Chronic Abdominal Pain in Children

Recurrent abdominal pain (RAP) was first defined in 1958 by Apley as “at least 3 bouts of pain, severe enough to affect activities, over a period of at least 3 months” (1). This was a landmark publication with great impact, showing, that emotional disturbances played a role in many patients. Since then, several studies showed, that anxiety, depression or behavioural problems are present in patients with abdominal pain, in patients with organic causes of pain as well as in patients with supposed functional pain, as is described by Di Lorenzo et al. on behalf of NASPGHAN in an evidence based report on chronic abdominal pain in children (2). In other words, it can be suggested, that the psychological symptoms could be the result of the pain in stead of the cause. However, in many papers RAP is considered identical to functional abdominal pain, but it is clearly not; in fact RAP is a symptom, not a diagnosis and we should carefully analyse the patients before conclusions are drawn regarding aetiology. In a follow up study, Apley et al. stated, that only “with extremely rare exceptions organic disease can be satisfactorily ruled out from a carefully taken history, …” and that “Two facets of diagnosis are necessary and complementary: reasonable evidence against organic disease, together with evidence in favour of an emotional disturbance. It is prudent not to rely on either one alone, but on both” (3). This in fact is confirmed in more recent studies: based on data obtained from history and physical examination differentiation between organic and functional causes of pain is not possible, as is concluded by Di Lorenzo et al. in their authoritative, evidence based report (2). Therefore, it is reasonable to state, that the diagnosis “functional abdominal pain” can only be made with certainty when organic disease has been ruled out.

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