Functional Abdominal Pain

Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional abdominal pain (FAP), functional dyspepsia, and irritable bowel syndrome. FAP can impair a child’s life and often leads to significant school absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in the developing nervous system can cause long-term changes in the brain-gut axis resulting in altered pain pathways and visceral hyperalgesia. Recent studies suggest that surgery, gastrointestinal tract inflammation, and infection in early life can predispose children to the development of pain-associated functional gastrointestinal disorders. Symptom-based criteria for the diagnoses of FAP have been proposed by the Rome committee. However, lack of well-designed studies evaluating their reliability in a clinical setting has hampered there use in clinical practice. Since the pathophysiology of FAP in children is poorly understood and limited data exist regarding safety and efficacy of therapeutic options in children, some care providers feel uncomfortable managing patients with chronic abdominal pain. The primary goal of therapy in FAP is to alleviate pain symptoms and to help the child return to normal daily activities. Treatment should be individualized and chosen based on the severity of symptoms, the existence of comorbid psychological disorders, and the impact the disorder has on the child’s school attendance and normal functioning. Various psychological interventions, such as cognitive behavioral therapy, hypnosis, and guided imagery, have been successfully used in children with chronic abdominal pain. Pharmacologic therapies such as antisecretory drugs, tricyclic antidepressants, and various serotonergic drugs have been used, but controlled trials are either lacking or have shown that pharmacologic agents are no better than placebo in treating children with FAP.