Abdominal Pain Related to Functional Gastrointestinal Disorders

Abdominal pain related to functional GI disorders is diagnosed in the presence of pain that is present at least once a week in the preceding 2 months and the absence of an organic cause such as an inflammatory, anatomic, metabolic and neoplastic process. The pain is typically periumbilical and is clearly localized by the child. After extensive studies, the most accepted under standing of childhood functional abdominal pain is of ‘visceral hyperalgesia’, referring to an altered excessive perception of normal gut motility that is interpreted by the child as pain. This perception is influenced by the psychosocial stressors in the school and family. The focus on the pain is further heightened by the growing concern in the family and the frequent visits to the doctors. Children of parents with increased anxiety and functional GI problems have an increased risk of developing abdominal pain. The following types are recognized. Functional dyspepsia. Persistent or recurrent pain or discomfort is centered in the upper abdomen, located above the umbilicus and not relieved by defecation nor associated with a change in stool frequency or form (i.e. no irritable bowel syndrome).

Abdominal migraine

Paroxysmal episodes of intense, acute periumbilical pain are noted, lasting for an hour or more with intervening periods of normal health lasting weeks to months. The episodes of pain interfere with normal activities and are associated with two or more of the following: anorexia, nausea, vomiting, headache, photophobia and pallor.

Irritable bowel syndrome

Abdominal discomfort or pain is associated with two or more of the following: improve ment with defecation, onset associated with a change in frequency of stool and onset associated with a change in consistency of stool.

Childhood functional abdominal pain syndrome

This refers to episodic or continuous abdominal pain that meets insufficient criteria for other types. The criteria for child hood functional abdominal pain are satisfied if the child has one or more of the following symptoms at least 25% of the time: some loss of daily functioning and additional somatic symptoms such as headache, limb pain, or difficulty in sleeping.

Red flags

1.Pain localized away from umbilicus in right upper or lower quadrant Nocturnal pain Failure to thrive;

2.weight loss Significant vomiting;

3. bilious vomiting

4.Gastrointestinal blood loss

5. Chronic diarrhea

6.Persistent fever

7. Jaundice

8. Arthritis;

9. rash

10.Family history of inflammatory bowel disease Localized tenderness or mass in abdomen;

11.organomegaly

12.Perianal fistulae