Coping with ignorance: exploring pharmacologic management for pediatric functional abdominal pain.

Chronic abdominal pain is a common pediatric problem, affecting 7 to 25% of youth (1–3) and accounting for 2 to 4% of pediatric office visits (4). The overwhelming majority of affected children suffer from a functional gastrointestinal disorder (FGID) in that explanatory physical disease in the form of demonstrable structural or biochemical abnormalities is absent (5). Symptom based diagnostic criteria for pediatric FGID are currently applied based on the perceived location of the discomfort and any associated changes in bowel patterns, with the best known FGID associated with pain being irritable bowel syndrome (i.e., functional abdominal pain with at least two of the following characteristics: relief with defecation; change in bowel frequency; change in bowel character) (6). Unfortunately, current nosology is incomplete at best, with less than half of youth with suspected chronic functional abdominal pain meeting formal criteria for irritable bowel syndrome and approximately 25% not meeting criteria for any specific FGID diagnosis (7). Consequently this practical review of pharmacologic interventions will focus on functional abdominal pain (FAP) broadly defined to mean a functional gastrointestinal disorder where abdominal pain or discomfort is the predominant symptom. Few randomized controlled trials have been conducted for pediatric FAP and conclusive evidence for the efficacy of any specific treatment is lacking (2,8,9). Nevertheless, the thoughtful practitioner should have an appreciation of the current state of knowledge in order to better guide patients and families and better inform day to day treatment decisions. RELEVANCE