Drotaverine for Recurrent Abdominal Pain in Children.

paroxysmal abdominal pain characterized by episodes of abdominal pain in children 4 to 16 years of age, lasting more than 3 months and affecting normal activity [1]. The Pediatric Rome II classification has been proposed to subcategorize chronic abdominal pain based on clinical presentations namely those with isolated paroxysmal pain, pain with dyspepsia, pain with altered bowel pattern or abdominal migraine [2,3]. Though it successfully attempts to segregate cases of chronic or recurrent pains into etiological groups, the functional abdominal pain (pain in absence of any attributable structural, infectious or biochemical cause) remains the most common cause in each category. In a prospective series of 107 children who met Apley’s criteria for recurrent abdominal pain, Walker, et al. [4] were able to group only 73% according to the Rome II criteria. The fact that 27% of the patients could not be classified implies that Rome II classifications may not be completely helpful to clinicians in guiding therapy that might be most effective for the presenting symptoms. It needs to be emphasized that many cases of recurrent abdominal pain remain undiagnosed or get labeled as functional because of either reluctance on the part of the pediatrician to investigate further for uncommon specific causes – like abdominal migraine, acute intermittent porphyria, lead toxicity, inflammatory bowel disease – or to refer to a gastroenterologist.