Recurrent Abdominal Pain: An Update

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Abstract
1. J. Timothy Boyle, MD* 1. 2. *Associate Professor of Pediatrics, Case Western Reserve University School of Medicine; Chief, Division of Gastroenterology and Nutrition, Rainbow Babies & Children’s Hospital, Cleveland, OH. 1. Recurrent abdominal pain (RAP) is not a diagnosis; it is defined as paroxysmal abdominal pain in children between the ages of 4 and 16 years that persists for more than 3 months and affects normal activity. 2. There are three clinical presentations of RAP: isolated paroxysmal abdominal pain, abdominal pain associated with dyspepsia, and abdominal pain associated with an altered bowel pattern. 3. Diagnostic evaluation depends on the clinical presentation of RAP and the presence of specific findings that suggest the possibility of an organic disorder. 4. The most common cause of all presentations of RAP in children is a functional bowel disorder. 5. A functional bowel disorder in children is a positive diagnosis. 6. Therapy of functional bowel abdominal pain is directed primarily toward environmental modification. The definition of recurrent abdominal pain (RAP) derives from the seminal description by Apley of paroxysmal abdominal pain in children between the ages of 4 and 16 years that persists for more than 3 months and affects normal activity. RAP is not a diagnosis. It may be the predominant clinical manifestation of a large number of precisely defined organic disorders, but in the majority of cases, RAP is due to a functional bowel disorder. The modifier “functional” is used in gastroen-terology if no specific structural, infectious, inflammatory, or biochemical cause for the abdominal pain can be determined. It is the delicate interface between organic and functional forms of pediatric RAP that challenges the primary care pediatrician. Because the exact etiology and pathogenesis of the pain are unknown and because no specific diagnostic markers exist, a diagnosis of functional bowel disorder often is viewed as a diagnosis of exclusion. Yet, functional abdominal pain can and should be a diagnosis that meets specific criteria. The diagnosis is established by a constellation of criteria based on a careful history, physical examination, …

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