Functional Abdominal Pain in Children

Recurrent abdominal pain is one of the most common presenting complaints to primary care providers and pediatric gastroenterologists. It affects up to 10% to 25% of school-aged children and adolescents and accounts for significant school loss, impaired quality of life, and parental frustration [1–3]. It continues to be misunderstood by both the medical and lay communities, often leading to underevaluation or overevaluation of symptoms. The terms “recurrent abdominal pain” and “chronic abdominal pain” are often used interchangeably. Recurrent implies occurring more than once, and for most clinicians a minimum of 3 separate episodes are required for a symptom to be considered recurrent. Chronic implies persisting over a specific time period. In the original description of recurrent abdominal pain of childhood by Apley and Naish [4], a minimum duration of 3 months was required, but more recently an expert consensus group lowered the minimum duration to 2 months [5]. The severity of pain can be variable, ranging from bothersome to severe, and variably affects the ability of the child to conduct age-appropriate activities. Although the term recurrent abdominal pain was used as an endpoint in the past (ie, a final diagnosis), it is more appropriately used as a description. There are many disorders that can be associated with recurrent or chronic abdominal pain; however, the majority of children suffer from “functional” symptoms, defined as symptoms that occur in the absence of inflammation, tissue damage, or anatomic abnormality [5,6]. In 2005, a committee of experts from the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition suggested that the term “recurrent abdominal pain” be retired and the term “functional abdominal pain” be used to describe the condition [7]. In this article, we will use the term “functional abdominal pain” in discussing children with recurrent or chronic abdominal pain in whom there is no obvious disease as described above. Functional abdominal pain disorders are associated with end-organ visceral hyperalgesia and increased perception of discomfort. Older terminology that described these children as having “nonorganic” abdominal pain reflected a lack of understanding of the pathophysiology of the complaints. This case-based review will illustrate our current Functional Abdominal Pain in Children