Submitted to: Journal of Pediatric Gastroenterology and Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/11/2006
Publication Date: 2/5/2007
Citation: Shulman, R.J., Eakin, M.N., Jarrett, M., Czyzewski, D.I., Zelter, L.K. 2007. Characteristics of pain and stooling in children with recurrent abdominal pain. Journal of Pediatric Gastroenterology and Nutrition. 44(2):203-208. Interpretive Summary: All children experience abdominal pain at some time. However, it is unknown how often normal children experience abdominal pain compared with children who seek medical attention for their recurrent abdominal pain. This study compared the frequency, location, interference with activities, and stooling pattern of normal children who have not seen a physician for abdominal pain with that of children who were under the care of a physician for recurrent abdominal pain of unknown cause. Abdominal pain occurred more frequently, was more severe, and affected activities more often in children with recurrent abdominal pain. The location of the pain did not differ between groups nor did stooling pattern. Soft or loose stools were associated with abdominal pain in both groups. These results define the normal vs abnormal pattern of abdominal pain in young children.
Technical Abstract: OBJECTIVE: To collect symptom data longitudinally from children with recurrent abdominal pain (RAP) and control (asymptomatic) children. PATIENTS AND METHODS: Children with RAP (n = 77) and controls (n = 33) 7 to 10 years of age completed daily diaries for 2 weeks tracking pain frequency and severity, how often the pain interfered with activities, and stooling pattern. RESULTS: RAP children reported a greater number of pain episodes and greater pain severity than control children. Pain commonly was reported to be in the periumbilical area and occurred evenly across the day in both groups. However, the pain interfered with activity more often in the RAP group. There was a positive relationship between pain and interference with activities. Both groups reported stool changes, but there were no differences between groups in stool character (e.g., hard, mushy). For both groups, the presence of watery stool was related positively to pain. Of children with RAP, 65% could be categorized as having irritable bowel syndrome, whereas 35% were classifiable as having functional abdominal pain according to the pediatric Rome II criteria. CONCLUSIONS: To the best of our knowledge, this is the first longitudinal report of symptoms in children with RAP compared with controls. These data demonstrate that there is considerable overlap between children with RAP and control children on a number of items commonly obtained in the history (e.g., pain location, timing, stooling pattern). Most children with RAP could be characterized as having irritable bowel syndrome. The relationship between pain reports and interference with activities substantiates the need to deal specifically with the abdominal pain to decrease disability. The relationship between pain and watery stools requires further study.