Approach to a Child with Functional Abdominal Pain

Abstract

Functional abdominal pain (FAP) is one of the most common functional gastrointestinal disorders (FGIDs) of childhood. Only a minority of patients with FAP seek medical attention, often presenting to the primary care physician while symptoms are still evolving. The bio-psychosocial model of treatment not only aims to alleviate the illness symptoms but also identifies and remedies the psychological comorbidities and social factors that contribute to illness behavior. Many patients with a mild illness can be managed in the primary care setting. However those with chronic, severe, frequently relapsing, and disabling illness usually are referred to a pediatric gastroenterologist. One of the reason for referral is to exclude organic disorders such as peptic ulcer disease, celiac disease or inflammatory bowel disease which can present with chronic abdominal pain. Recent data suggest that psychological therapy is very effective in alleviating symptoms, a subset of patients may require dietary modification and medications as an adjunct to psychological treatment.

Functional Abdominal Pain Disorders in Children

“…Only cases that may be related to organic disorder, the case with the warning signs, requires further investigations. 11 Perception of visceral pain pathways involving complex peripheral and central neural structures that encode, distribute, and modify the afferent stimuli. Several hypotheses made to explain the occurrence of functional abdominal pain, including visceral hyperalgesia, dysmotility, interaction of the 'brain-gut', inflammation, immunity, genetics, stress conditions, and biopsychosocial.…”

“…Several hypotheses made to explain the occurrence of functional abdominal pain, including visceral hyperalgesia, dysmotility, interaction of the 'brain-gut', inflammation, immunity, genetics, stress conditions, and biopsychosocial. 11 Functional abdominal pain is a multifactorial disorder due to the complex interaction between psychosocial, genetic, environmental and life experiences of children through the gut brain axis. The bidirectional interaction of the gut brain is able to explain functional abdominal pain quite clearly.…”

“…The brain then sends feedback to various targets to maintain homeostasis. 11 In a healthy child, most of the interoceptive information that reaches the brain is not consciously perceived. This interoceptive information is only used as input to the autonomic reflex pathways involved in homeostasis.…”

“…Not only have the phrases changed, but the classification and diagnostic criteria have also changed. 10,11 According to Rome IV criteria, functional abdominal pain disorders are divided into functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, and functional abdominal pain-not otherwise specified (FAP-NOS). 1 The prevalence of functional abdominal pain in children using the Rome III criteria has been widely studied.…”

Editorial: Striving for Excellence in Pediatric Gastroenterology Care — A Continuous Effort

“…This article on BApproach to a child with functional abdominal pain^not only describes the various types of functional abdominal pains (FAP) but also provides guidance regarding differentiation of FAP from organic causes and planning of investigations [6]. It addresses the management issues including counselling and psychological care in detail.…”