A recent editorial (MK Farrell. J Pediatr 2016; 177: 16-17) provides many useful pointers from a master clinician along with commentary on an epidemiology study of recurrent abdominal pain (ML Lewis et al. J Pediatr 2016; 177: 39-43).

The main finding of the study which used an internet survey of mothers (children 4-18) was that 23% of US children met the Rome III criteria for a functional GI disorder.  Constipation was the most common.

Key points in commentary:

• John Apley’s monograph The Child with Abdominal Pains “should be read by all who care for children.”
• Worldwide prevalence of functional GI disorders has been estimated to be 13%. Peak ages were 4-6 years and early adolescence with a greater prevalence in females
• “A variety of phamacologic and nonpharmacologic treatments have been proposed, but none have been consistently effective except perhaps cognitive behavioral therapy and hypnotherapy.”
• “Negative studies are not reassuring” [to families]

Pithy observations from Apley:

• “The more time the doctor spends on the history, the less time he is likely to spend on treatment.”
• “Doctors who treat the symptoms tend to file a prescription. Doctors who treat the patient are more likely to offer guidance.”
• “It is a fallacy that a physical symptoms always has a physical cause and needs a physical treatment.”
• “Anxiety like courage is contagious.”

My take: Dr. Farrell urges more research focus on interventions (diet, behavioral, alternative therapies, medical treatments) to improve outcomes and less focus on epidemiology.

Related blog posts:

• Anxiety and Functional Abdominal Pain | gutsandgrowth
• Brave New World: Psychotropic Manipulation … – gutsandgrowth
• Acupuncture for irritable bowel syndrome | gutsandgrowth
• Pain changes brain | gutsandgrowth
• Cognitive Behavioral Therapy for Childhood … – gutsandgrowth
• Dreaded Nausea | gutsandgrowth
• Disaccharidase Deficiencies in Recurrent Abdominal Pain …
• Unexplained chest pain | gutsandgrowth
• Does negative testing reassure patients? | gutsandgrowth
• Understanding Idiopathic Nausea | gutsandgrowth
• Does buspirone help functional dyspepsia? | gutsandgrowth

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

The Lawn, University of Virginia