Submitted to: Gastroenterology
Publication Type: Abstract Only
Publication Acceptance Date: 9/5/2006
Publication Date: 10/3/2006
Citation: Shulman, R.J., Czyzewski, D., Jarrett, M., Zeltzer, L. 2006. Gastrointestinal (GI) inflamation in children with recurrent abdominal pain (RAP) is not related to pain and stooling pattern [abstract]. Gastroenterology. 130(4):A190. Interpretive Summary:
Technical Abstract: Objective: Recent histologic studies have suggested evidence of low grade inflammation in many adult patients with irritable bowel syndrome (IBS). Additionally, fecal calprotectin concentration, a marker of GI inflammation has been reported to be abnormal in up to 30% of adults with IBS (Gastroenterology 2002;123:450). Whether the same is true for children with RAP, a condition that affects 10-15% of school age children and bears many physiological similarities to IBS in adults (e.g., functional pain, visceral hyperalgesia), has not been studied. Study Design: Children (age 7-10 yr) were identified initially by chart review in pediatrician's or pediatric gastroenterologist's offices. Children with RAP met Rome II criteria for functional abdominal pain or IBS. Non-RAP Control subjects were recruited through the same pediatrician's offices. Further screening was done with parents by phone. After instruction in the home by research assistants children saved a stool for measurement of calprotectin concentration and kept a 2-wk diary to record abdominal pain frequency and severity and number and character of stools. Results: Groups were comparable in age: RAP: 8.5 +/- 1.1 vs C: 8.7 ± 1.0; mean +/- SD. Fecal calprotectin concentration was greater in children with RAP than in Controls (Table). Differences between RAP and Controls also were noted for mean pain score, maximum reported pain, and number of pain episodes, though not for number of stools or number of days with no stool. However, more stools were hard balls in RAP children (19% vs 7%, RAP vs Control). Regression analyses revealed no relationship between fecal calprotectin concentration and abdominal pain frequency and severity and number and character of stools for the groups combined or separately. Conclusions: 1) Children with RAP have evidence of GI inflammation as measured by fecal calprotectin concentration; 2) Pain and stooling pattern do not appear to be related to calprotectin concentration; 3) GI inflammation as measured by fecal calprotectin concentration does not appear to play a significant role in pain and bowel symptoms in children with RAP.