Abdominal Pain Responds to Rx and Therapy

Article excerpt

COLUMBIA, MO. -- Most children with functional recurrent abdominal pain benefit from behavioral therapy and treatment with anti-anxiety medications, Dr. Alejandro Ramirez said at a meeting on common pediatric problems sponsored by the University of Missouri--Columbia.

The pain felt by children with functional recurrent abdominal pain (RAP) is genuine but has no underlying organic cause. In most cases, their pain is associated with their high anxiety levels, said Dr. Ramirez, who added that the main difference between children with functional RAP and other children is their inability "to cope with stressful events."

During an interview with this newspaper following his presentation, Dr. Ramirez said that these children tend to fret and obsess about the stressful, minute details of life. Stress management therapy, a form of behavioral therapy, helps them shift their focus from life's worrisome minutiae to the "big picture."

Functional RAP is most common among children aged 4-16 years and accounts for about 4% of all pediatric office visits. While the exact prevalence is not known, the incidence of functional RAP peaks at age 12 years in both boys and girls. Thereafter, it becomes less common in boys but not so in girls, said Dr. Ramirez of the university.

While up to 75% of adolescents experience occasional abdominal pain, only 15% have pain on a weekly basis, and of that 15%, only 20% have pain that is severe enough to affect activity. By definition, functional RAP is that which persists for 3 months in any 12-month period; the 3 months of pain need not be consecutive to make the diagnosis.

There is a long list of possible causes of organic abdominal pain--which is not termed recurrent-including inflammatory bowel disease, bowel obstruction, infection, pelvic disease, malignancy, allergy, and various metabolic diseases. Each has its own clues, and helpful laboratory tests.

The diagnosis of functional RAP is made only when the physician can find nothing physically wrong with the child. The causes of functional RAP include irritable bowel syndrome, dyspepsia, abdominal migraine, aerophagia, and psychiatric disorders.

Neither dietary modifications nor anticholinergic medications have been shown to lessen the symptoms of functional RAP. What does work is psychotherapy, Dr. …