Pediatric Annals

Guest Editorial 

Functional Abdominal Pain in Children: New Understanding, Diagnostic Criteria, and Treatment Approaches

B U.K. Li, MD

Abstract

Recurrent abdominal pain remains an inordinately common complaint in pediatric practices, as it comprises 2% to 4% of pediatric visits. That is just the tip of the iceberg as 23% of a school-based cohort was noted to have 4 weeks of recurring pain. Much has changed since we discussed this topic in Pediatric Annals in February 2004. Recurrent abdominal pain is no longer a single diagnosis. Instead, we can currently differentiate that complaint into four functional pain disorders: functional abdominal pain, functional dyspepsia, irritable bowel syndrome, and abdominal migraine based upon the Rome III criteria. These symptom-based criteria are readily applied in an office setting to make a diagnosis. As long as there are no red flags, it is no longer necessary to perform extensive exclusionary testing to arrive at a proper diagnosis. In addition, research into these disorders has been spurred by the Rome process.

ABOUT THE AUTHORS

Joshua D. Noe, MD, is Assistant Professor, Pediatric Gastroenterology, Hepatology & Nutrition, Medical College of Wisconsin. B U.K. Li, MD, is Professor, Pediatric Gastroenterology, Hepatology & Nutrition, Medical College of Wisconsin.

Address correspondence to: 8701 Watertown Plank Rd., Milwaukee, WI 53226.

Dr. Li and Dr. Noe have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Define a five-step approach for the child with abdominal pain.
  2. Review the historical components of a child with abdominal pain, which would indicate the need for further evaluation.
  3. List specific diagnostic testing that may be of value in the evaluation of the child with abdominal pain.

Abstract

Recurrent abdominal pain remains an inordinately common complaint in pediatric practices, as it comprises 2% to 4% of pediatric visits. That is just the tip of the iceberg as 23% of a school-based cohort was noted to have 4 weeks of recurring pain. Much has changed since we discussed this topic in Pediatric Annals in February 2004. Recurrent abdominal pain is no longer a single diagnosis. Instead, we can currently differentiate that complaint into four functional pain disorders: functional abdominal pain, functional dyspepsia, irritable bowel syndrome, and abdominal migraine based upon the Rome III criteria. These symptom-based criteria are readily applied in an office setting to make a diagnosis. As long as there are no red flags, it is no longer necessary to perform extensive exclusionary testing to arrive at a proper diagnosis. In addition, research into these disorders has been spurred by the Rome process.

ABOUT THE AUTHORS

Joshua D. Noe, MD, is Assistant Professor, Pediatric Gastroenterology, Hepatology & Nutrition, Medical College of Wisconsin. B U.K. Li, MD, is Professor, Pediatric Gastroenterology, Hepatology & Nutrition, Medical College of Wisconsin.

Address correspondence to: 8701 Watertown Plank Rd., Milwaukee, WI 53226.

Dr. Li and Dr. Noe have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Define a five-step approach for the child with abdominal pain.
  2. Review the historical components of a child with abdominal pain, which would indicate the need for further evaluation.
  3. List specific diagnostic testing that may be of value in the evaluation of the child with abdominal pain.

Recurrent abdominal pain remains an inordinately common complaint in pediatric practices, as it comprises 2% to 4% of pediatric visits. That is just the tip of the iceberg as 23% of a school-based cohort was noted to have 4 weeks of recurring pain. Much has changed since we discussed this topic in Pediatric Annals in February 2004. Recurrent abdominal pain is no longer a single diagnosis. Instead, we can currently differentiate that complaint into four functional pain disorders: functional abdominal pain, functional dyspepsia, irritable bowel syndrome, and abdominal migraine based upon the Rome III criteria. These symptom-based criteria are readily applied in an office setting to make a diagnosis. As long as there are no red flags, it is no longer necessary to perform extensive exclusionary testing to arrive at a proper diagnosis. In addition, research into these disorders has been spurred by the Rome process.

ABOUT THE AUTHORS

Joshua D. Noe, MD, is Assistant Professor, Pediatric Gastroenterology, Hepatology & Nutrition, Medical College of Wisconsin. B U.K. Li, MD, is Professor, Pediatric Gastroenterology, Hepatology & Nutrition, Medical College of Wisconsin.

Address correspondence to: 8701 Watertown Plank Rd., Milwaukee, WI 53226.

Dr. Li and Dr. Noe have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Define a five-step approach for the child with abdominal pain.
  2. Review the historical components of a child with abdominal pain, which would indicate the need for further evaluation.
  3. List specific diagnostic testing that may be of value in the evaluation of the child with abdominal pain.

10.3928/00904481-20090501-02

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