroenterología y Nutrición Pediátrica, Hospital Virgen del Castillo, Yecla, Spain.
Insights
Chronic abdominal pain in children often involves extensive diagnostic studies. While many tests show low discriminative value, ultrasound and parasite tests are safe initial options for identifying organic disorders.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Health Economics
Background:
- Chronic abdominal pain (CAP) is a common pediatric complaint, impacting families and often necessitating diagnostic studies (DS).
- A comprehensive analysis of requested diagnostic tests for CAP was warranted.
Purpose of the Study:
- To conduct a qualitative, quantitative, and economic analysis of diagnostic studies used for pediatric chronic abdominal pain.
- To evaluate the effectiveness and cost-efficiency of various diagnostic approaches.
Main Methods:
- An observational, prospective, multicenter study included 235 children (ages 4-15) with CAP.
- Data collected included patient history, warning signs, symptoms, diagnostic tests performed, and their associated costs.
- Distinction was made between organic and functional gastrointestinal disorders.
Main Results:
- 79% of cases were functional disorders, 21% organic. Warning signs were frequent but had low discriminative capacity.
- Urinary symptoms were exclusively linked to organic disorders. Abdominal ultrasound, fecal parasite tests, breath tests, and endoscopy were most associated with organic conditions.
- Total economic cost was €52,490.80, with average costs of €195/patient for functional and €306/patient for organic disorders.
Conclusions:
- Alarm signs in pediatric CAP are common but lack strong discriminative power.
- Abdominal ultrasound and fecal parasite tests are safe, potentially useful first-line studies.
- Endoscopy and breath tests showed higher discrimination for organic disease, but the overall economic cost of diagnostic exclusion for CAP is substantial.
Introduction:
Chronic abdominal pain (CAP) in children is a symptom that frequently leads to a visit to the paediatrician, which affects family life and occasionally requires the need to perform diagnostic studies (DS). The objective was to carry out a qualitative, quantitative, and economic analysis on the tests requested.
Material And Methods:
An observational, prospective and multicentre study was conducted that included children between 4-15 years old affected by CAP. The difference between organic and functional disorders was taken into account. The following variables were collected: history, warning signs and symptoms, DS, and the cost of these.
Results:
The study included 235 children with CAP (Age; mean 9.7 ± 2.7 SD). The large majority (79%) were functional disorders and 21% organic disorders. Almost half of the patients had some warning sign or symptom, but urinary symptoms were only associated with organic disorders. The abdominal ultrasound, faecal parasites, breath test, and endoscopy were the most associated with organic disorders. There was a difference between the costs of the DS according to each centre. The total economic cost was 52,490.80 euros, with 195 euros per patient for functional disorders and 306 euros for organic disorders.
Conclusion:
Signs and symptoms of alarm in CAP were very frequent, but had low discriminative capacity. The abdominal ultrasound and faecal parasites are innocuous DS, and could be useful as a first level study. The endoscopy and the breath test were the most discriminative of organic disease. The economic cost of DS arising from the diagnosis of exclusion in CAP was high.
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