Non-organic abdominal pain Flashcards
Recurrent abdominal pain definition
Pain that waxes and wanes
At least 3 episodes in 3 months
Severe enough to affect activities
Chronic abdominal pain definition
Long-standing, intermittent or constant
Non-organic (‘functional’) in most children
Functional abdominal pain definition
No evidence of an inflammatory, anatomical, metabolic or neoplastic process that explains symptoms
At least once a week for two months
Must include all of:
Episodic or continuous abdominal pain
Insufficient criteria for other functional GI disorders
Functional dyspepsia definition
No evidence of an inflammatory, anatomical, metabolic, or neoplastic process that explains symptoms
At least once a week for two months
Must include all of:
Persistent or recurrent pain or discomfort centred in the upper abdomen (above the umbilicus)
Not relieved by defecation or associated with the onset of a change in stool frequency or stool form
IBS definition
No evidence of an inflammatory, anatomical, metabolic, or neoplastic process that explains symptoms
Abdominal discomfort or pain associated with two or more of the following at least 25% of the time: Improved with defecation; onset associated with a change in frequency of stool; onset associated with a change in form (appearance) of stool.
Functional abdominal pain syndrome definition
Must include functional abdominal pain at least 25% of the time
No evidence of an inflammatory, anatomical, metabolic, or neoplastic process that explains symptoms
At least once a week for at least two months
At least one of:
Some loss of daily functioning.
Additional somatic symptoms such as headache, limb pain, or difficulty in sleeping
Abdominal migraine definition
No evidence of an inflammatory, anatomical, metabolic, or neoplastic process that explains symptoms
Two or more times in the preceding 12 months
Must include all of:
Paroxysmal episodes of intense, acute periumbilical pain lasting for one or more hours.
Intervening periods of usual health lasting weeks to months
The pain interferes with normal activities.
The pain is associated with two or more of the following: anorexia, nausea, vomiting, headache, photophobia, pallor
Risk factors
Female Sexual abuse Parental anxiety in first year of life FH of GI problems History of illness in siblings
Clinical features
Often central or epigastric FH of depression, headache or tummy ache Anxiety likely Headache likely Alarm symptoms not likely to be present Abnormal signs and growth not likely Abnormal investigations not found
Alarm symptoms
Involuntary weight loss. Deceleration of linear growth. Gastrointestinal blood loss. Significant vomiting. Chronic severe diarrhoea. Unexplained fever. Persistent right upper or right lower quadrant pain. Family history of inflammatory bowel disease.
Management
Reassurance, discussion and time CBT Family therapy (often part of CBT) Weak evidence: Peppermint oil for IBS Pizotifen for abdominal migraine H2-receptor antagonists for those with severe dyspeptic symptoms
