Abdominal Pain Related to

functional GI Disorder

MANISH GUPTA
47
PAIN that is present once in a week in preceeding 2
months and absence of an organic cause s/a
inflammatory,anatomic,metabolic and neoplastic
process.
• Pain is typically periumblical area nd clearly localised by
child.
• CHILDhood functional abdominal pain is OF visceral
hyperalgesia referring to an altered excessive
perception of normal gut motility tht is interpreted by
child as pain.
• Influenced by psychosocial stress in school and family.
• Children of parents with increased anxiety and functional
GI problems have increased abd pain.
• TYPES-
• FUNCTIONAL DYSPEPSIA-persistt or recurrent pain enor
discomfort is centerd in upper abdomen,above the
umbilicus and not relieved by defecation nor associated
with a change in stool frequency or form(i.e NO IRRITABLE
BOWEL SYNDROME)
• IRRITABLE BOWEL SYNDROME-abdominal pain associated
with 2 or more of the following: improvement with
defecation,onset associated with change in frequency and
consistency of stool
• ABDOMINAL MIGRAINE-PAROXYSMAL episodes of
intense, acute periumblical pain lasting for an hour or
more with intervening periods of normal health lasting
weeks to months.
• Episodes of pain interfere with normal activities and are
associated with 2 or more of the
following:anorexia,vomiting,nausea,headache,
photophobia and pallor.
• CHILDHOOD FUNCTIONAL ABDOMINAL PAIN
SYNDROME-EPISODIC OR CONTINUOUS abdominal
pain.
• The criteria for this is satisfied if the child has 1 or more
following symptoms atleast 25% of time:some loss of
daily functioning and additional somatic symptoms such
as headache ,limb pain or difficulty in sleeping.
• Diagnosis – basically rule out any organic cause
• History should include not only details of pain but also
family details,child emotional environment in home and
school,personality, coping skills,school performance and
stress factor
• Presence of RED FLAG SIGNS increases probability of
organic cause.
• Examination
• Investigations-ESR,stool routine n occult
blood,hemogram, urine microscopy.
• Abd USG not helpful,lymph node<10cm not significant.
• AIM OF MANAGEMENT-make positive
diagnosis,normalise the lifestyle to not allow pain to
curtail daily activitites or school performance, and to
rectify psychological factors.
• CRUX OF MANAGEMENT-counsel parients and child both
jointly and separately. Concept of visceral hyperalgesia
should be explained to parents.
• Provision of nutritious diet with adequate fiber and
avoiding intake of carbonated beverages and refined food
helps in reducing bloating
• Role of amitriptyline nd hypnotherapy for few refractory
cases.