A large proportion of children with functional abdominal pain still have frequent abdominal pain in adolescence and young adulthood, even though fewer than 1% have a gastrointestinal (GI) disease, researchers report in the December issue of Clinical Gastroenterology and Hepatology.
Chronic or recurrent abdominal pain is common in childhood, affecting 8%−25% of otherwise healthy school-aged children. For most cases, medical evaluation produces no evidence for disease (no abnormal imaging or laboratory findings to explain the pain), so the pain is considered to be functional.
Little is known, however, about whether this pain is maintained into adolescence and young adulthood. Many children with functional abdominal pain also have extra-intestinal and psychological symptoms such as depression—it is not clear whether or how these affect the children years later.
They performed a longitudinal analysis of 392 children (8−16 years old) initially seen at a subspecialty clinic for recurrent abdominal pain. Horst et al assessed the contribution of gastrointestinal symptoms, extra-intestinal somatic symptoms, and depressive symptoms to FGIDs 5−15 years later.
They found that on average 9 years later, 41% met symptom criteria for FGID—mostly irritable bowel syndrome and functional dyspepsia.
Extra-intestinal somatic and depressive symptoms at the initial pediatric evaluation were significant predictors of FGID in adolescence and young adulthood, after controlling for initial levels of GI symptoms. Age, sex, and abdominal pain severity at initial presentation did not predict which patients would develop FGID later in life.
Levels of depressive symptoms in childhood correlated a greater likelihood of FGID later in life (see figure).
Little is known about the mechanisms linking depressive symptoms with the long-term persistence of functional abdominal pain. The association could be related to central nervous system modulation of GI function, including motility and visceral pain.
In an editorial that accompanies the article, Douglas Drossman states that the study is important because many clinicians note that adults with FGIDs recall having GI difficulties in childhood.
Drossman says the findings of Horst et al are reliable because of the study’s prospective design, the retention of a large number of patients during a period of many years, and the use of standard psychometric measures.
He adds that the findings attest to the importance of psychological factors and somatic reporting tendency in understanding childhood abdominal pain. Furthermore, the study provides some reassurance to clinicians who feel compelled to rigorously evaluate children with functional abdominal pain for other disorders.
How can these children be treated, and later FGIDs prevented? Drossman explains that sessions of social learning and cognitive behavioral therapy can reduce the severity of children’s GI symptoms and increase their pain tolerance. Such therapy can also reduce solicitous behaviors in children and their parents’ beliefs about their child’s pain—factors shown to mediate the development and perpetuation of pediatric GI symptoms.
Horst et al conclude that extra-intestinal and depressive symptoms might be assessed to help physicians identify children with increased risk for FGID in adolescence and young adulthood. The identification of characteristics of pediatric patients at risk for later FGIDs might increase our understanding its etiology and lead to new treatments.
Future research should explore whether treating depressive symptoms in patients with pediatric functional abdominal pain can reduce their risk for later FGIDs.