Abstract
Apley, working in Bristol, UK, defined recurrent abdominal pain (RAP) in 1958. After extensive investigations, he found that 8% of children presenting to his clinic with RAP had an organic pathology. The aims of this study were to identify (1) causes of RAP using modern methodology, (2) factors associated with organic RAP and (3) children with none-organic RAP who fulfill the diagnostic criteria for irritable bowel syndrome (IBS). Children, aged over 3 years, presenting with RAP were prospectively recruited to this study. They had a detailed questionnaire completed, a full examination with screening tests (blood for coeliac screen, Helicobacter pylori antibody titre, inflammatory markers, serum amylase, liver function tests, and full blood count, urine and stool analyses and abdominal ultrasonography). Endoscopy and oesophageal pH monitoring were performed if clinically indicated. IBS was diagnosed if the child had no organic pathology and fulfilled the Rome II criteria. Out of 103 children (median age of 10 years, mean 10.04, SD ±3.44,), 31 children (30%) had organic pathologies. Factors associated with organic pain were nocturnal symptoms (P<0. 01) and abdominal tenderness (P<0.005) and with non-organic pain were periumbilical locality (P<0.002), pain alleviation on defaecation (P<0.04) and low fibre diet (P<0.005). Of children with non-organic pain, 37/52 (51%) fulfilled the criteria for IBS (36% of the total). Conclusion:of children presenting with recurrent abdominal pain in a hospital setting, 30% have a diagnosable organic aetiology compared to 8% in Apley’s time. Irritable bowel syndrome, however, may be the commonest cause of recurrent abdominal pain and should be considered.
Similar content being viewed by others
Abbreviations
- CRP :
-
C-reactive protein
- GORD :
-
gastro-oesophageal reflux disease
- IBS :
-
irritable bowel syndrome
- RAP :
-
recurrent abdominal pain
References
Apley J (1975) The child with abdominal pains. Blackwell Scientific Publications, Oxford
Apley J, Naish N (1958) Recurrent abdominal pain: a field study of 1000 school children. Arch Dis Child 33: 165–170
Bury RG (1987) A study of 111 children with recurrent abdominal pain. Austral Paediatr J 23: 117–119
Croffi JM, Fitzgerald JF, Chong SK (2000) Recurrent abdominal pain in children. A retospective study of outcome in a group referred to a pediatric gastroenterology practice. Clin Pediatr 39: 267–274
Dimson SB (1971) Transit time related to clinical findings in children with recurrent abdominal pain. Pediatrics 47: 666–674
Faull C, Nicol AR (1986) Abdominal pain in six-year-olds: an epidemiological study in a new town. J Child Psychol Psychiatry 27: 251–260
Friedman R (1972) Some characteristics of children with psychogenic pain. Clin Pediatr 11: 31–53
Garber J, Zeman J, Walker LS (1990) Recurrent abdominal pain in children: psychiatric diagnoses and parental psychopathology. J Acad Child Adolesc Psychiatry 29: 648–656
Gaylord N, Carson S (1983) Assessing recurrent abdominal pain in children. Nurse Practitioner 45: 19–24
Green M (1967) Diagnosis and treatment: psychogenic, recurrent abdominal pain. Pediatrics 40: 84–89
Hodges K, Kline J, Barbero G, Flanery R (1985) Depressive symptoms in children with recurrent abdominal pain and in their families. J Pediatr 107: 622–626
Huestas-Ceballos A, Macanthus C, Logan S (2002) Pharmacological intervention for recurrent abdominal pain (RAP) in children. The Cochrane Systemic Review. The Cochrane Library, Issue 1, Oxford
Hyams JS, Burke G, Davis PM, Treem WR, Shoup M (1995) Characterization of symptoms in children with recurrent abdominal pain: resemblance to irritable bowel syndrome. J Pediatr Gastroenterol Nutr 20: 209–214
Liebman WM (1978) Recurrent abdominal pain in children: a retrospective survey of 119 patients. Clin Pediatr 17: 149–153
MacKeith R, O’Neil D (1951) Recurrent abdominal pain in children. Lancet ii: 278–282
Mew CF, Sinatra FA (1993) Abdominal pain. In: Wyllie R, Hyams JS (eds) Pediatric gastrointestinal disease. Pathophysiology, diagnosis, and management. Saunders, Philadelphia, pp 177–186
Oster J (1972) Recurrent abdominal pain, headache, and limb pains in children and adolescents. Pediatrics 50: 429–436
Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, Staiano A (1999) Childhood functional gastrointestinal disorders. Gut 45[Suppl II]: 1160–1168
Sawczenko A, Sandhu BK, Logan RF, Jenkins H, Taylor CJ, Mian S, Lynn R (2001) Prospective survey of childhood inflammatory bowel disease in British Isles. Lancet 357: 1093–1094
Stone RT, Barbero GJ (1970) Recurrent abdominal pain in childhood. Pediatrics 45: 732–738
Thompson WG, Dotevall G, Drossman DA, Heaton KW, Druis W (1989) Irritable bowel syndrome: guidelines for the diagnosis. Gastroenterol Int 2: 92–95
Walker LS, Guite JW, Duke M, Barnard JA, Greene JW (1998) Recurrent abdominal pain: a potential precursor of irritable bowel syndrome in adolescents and young adults. J Pediatr 132: 1010–1015
Zuckerman B, Stevenson J, Bailey V (1987) Stomachaches and headaches in a community sample of preschool children. Pediatrics 79: 677–682
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
El-Matary, W., Spray, C. & Sandhu, B. Irritable bowel syndrome: the commonest cause of recurrent abdominal pain in children. Eur J Pediatr 163, 584–588 (2004). https://doi.org/10.1007/s00431-004-1503-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-004-1503-0