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??Sudden and violent abdominal pain with comparatively fixed location should be clinical features in children with acute abdominal diseases. The constant development of system and organs in childhood makes it difficult for pediatricians to make correct diagnosis of pediatric acute abdomen. Complete inspection and particularly abdominal palpation and digital examination should be emphasized. Correct understanding of abdominal pain in children with acute abdominal diseases is of critical importance.     

Appendicitis and non-specific abdominal pain in childhood

Abdominal pain is a common experience during childhood and frequently presents to secondary healthcare facilities. Although non-specific abdominal pain and appendicitis are the most common causes, the clinician should also be aware of the diagnosis and management of all causes of abdominal pain in children. This article provides an overview of abdominal pain in children, including history and examination, initial management, diagnostic categories, modes of investigation, and definitive treatment.     

The evaluation and management of recurrent abdominal pain in childhood

Recurrent abdominal pain is a common symptom in children. It presents a diagnostic and management challenge. Underlying organic disease is rare but important to correctly identify. Most children with recurrent abdominal pain have a functional gastro-intestinal disorder. There are several recognized patterns of functional gastro-intestinal disorder affecting children. A combination of biological, psychological and social factors contribute to the aetiology of pain. Management is centred on identifying and modifying factors that may be contributing to the symptoms. The prognosis for functional gastro-intestinal disorder is generally good, though there is an increased chance of somatising and psychiatric disorders developing later in life.     

Prevalence and pattern of childhood abdominal pain in an Australian general practice

OBJECTIVE: Abdominal pain is a common problem in childhood and accounts for a significant workload in general practice. The aim of this study was assess the nature of abdominal pain in a sample of Australian children attending a Western Australian general practice for any reason, and to determine factors associated with the reporting of such pain. METHODOLOGY: A prospective study of children and their families attending a rural general practice was undertaken using a parental survey to assess the frequency and nature of abdominal pain, demographic features, physical and behavioural characteristics. RESULTS: Abdominal pain was common in this population; 44% (70 of 164) of parents reported that the index child had experienced abdominal pain in the past 12 months. The average age of children who experienced recent abdominal pain was 9 years and 9 months. Multivariate analysis suggested that children experiencing abdominal pain in the preceding 12 months were more likely to be anxious (odds ratio (OR) = 3.74, P = 0.01), to have a family history of similar problems in siblings (OR = 4.26, P = 0.01) and to experience sleep disturbance (OR = 3.90, P = 0.02) than children without abdominal pain. Consumption of three or more serves of wholemeal bread or cereals per day had a significant protective effect on reported abdominal pain in children (OR = 0.12, P = 0.03). The majority of families (66%) dealt with the pain without resorting to medical care. CONCLUSIONS: Abdominal pain remains a common problem of children attending an Australian general practice, and was associated with features suggesting that it is related to anxiety and coping ability. Abdominal pain is not usually associated with disease; most families recognize this and cope with abdominal pain without medical consultation.     

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??Abdominal pain is a common symptom of food allergy. It may be the main symptom of some diseases of digestive system?? such as infant colic. It may be accompany symptom of some diseases?? such as eosinophilic gastroenteritis?? or it is a manifestation of systemic disease?? such as anaphylaxis. Oral tolerance development?? bacterial intestinal microflora?? intestinal barrier function?? transepithelial transport of food antigens?? eosinophil recruitment in the gastrointestinal tract?? and effect of food allergens on gastrointestinal motility are the contribution to pathophysiology of gastrointestinal food allergy.     

Lactose and fructose malabsorption in children with recurrent abdominal pain: results of double-blinded testing

Aim: To investigate malabsorption of lactose and fructose as causes of recurrent abdominal pain (RAP). Methods: In 220 children (128 girls, mean age 8,8 [4.1–16.0] years) with RAP, hydrogen breath tests (H₂BT; abnormal if ΔH₂ > 30 ppm) were performed with lactose and fructose. Disappearance of RAP with elimination, recurrence with provocation and disappearance with re‐elimination, followed by a 6‐month pain‐free follow‐up, were considered indicative of a causal relation with RAP. For definite proof, a double‐blinded placebo‐controlled (DBPC) provocation was performed. Results: Malabsorption of lactose was found in 57 of 210, of fructose in 79 of 121 patients. Pain disappeared upon elimination in 24/38 patients with lactose malabsorption, and in 32/49 with fructose malabsorption. Open provocation with lactose and fructose was positive in 7/23 and 13/31 patients. DBPC provocation in 6/7 and 8/13 patients was negative in all. However, several children continued to report abdominal symptoms upon intake of milk or fructose. Conclusion: Lactose intolerance nor fructose intolerance could be established as causes of RAP, according to preset criteria including elimination, open provocation and DBPC provocation. However, in clinical practice, persistent feeling of intolerance in some patients should be taken seriously and could warrant extended elimination with repeated challenges.     

Central/diffuse abdominal perception of urological pain in children

AIM: In children with recurrent abdominal pain (RAP), the location of pain to the flank may suggest the involvement of the urinary apparatus. We aimed to evaluate the location of pain in different age groups of children with idiopathic hypercalciuria (HC) and/or hyperuricosuria (HU) and RAP. METHODS: Location of pain was assessed in 180 consecutive HC/HU children with RAP, aged 3-17.6 y, presenting to a single centre. RESULTS: Considering four age groups, central/diffuse was more prevalent than lateral location of pain in youngsters, with a progressive and significant (p<0.0001, chi2 test for trend) decrease of the prevalence of central/diffuse location with rising age, and with the most relevant drop after age 8 y. Location of pain was central/diffuse in 81% of patients under and lateral in 79% of those over 8 y of age (p<0.0001). The location of pain changed from central/diffuse to lateral in 16/18 children followed at least 1 y, within 1 to 2 y by age 8. CONCLUSION: Only after 8 y of age did the lateral location of abdominal pain become the rule in children with HC/HU and RAP. This has to be kept in mind in order to avoid overlooking the urologic origin of pain.     

Recurrent abdominal pain in children: a long term follow-up

A long-term follow-up study (minimum of 10 years) of 16 children admitted for recurrent abdominal pain revealed that in 50% of the sample the disturbance disappeared completely, persisted in 25% and in the remaining 25% other painful symptoms developed. The variables that characterized the poor outcome group were: belonging to a painful family, many surgical procedures, low educational level and social class and a low score in the Q3 factor of the Sixteen Personality Factor Questionnaire (spare capacity to control emotions).Abbreviations RAP recurrent abdominal pain - SDS self-rating depression scale - 16 PF Sixteen Personality Factor Questionnaire - SD standard deviation - Q quartile     

Motilin in children with recurrent abdominal pain: a controlled study

Fjord Christensen M. Motilin in children with recurrent abdominal pain: a controlled study. Aeta Pædiatr 1994;83:542–4. Stockholm. ISSN 0803–5253
The aim of this study was to compare serum motilin levels in children with and without recurrent abdominal pain, based on the assumption that recurrent abdominal pain in children is a gut motility disorder. In this controlled study, 19 children between 6 and 15 years or age with recurrent non-organic abdominal pain and 20 control children between 6 and 15 years of age without abdominal pain or other functional somatic complaints were evaluated. No slatistical significant difference was found in serum motilin levels between children with and without abdominal pain. Median difference between the groups was II pmol/1 (95% confidence limits of median difference -9 to +33). This investigation could not support the assumption that motilin might be a pathogenic factor in children with recurrent abdominal pain. It is suggested, however, that future research should compare serum motilin levels during and between attacks of pain.     

超声引导内镜下逆行阑尾炎治疗术在阑尾相关慢性腹痛患儿中的应用价值北大核心CSCD

目的 探讨超声引导内镜下逆行阑尾炎治疗术在儿童阑尾相关慢性腹痛中的临床疗效。方法 回顾性收集2019年8月至2021年5月收治的以慢性腹痛为主诉,超声提示阑尾炎症或腔内粪便或粪石且行超声引导内镜下逆行阑尾炎治疗术患儿30例的临床资料,分析其临床表现、内镜下表现、白细胞计数及中性粒细胞百分比、住院时间、治愈率。结果 30例慢性腹痛患儿中,男童13例(43%),女童17例(57%),平均确诊年龄(9±3)岁,年龄范围3~15岁,中位病程持续时间12个月,中位住院时间3 d;中位白细胞计数6.7×10^(9)/L,中性粒细胞百分比为(50±13)%。21例(70%)术中阑尾腔内冲洗出粪石及大量粪渣。随访率97%(29/30),中位随访时间11(范围:5~26)个月,27例(93%)腹痛症状完全消失。结论 超声引导内镜下逆行阑尾炎治疗术对阑尾腔内粪便或粪石引起的儿童慢性腹痛治疗有效。     

Gastroesophageal reflux in children with recurrent abdominal pain

In this study we investigated the presence of gastroesophageal reflux in children with recurrent abdominal pain and its possible relationship to food intolerance-associated duodenal inflammation. Twenty-four-hour intra-esophageal pH monitoring, an endoscopic duodenal biopsy and a small bowel 51Cr-EDTA permeability test were performed in 25 children with recurrent abdominal pain. In 14 cases (56%) the pH monitoring was abnormal, pointing to the presence of pathological gastroesophageal reflux. Treatment of gastroesophageal reflux in the latter patients resulted in resolution or improvement of abdominal pain in 10 cases (71%). Gastroesophageal reflux did not appear to be associated with either intestinal permeability to 51Cr-EDTA or duodenal biopsy findings. We conclude that pathological gastroesophageal reflex is a frequent finding in children with recurrent abdominal pain, that it is unrelated to duodenal inflammation and that there might be a causal relationship between pathological gastroesophageal reflux and recurrent abdominal pain in children.     

Lactase deficiency among Malaysian children with recurrent abdominal pain

OBJECTIVES: To determine the prevalence of lactase deficiency among Malaysian children with recurrent abdominal pain and to describe their clinical characteristics. METHODOLOGY: Twenty-four children referred consecutively to the University of Malaya Medical Centre who fulfilled Apley's criteria (at least three episodes of abdominal pain severe enough to affect normal activity over a period longer than 3 months) were tested for lactase deficiency using a pocket breath test analyser (BreatH2 meter; Europa Scientific, Cheshire, England). Lactulose was used to check for hydrogen-producing capacity. RESULTS: There were 14 males and 10 females in the study, consisting of five Malays, 14 Chinese and five Indians. Mean age was 9.9 years. Seventeen of the 24 children (70.8%) with recurrent abdominal pain who underwent the breath hydrogen test had a positive result. In those with a negative result, subsequent lactulose administration resulted in a positive rise in breath hydrogen. None of the 24 children developed abdominal pain during the test. All the Indian subjects, 71.4% of the Chinese subjects and 40% of the Malay subjects with recurrent abdominal pain had lactase deficiency. The proportion of boys and girls with lactase deficiency was similar (71.4 vs 70.0%, respectively). There was no significant difference between lactase sufficient and deficient children with recurrent abdominal pain with regard to sex, age, ethnic group and clinical features. Following a lactose-free diet, none of the children in the breath hydrogen positive and negative groups reported any appreciable difference in pain symptoms. CONCLUSIONS: The prevalence of lactase deficiency among this group of Malaysian children with recurrent abdominal pain was high, but lactase deficiency did not appear to play an important role in causing the symptoms.     

Intra-rachidian disorders: two unusual cases of recurrent abdominal pain in children

Recurrent abdominal pain (RAP) is generally thought to be of psychological origin but organic aetiologies are increasingly being identified. The cases of two children with vertebral disorders revealed by recurrent abdominal pain are reported. A 14-y-old girl presented with RAP associated with scoliosis, due to a T8-T9 intra-dural extra-medullary tumour. A 7-y-old girl who suffered from nocturnal RAP located in the right iliac fossa for 1 y had decreased muscular strength, pyramidal signs, and a 10 degree Lassègue sign in the right lower limb, revealing a vascular malformation extending from T12 to L2. Conclusion: Atypical pain and associated neurological signs or scoliosis must raise the possibility of intra-rachidian disorders. Magnetic resonance examination will then precisely state the location and nature of the pathological process, avoiding excessive delay in therapeutic management.     

Prevalence of abdominal migraine and recurrent abdominal pain in a Japanese clinic

Prevalence of abdominal migraine (AM) and recurrent abdominal pain (RAP) was evaluated in patients who visited Hikita Pediatric Clinic between May 2010 and April 2015. Patient data were collected prospectively using a questionnaire. Out of a total of 3611 cases, observed prevalence was 2.44% for repeated abdominal pain over a period of ≥3 months, 1.47% for RAP, and 0.19% for AM. Duration of abdominal pain was longer for AM than for non‐AM RAP. Certain clinical features were significantly different between AM and non‐AM RAP. No correlations were found among age at onset, frequency of attack, and duration of attack for various types of RAP. It was difficult to determine useful diagnostic criteria for distinguishing between AM and non‐AM RAP. They did not appear to be separate disease entities but, instead, lie on a disease spectrum. The present prevalence of AM (0.19%) was lower than that in many previous studies from countries other than Japan.     

反复腹痛患儿蓝氏贾第鞭毛虫的检测与治疗

目的 探讨儿童反复腹痛与蓝氏贾第鞭毛虫感染的关系和相应的治疗.方法 对200例反复腹痛患儿进行蓝氏贾第鞭毛虫的检测并进行相应的治疗.结果 发现蓝氏贾第鞭毛虫感染106例,感染率为53.0%.通过相应的治疗,总有效率为97.2%.结论 儿童反复腹痛患儿中蓝氏贾第鞭毛虫感染率很高,反复腹痛儿童病因的检测应包括蓝氏贾第鞭毛虫,使治疗更有针对性.     

Clinical spectrum of acute abdominal pain in Turkish pediatric patients: A prospective study

Abstract Background : The aim of the present study was to determine the prevalence, associated symptoms, and clinical outcomes of children with acute abdominal pain who had been admitted to an emergency department. Methods : Children aged between 2 and 16 years who presented to the emergency department of Cerrahpa?a Medical School, Istanbul University between July 2001 and August 2002 with acute abdominal pain were enrolled in this study. A questionnaire was completed each patient admitted to our pediatric emergency unit for acute abdominal pain. Data collected included presenting signs and symptoms, the hospital follow up for all children who returned within 10 days, test results, and telephone follow up. Results : The number of children referred to the emergency department was 7442, with 399 (5.4%) of these having acute abdominal pain. The mean age of the study population was 6.9 ± 3.5 years, and 201 of the patients were male. The five most prevalent diagnoses were: (i) upper respiratory tract infection and/or complicated with otitis media or sinusitis (23.7%); (ii) abdominal pain with uncertain etiology (15.4%); (iii) gastroenteritis (15.4%); (iv) constipation (9.4%); and (v) urinary tract infection (8%). The most common associated symptoms were decreased appetite, fever and emesis. Because of follow‐up deficiency the progress of 28 patients was not obtained. Eighty‐two children were referred to the department of pediatric surgery, but only 17 of 82 (20.7%) required surgical intervention (15 of these 17 for appendicitis). Eleven patients returned within 10 days for re‐evaluation, but the initial diagnosis was not changed. The complaints of 57 patients with uncertain etiology were resolved within 2 days. Conclusions : An acute complaint of abdominal pain was usually attributed to a self‐limited disease. However, the percentage of surgical etiology is not negligible.     

Irritable bowel syndrome: the commonest cause of recurrent abdominal pain in children

Apley, working in Bristol, UK, defined recurrent abdominal pain (RAP) in 1958. After extensive investigations, he found that 8% of children presenting to his clinic with RAP had an organic pathology. The aims of this study were to identify (1) causes of RAP using modern methodology, (2) factors associated with organic RAP and (3) children with none-organic RAP who fulfill the diagnostic criteria for irritable bowel syndrome (IBS). Children, aged over 3 years, presenting with RAP were prospectively recruited to this study. They had a detailed questionnaire completed, a full examination with screening tests (blood for coeliac screen, Helicobacter pylori antibody titre, inflammatory markers, serum amylase, liver function tests, and full blood count, urine and stool analyses and abdominal ultrasonography). Endoscopy and oesophageal pH monitoring were performed if clinically indicated. IBS was diagnosed if the child had no organic pathology and fulfilled the Rome II criteria. Out of 103 children (median age of 10 years, mean 10.04, SD ±3.44,), 31 children (30%) had organic pathologies. Factors associated with organic pain were nocturnal symptoms (P<0. 01) and abdominal tenderness (P<0.005) and with non-organic pain were periumbilical locality (P<0.002), pain alleviation on defaecation (P<0.04) and low fibre diet (P<0.005). Of children with non-organic pain, 37/52 (51%) fulfilled the criteria for IBS (36% of the total). Conclusion:of children presenting with recurrent abdominal pain in a hospital setting, 30% have a diagnosable organic aetiology compared to 8% in Apleys time. Irritable bowel syndrome, however, may be the commonest cause of recurrent abdominal pain and should be considered.Abbreviations CRP C-reactive protein - GORD gastro-oesophageal reflux disease - IBS irritable bowel syndrome - RAP recurrent abdominal pain