Recurrent Abdominal Pain in a Child - Evaluation and Management

Recurrent abdominal pain (RAP) is defined as the presence of at least 3 episodes of abdominal pain for 3 mo duration, including both organic and functional etiology. Up to 95% of the causes of RAP are due to functional abdominal pain disorders (FAPD). Peptic ulcer disease, cholelithiasis, chronic pancreatitis, abdominal tuberculosis, inflammatory bowel diseases (IBD), parasitic infection, and urinary tract infection (UTI) are prominent organic causes of RAP. The published data from developed countries reported pooled prevalence of FAPD in children is 13.5%, in which irritable bowel syndrome (IBS) is the most common sub-type. The evaluation includes history taking regarding pain characteristics, associated symptoms, and the presence of stressors. A detailed history and examination are required to assess for alarm symptoms and signs. The presence of alarm symptoms increases the chances of organic etiology for RAP. Basic work-ups such as complete blood counts, stool and urine examinations, serum albumin, and inflammatory markers may be required to look for chronic organic etiologies. Fecal calprotectin (FCP) is a highly sensitive tool to differentiate IBD from IBS. Ultrasound abdomen (USG) helps in the evaluation of cholelithiasis, biliary obstruction, chronic pancreatitis, malrotation, and bowel thickening. Endoscopies are useful for peptic ulcer disease, inflammatory bowel diseases, abdominal tuberculosis, Helicobacter pylori infection, etc. Organic causes need specific management. FAPD requires patient counselling and medications. Cognitive behavioral therapy, hypnotherapy, yoga, and percutaneous electrical superficial nerve stimulation are indicated for refractory cases.