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How Long Does Recurrent Abdominal Pain in Children Last?

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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.

Prevalence of recurrent abdominal pain. P, between boys and girls (Pearson chi-square).

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.

RAP was reported by 26.2% of children on at least 1 of 3 assessment points (see figure), of which 11.3% reported symptoms more than once.

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.

Any AP-FGID was reported by 11.7% of children with RAP in early childhood and by 33.0% of children with RAP at 12 years. IBS was the most commonly reported subtype in all participants, in children with early childhood RAP, and in children with RAP at 12 years. Any history of childhood RAP was found in 16.1% of children with AP-FGID, and more prevalent in children with IBS (18.0%) or functional dyspepsia (18.2%) than with FAP (9.7%). A higher proportion of girls with IBS had a history of RAP (25.6%, 22 of 183) than boys with IBS (5.7%, 3 of 91) (P < .01).
Sjölund et al conclude that many children (from early childhood through adolescence) have RAP, but that most children do not have persistent symptoms. Although most children with RAP at 12 years do not have persistent symptoms 4 years later, they still have a 2- to 3-fold increased risk for RAP, any AP-FGID, and IBS at 16 years. Studies are needed to characterize this group of pre-adolescents further to identify prognostic factors and improve patient management.
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Kristine Novak

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About The Author:

Dr. Kristine Novak

Dr. Kristine Novak

Dr. Kristine Novak is a science writer and editor based in San Francisco. She has extensive experience covering gastroenterology, hepatology, immunology, oncology, clinical, and biotechnology research discoveries.

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