December 23, 2010

A Prescription for Abdominal Pain: Due Diligence

From: NYTimes.com: “For some reason people respect headaches,” said Dr. Carlo Di Lorenzo, a leading pediatric gastroenterologist and a professor of clinical pediatrics at Ohio State. “I’ve never seen a parent or a pediatrician tell a child complaining of a headache, ‘You don’t have a headache — it’s not real.’ Bellyache is just as real as headache.”

Indeed it is. And recurrent abdominal pain in children is common, frustrating and often hard to explain.

Consider a girl who came to the clinic for her 10-year physical exam. She gets these bellyaches, she told me. Had a bad one that week, but her stomach wasn’t hurting right at the moment.

She’d been treated for constipation; she’d been tested for celiac disease and other problems. Every blood and stool test over the two years since the pain began was completely normal. One night the bellyache was so bad she went to the emergency room — and her abdominal X-rays were normal as well.

The diagnostic term for this common and perplexing condition is “functional abdominal pain”: recurrent stomachaches, as the American Academy of Pediatrics put it in 2005, with no “anatomic, metabolic, infectious, inflammatory or neoplastic disorder” to explain them.

When I was a resident, we often smirked when we spoke of functional abdominal pain, treating it as a code for a troublesome patient, dubious symptoms or an anxious family. But recent research suggests we were too biomedically narrow in our thinking.

Scientists are coming to understand that abdominal pain is transmitted by a specialized nervous system that may be hypersensitive or hyperactive in some children. Studies in which researchers inflated balloons in children’s intestines suggested that those with functional abdominal pain might be unusually sensitive to any distension on the inside.

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