An Update on the Assessment and Management of Pediatric Abdominal Pain
The majority of youth with chronic abdominal pain meet Rome criteria for a functional abdominal pain disorder (FAPD). FAPDs are complex and involve several contributing factors. This review gives an overview of the pathophysiology of FAPDs and a summary of existing literature.
Craig Friesen, MD, Jennifer Colombo, MD, Amanda Deacy, PhD, and Jennifer Schurman, PhD first describe criteria for FAPDs in children and adolescents based on Rome criteria, including overlap that may occur and symptom variability. They also outline prevalence and impact on quality of life.
Next, they describe the biopsychosocial model which recognizes biologic, psychologic and social factors that may be contributing to chronic abdominal pain. They note that this model is constantly evolving as there is great complexity within FAPD pathophysiology and ever-interacting systems (i.e., biologic factors can be divided into neurologic, immunologic and endocrinologic systems which communicate with each other and also the psychologic system).
Check out Figure 1 which shows an overview of the factors involved in the pathophysiology of FAPDs.
The authors also detail evaluation, mentioning the large inconsistency that exists in testing across pediatric gastroenterologists. Common practice includes identifying alarm symptoms and using non-invasive lab tests before additional evaluation is needed (i.e., endoscopy).
Finally, they describe the many treatment options – from adjusting diet (elimination, FODMAPs, gluten, food allergies, etc.) to psychologic treatment (cognitive behavioral therapy, hypnotherapy, biofeedback, mindfulness, etc.) and medications.
In conclusion, the authors share that there are no established guidelines for managing pediatric FAPDs, but they offer recommendations based on existing evidence, adult guidelines and their clinical experience.
GI Connect