Recurrent abdominal pain (RAP) in children does not usually persist, but RAP at age 12 years is a risk factor for abdominal pain–related functional gastrointestinal disorders at 16 years, researchers report in the May issue of Clinical Gastroenterology and Hepatology.
RAP, defined as frequent and unexplained abdominal pain, has an estimated pooled prevalence of 13.5% among children, accounting for 5% of childhood primary care consultations, and is associated with extensive diagnostic analyses. RAP places a burden on health care systems and is associated with lower quality of life and school absenteeism. Some studies have reported that up to 50% of children have symptom persistence into adolescence, but little is known about causes or progression of RAP.
Jessica Sjölund et al investigated the prevalence and progression of childhood RAP and its association with Rome III abdominal pain–related functional gastrointestinal disorders (AP-FGID) and irritable bowel syndrome (IBS) during adolescence.
The authors collected data from a population-based birth cohort study of 4089 children (born from 1994 through 1996 in Sweden) and analyzed data from 2455 children with complete follow-up evaluation at ages 1, 2, 12, and 16 years and no parent-reported diagnoses of inflammatory bowel diseases or celiac disease at ages 12 or 16 years.
A subpopulation of 2374 children who had answered questions based on the Rome III criteria at age 16 years was identified. For example, at 1 and 2 years, parents answered the question: “Has your child had repeated attacks of colic after the age of 6 months [at 1 year]/12 months [at 2 years]?” Children to parents who answered yes to this question at 1 and/or 2 years were defined as having early childhood RAP.
At 12 years, children answered the questions “Do you repeatedly have abdominal pain (apart from menstrual cramps)?” and “How often do you have repeated abdominal pain (apart from menstrual cramps)?” At 16 years children answered the question “How often in the past 2 months have you felt abdominal pain or discomfort?” Children reporting abdominal pain every week or more often were defined as having RAP at 12 and 16 years, respectively. AP-FGID at age 16 years was defined according to the Rome III criteria.
Almost half of the children with RAP at 12 years had persistent symptoms at 16 years (44.9% of cases). Children with RAP at 12 years also had increased risks for RAP at 16 years (relative risk, 2.2; 95% CI, 1.7–2.8), any AP-FGID at 16 years (relative risk, 2.6; 95% CI, 1.9–3.6), and IBS at 16 years (relative risk, 3.2; 95% CI, 2.0–5.1) at 16 years. Early childhood RAP was not associated significantly with any outcome.
Significantly more children with RAP at 12 years, RAP at 16 years, any AP-FGID at 16 years, and IBS at 16 years, were female.