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Functional abdominal pain in children and adolescents: Management in primary care

Authors
Mariam R Chacko, MD
Eric Chiou, MD
Section Editors
Amy B Middleman, MD, MPH, MS Ed
Jan E Drutz, MD
B UK Li, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Functional abdominal pain disorders (FAPDs), also called pain-predominant functional gastrointestinal disorders (FGIDs), are the most common cause of chronic abdominal pain in children and adolescents. FAPDs involve interplay among regulatory factors in the enteric and central nervous systems [1]. FAPD may be associated with visceral hyperalgesia, reduced threshold for pain, abnormal pain referral after rectal distension, or impaired gastric relaxation response to meals [2-6]. In addition, persistent experiences of pain may have an adverse effect on psychologic symptoms. (See "Chronic abdominal pain in children and adolescents: Approach to the evaluation", section on 'Pathogenesis'.)

The management of children and adolescents with FAPDs is reviewed here. The evaluation of children and adolescents with chronic abdominal pain and functional abdominal pain in adults are discussed separately. (See "Chronic abdominal pain in children and adolescents: Approach to the evaluation" and "Functional dyspepsia in adults" and "Clinical manifestations and diagnosis of irritable bowel syndrome in adults" and "Treatment of irritable bowel syndrome in adults".)

TERMINOLOGY

Functional abdominal pain may be diagnosed in children who have chronic (≥2 months) abdominal pain, no alarm findings (table 1), normal physical examination, and a stool sample negative for occult blood [7]. Several pain-predominant functional gastrointestinal disorders (FGIDs) of childhood have recognizable patterns of symptoms and include functional dyspepsia, irritable bowel syndrome (IBS), abdominal migraine, and FAP—not otherwise specified (FAP-NOS) (table 2) [8]. (See "Chronic abdominal pain in children and adolescents: Approach to the evaluation", section on 'Diagnosis of functional abdominal pain'.)

Terms that have been used interchangeably with FAP-NOS (often referred to as FAP) include "nonorganic abdominal pain," "psychogenic abdominal pain," and "recurrent abdominal pain." The 2005 American Academy of Pediatrics (AAP) and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition clinical report on chronic abdominal pain recommended that the term "recurrent abdominal pain" not be used as a synonym for functional, psychologic, or stress-related abdominal pain, but this use persists [7,9].

MANAGEMENT APPROACH

Overview — The goal of management of functional abdominal pain disorders (FAPDs) in children and adolescents is return to normal function (ie, rehabilitation) rather than complete elimination of pain [1,7,10-12].

                     

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Literature review current through: Nov 2016. | This topic last updated: Wed Oct 26 00:00:00 GMT 2016.
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