Recurrent Abdominal Pain in a Child - Evaluation and Management

Area of Science:

• Pediatric Gastroenterology
• Internal Medicine
• Clinical Diagnostics

Background:

• Recurrent abdominal pain (RAP) affects many children and adults, with functional abdominal pain disorders (FAPD) accounting for up to 95% of cases.
• Prominent organic causes include peptic ulcer disease, inflammatory bowel diseases (IBD), and infections, necessitating careful differential diagnosis.

Purpose of the Study:

• To outline the diagnostic approach for recurrent abdominal pain, differentiating between functional and organic etiologies.
• To highlight key investigations and management strategies for various causes of RAP.

Main Methods:

• Comprehensive history taking focusing on pain characteristics, associated symptoms, and stressors.
• Physical examination to identify alarm symptoms suggestive of organic disease.
• Utilizing laboratory tests (CBC, stool/urine exams, inflammatory markers), fecal calprotectin (FCP), ultrasound abdomen (USG), and endoscopy for diagnosis.

Main Results:

• Fecal calprotectin (FCP) effectively differentiates Inflammatory Bowel Disease (IBD) from Irritable Bowel Syndrome (IBS).
• Ultrasound abdomen (USG) aids in detecting gallstones, pancreatitis, and bowel abnormalities.
• Endoscopies are crucial for diagnosing conditions like peptic ulcers, IBD, and abdominal tuberculosis.

Conclusions:

• Accurate diagnosis of RAP requires a systematic approach, distinguishing functional from organic causes.
• Specific management is crucial for organic etiologies, while FAPD benefits from counseling and targeted therapies.
• Refractory cases may require interventions like cognitive behavioral therapy or hypnotherapy.