Chronic abdominal pain in children.
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Date
2010-03
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Abstract
Chronic abdominal pain (CAP) continues to be a diagnostic and
therapeutic challenge. It affects about 10% of school-going
children and adolescents. Few Indian studies have reported an
organic cause in 30%–40% of children with recurrent abdominal
pain. In developing countries, parasitic infestations such as
giardiasis and ascariasis are an important cause of recurrent
abdominal pain but their frequency has decreased over time.
There is a paucity of data from India on the aetiology, epidemiology
and management strategies for CAP, and there is no consensus
on the clinical approach to this problem. We present a practical
approach to CAP in children. The first step is to elicit a detailed
history and do a thorough physical examination so as to categorize
CAP according to the site of pain (epigastric, periumbilical or left
lower quadrant), the predominant symptom associated with pain
(dyspepsia, isolated pain or altered bowel habits) and to differentiate
the pain as organic or functional based on the characteristics of
pain and presence or absence of alarm signs. The second step is
to do appropriate investigations, restricted to simple tests when
functional pain is suspected (Level I) and more investigations
(Level Ia) if there are alarm signs and pain appears to be organic
in nature. Invasive investigations such as gastrointestinal endoscopy
(Level II) may be reserved for those with possible organic pain.
Level III investigations need to be done in a small percentage of
children and include EEG, workup for food allergy and porphyria. The third step is management of organic CAP according to the aetiology, while for functional CAP the pharmacological and, rarely, psychological intervention is more difficult but should be done discreetly and tailored to the needs of the child.
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Ganesh R, Kumar R Arvind, Suresh N, Sathiyasekeran Malathi. Chronic abdominal pain in children. National Medical Journal of India. 2010 Mar-Apr; 23(2): 94-99.