The Frequency and Clinical Characteristics of Organically Caused Recurrent Abdominal Pain in Children

Abstract

SUMMARY

The organic causes of recurrent abdominal pain (RAP) are the result of the presence of abnormal anatomic structural or disturbed physiological processes, such as inflammatory, metabolic, infective and neoplastic changes. 

Aim: The aim of the study was to examine the frequency and clinical characteristics of recurrent abdominal  pain with organic causes in children, in relation to age and gender.

Patients and Methods: A total of 1013 children were included, aged from 3 to 15 years in prospective research over a one-year period in a specialized out-patients' clinic for gastroenterology and/or on the gastroenterology ward of the Children's Hospital, UCC Tuzla. The test group (77) comprised children with organic aetiology of their illness, in whom esophagogastroduodenoscopy (EGD) was performed. One group of patients had several recorded causes of the organic aetiology of RAP.

Results: 183/1013 (18.3%) children had symptoms of RAP, whilst 77 or 42.1% of the subjects had organic aetiology of the illness, of which 47 (61%) were girls and 30 (39%) were boys. Of the total number of subjects, 65% were adolescents. Alarm symptoms were present in 24(80%) of male and 37 (78.7%) of female children. Night pain which disturbed the child's sleep, vomiting and pain caused by food were the most common alarm symptoms recorded. The most common causes of RAP were pathological EGD findings in 25 or 83.3% boys, and 35 or 74.4% girls, duodenogastric reflux in 36% subjects of both genders (11 boys and 17 girls), and hiatal hernia (8 or 26.6% boys and 8 or 17.2% of girl subjects).  Parasitosis was recorded in 13% of subjects of both genders (four boys and six girls) whilst in three children (10% boys and 6.38% girls), on the basis of a positive biopsy finding of the mucous of the small intestine, the diagnosis of coeliac disease was confirmed. Amongst those with negative endoscopy findings, four children were recorded as having parasitosis, whilst three had urinal infection, and one subject had cholestasis confirmed by ultrasound. 

Conclusion The frequency of organic aetiology in our subjects with recurrent abdominal pain was 42.1% with predominance in females. Gastropathy, duodenogastric reflux, hiatal hernia and parasitosis were the most common causes of the illness. The most common alarm symptoms were night pain, vomiting and pain caused by food.

Key Words: recurrent abdominal pain, organic aetiology, children, alarm symptoms and signs