Recurrent abdominal pain in children: Evidence from a population-based study that social and familial factors play a major role but not Helicobacter pylori infection

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Abstract

Objective: To analyze the relationship between social and familial factors, Helicobacter pylori infection and recurrent abdominal pain (RAP) in children in a population-based cross-sectional study among 1221 preschool children aged 5–8 years. Methods: H. pylori infection status was determined by 13C-urea breath test (13C-UBT) and information on medical history of the child and on RAP as well as on family demographics was obtained by a standardized questionnaire. Results: Overall, 129 children (11.3%) were infected with H. pylori and 29 children were identified as having RAP within the past 3 months (2.5%). Analysis by multiple logistic regression demonstrated a clear relationship of RAP with living in a single parent household [odds ratio (OR) 2.9, 95% confidence interval (95% CI) 1.2–6.7], with parental history of peptic ulcer (OR 3.7, 95% CI 1.3–10.4) and with parental history of nonulcer gastrointestinal disorders (OR 5.3, 95% CI 2.1–13.2). By contrast, there was a nonsignificant relation between H. pylori infection and occurrence of RAP (OR 1.6, 95% CI 0.5–5.5). Conclusion: Social and familial factors play a major role but not H. pylori infection in RAP.

Introduction

Recurrent abdominal pain (RAP) is defined as episodic attacks of abdominal pain over at least 3 months that are severe enough to affect the usual activity of the child. In a large field survey conducted in the 1950s, Apley and Naish estimated that 10–15% of children and adolescents aged 4–16 years were affected. For more than 90% of these children, no organic cause for their abdominal pain could be found. Therefore, Apley and Naish [1] emphasized the role of environmental and school stress in the development of RAP.

Meanwhile, the advent of various new techniques to study the gastrointestinal system in children has clearly demonstrated the role of organic disorders in a part of children with RAP complaints [2], [3]. The discovery of Helicobacter pylori started speculations about the aetiology of RAP and provoked a controversial discussion whether or not H. pylori-associated gastritis might be the cause of symptoms in these children [4], [5].

Recent data from a first population-based study among preschool children from Germany performed by our group in 1996 are not supporting the concept that the colonization by the organism and the resulting gastritis cause specific symptoms [6]. However, the study had not included specific questions concerning the occurrence of RAP.

Therefore, in a second and independent study, which was carried out in 1997 and which was primarily designed to address the transmission pathway of H. pylori infection in a large population-based sample of children, we identified children with RAP and evaluated the association of current H. pylori infection and other potential determinants with this condition.

Section snippets

Study population and study design

In Germany, school attendance is mandatory, and all children who are to attend school for the first time have to undergo a medical examination by physicians of the Public Health Service to determine school fitness. A cross-sectional study was carried out concurrent with the school fitness examinations among all 1522 preschool children aged 5–8 years who were to attend first grade in the school year 1997/1998 and who lived within the city limits of Ulm (a city of about 120,000 inhabitants,

Results

Overall, 1221 out of 1522 eligible children participated in the study (response rate 80.2%). Seventy-eight children who had received antibiotic treatment within the past 4 weeks were excluded from the analysis because of the possibility of false-negative results of the 13C-UBT, leading to a final sample size of 1143 children.

As Table 1 shows, the majority of children were 6 years old (77.1%) followed by 17.1% of the children aged 5 and 5.7% of the children aged 7. Most of the children were of

Discussion

This large population-based study suggests that current H. pylori infection does not play a major role in RAP in children. In contrast, social and familial factors like living in a single parent household or the history of certain gastrointestinal disorders within the family appear to be strong independent determinants of RAP complaints.

Chronic pain is a common complaint in childhood [13]. Since the original definition of RAP by Apley and Naish [1], various new techniques to study the

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