RECURRENT ABDOMINAL PAIN IN CHILDREN

Objective: To determine the causes of recurrent abdominal pain (RAP) in children and suggest general management guidelines. Methodology: It is a descriptive observational study conducted from August 2000 to July 2003. One hundred fifty two children of 2-15-Years age with recurrent abdominal pain were enrolled in this study. A pre-designed proforma was filled and investigations like Complete Blood Count (CBC), urine and fresh stool analysis was performed in all cases. Patients presenting with upper abdominal pain with or without dyspeptic symptoms were evaluated for H. Pylori by serology. Helicobacter pylori antibody serology (value >50 i.u Elisa method) positive patients were offered endoscopy examination and endoscopic antral biopsies were done. Other tests Like x-ray chest and or abdomen, barium meat study, ultrasonography of abdomen, EEG examination and tuberculin test were done as indicated. Patients were followed at 2-week interval for three months and specific treatment prescribed as per etiology identified. Results: Out of 152 children, a female to mate ratio was 2: 1, age range was 2-15 years and mean age was 8.9 years. Mean duration of symptoms was 16 months. Patients presented with epigastric localization of pain 65%, 25% presented with 'whole' abdominal pain while 5% patients presented with pain in loins and 5% had pain in lower abdomen. Protozoal infections which included giardiasis and amoebiasis (33%) were the commonest association followed by Helicobacter pylori (31%). Endoscopy was performed in 15 cases; biopsy was positive for H. Pylori in all (100%) cases. Thirteen percent had worms in addition to giardia and entamoeba histolytica and 10% had gastro-esophageal reflux. Among other causes urinary tract infection was 5%, constipation was 3% & peptic ulcer diseases was 02%. Abdominal epilepsy, abdominal migraine, cholilithiasis, ovarian cyst, ulcerative colitis and gastric-trichobizoar all were less than 1%. Conclusions: Recurrent abdominal pain is frequent and challenging pediatric problem. High index of suspicion and careful thorough clinical evaluation supported by stepwise laboratory work-up according to it's clinical presentation and consideration of common treatable causes will be a cost effective approach. Balanced diet with higher fiber content, environmental cleanliness, better quality of water and good personal hygiene practices can reduce common infections with causative factors.