Chronic Abdominal Pain

Recurrent abdominal pain (RAP) is a common complaint in children, and in most cases no physical cause can be found. What happens to these children when they grow up?

Researchers from England report findings from a national study that followed a birth cohort of 5362 subjects born in 1946, with follow-up available when these subjects reached age 43. Children were considered to have RAP if abdominal pain was reported in the previous year at the interviews conducted at ages 7, 11, and 15 years. Children who had hospital records identifying organic illness as the cause of abdominal pain were excluded.

On the surveys at ages 7, 11, and 15 years, 2.1% (76) of the subjects reported having had abdominal pain in the previous year. Only three had hospital records indicating an organic cause. Among children with RAP, none developed inflammatory bowel disease by age 43. On the other hand, there were high rates of concern about parent¹s physical health and the mothers had higher neuroticism scores. Study subjects were not especially prone to physical symptoms, but were 2.7 times more likely to suffer from psychiatric disorders in adulthood.

The authors conclude: Overall, the results suggest that the outcome in terms of symptoms of persistent pain is good. Though there is some evidence that persistent abdominal pain in childhood is associated with medically unexplained physical symptoms in adult life, it is a more powerful predictor of adult psychiatric disorder.

(Hotopf M et al. Children with abdominal pain‹what happens when they grow up? Br Med J 1998; 316:1196-1200)

COMMENT: It is important to rule out chronic gastric ulcer due to the bacterium Helicobacter pylori which has an effective treatment (amoxicillin, Flagyl and Pepto-Bismol). As science advances, the line between physical and mental health problems becomes less blurred.