Functional Abdominal Pain (Nonorganic Chronic Abdominal Pain)

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Chapter 334 Functional Abdominal Pain (Nonorganic Chronic Abdominal Pain)

Recurrent abdominal pain (RAP) in children was defined as at least 3 episodes of pain over at least 3 mo that interfered with function. In many situations the term recurrent abdominal pain was used synonymously with functional abdominal pain. Other terms such as chronic abdominal pain, nonorganic abdominal pain, and psychogenic abdominal pain that were used for describing abdominal pain in children led to clinical confusion. The American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain and the North American Society for Pediatric Gastroenterology Hepatology and Nutrition Committee on Abdominal Pain suggested that RAP no longer be used. The recommended clinical definitions for long-lasting intermittent or constant abdominal pain by the same committees are outlined in Table 334-1.

Table 334-1 RECOMMENDED CLINICAL DEFINITIONS OF LONG-STANDING INTERMITTENT OR CONSTANT ABDOMINAL PAIN IN CHILDREN

DISORDER	DEFINITION
Chronic abdominal pain	Long-lasting intermittent or constant abdominal pain that is functional or organic (disease based)
Functional abdominal pain	Abdominal pain without demonstrable evidence of pathologic condition, such as anatomic metabolic, infectious, inflammatory or neoplastic disorder. Functional abdominal pain can manifest with symptoms typical of functional dyspepsia, irritable bowel syndrome, abdominal migraine or functional abdominal pain syndrome.
Functional dyspepsia	Functional abdominal pain or discomfort in the upper abdomen
Irritable bowel syndrome	Functional abdominal pain associated with alteration in bowel movements
Abdominal migraine	Functional abdominal pain with features of migraine (paroxysmal abdominal pain associated with anorexia, nausea, vomiting or pallor as well as maternal history of migraine headaches)
Functional abdominal pain syndrome	Functional abdominal pain without the characteristics of dyspepsia, irritable bowel syndrome, or abdominal migraine.

Adapted from Di Lorenzo C, Colletti RB, Lehmann HP, et al; American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain; NASPGHAN Committee on Abdominal Pain: Chronic abdominal pain in children: a clinical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, J Pediatr Gastroenterol Nutr 40(3):245–248, 2005.

Chronic abdominal pain can be organic or nonorganic, depending on whether a specific etiology is identified. Nonorganic abdominal pain or functional abdominal pain refers to pain without evidence of anatomic, inflammatory, metabolic, or neoplastic abnormalities. Functional gastrointestinal disorders (FGIDs) are a group of gastrointestinal (GI) disorders that include variable combinations of chronic or recurrent GI symptoms not explained by structural or biochemical abnormalities. The Rome Committee updates and modifies the information on FGIDs for clinical and research purposes. The Rome III process had 2 pediatric subcommittees based on age range: Neonate/Toddler (0-4 yr) and Child/Adolescent (4-18 yr). The Child/Adolescent committee categorized abdominal pain-related FGIDs under Category H2 in Table 334-2. The Rome III criteria for the diagnosis of Childhood Functional Abdominal Pain (category H2d) and Childhood Functional Abdominal Pain Syndrome (category H2d1) is represented in Table 334-3.

Table 334-2 CHILDHOOD FUNCTIONAL GI DISORDERS: CHILD/ADOLESCENT (CATEGORY H)

H1 Vomiting and aerophagia

H1a Adolescent rumination syndrome

H1b Cyclic vomiting syndrome

H1c Aerophgia

H2 Abdominal pain—–related FGIDs

H2a Functional dyspepsia

H2b Irritable bowel syndrome

H2c Abdominal migraine

H2d Childhood functional abdominal pain

H2d1 Childhood functional abdominal pain syndrome

H3 Constipation and incontinence

H3a Functional constipation

H3b Nonr-Retentive fecal incontinence

Adapted from Rome Foundation: Rome III disorders and criteria (website). www.romecriteria.org/criteria/. Accessed May 7, 2010.

Table 334-3 ROME III CRITERIA FOR CHILDHOOD FUNCTIONAL ABDOMINAL PAIN H2D AND CHILDHOOD FUNCTIONAL ABDOMINAL PAIN SYNDROME H2D1

H2d. CHILDHOOD FUNCTIONAL ABDOMINAL PAIN

Diagnostic criteria* must include all of the following:

• Episodic or continuous abdominal pain

• Insufficient criteria for other FGIDs

• No evidence of an inflammatory, anatomic, metabolic or neoplastic process that explains the subject’s symptoms

H2d1. CHILDHOOD FUNCTIONAL ABDOMINAL PAIN SYNDROME

Diagnostic criteria* must satisfy criteria for childhood functional abdominal pain and have at least 25% of the time one or more of the following:

• Some loss of daily function

• Additional somatic symptoms such as headache, limb pain, or difficulty sleeping.

FGID, functional gastrointestinal disorder.

* Criteria fulfilled at least once per week for ≥2 mo prior to diagnosis

Adapted from Rome Foundation: Rome III disorders and criteria (website). www.romecriteria.org/criteria/. Accessed May 7, 2010.

The exact incidence and prevalence of chronic abdominal pain is not known. There are reports of chronic abdominal pain affecting 9-15% of children. There are also reports that 13% of middle school and 17% of high school children have weekly complaints of abdominal pain.