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Volume 25 |
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Number 1 |
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Published by : PROFESSIONAL MEDICAL PUBLICATIONS |
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Volume 25 |
January - March 2009 |
Number 1 |
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Recurrent Abdominal Pain in Children
Iqbal A. Memon1, M.N. LAL2, G.Murtaza3,
Amara Jamal4, Rab Nawaz Bhatti5, SaminaTariq6ABSTRACT
Objective: To determine the causes of recurrent abdominal pain (RAP) in children and suggest general management guidelines.
Methodology: It is a descriptive observational study conducted from August 2000 to July 2003.One hundred fifty two children of 2- 15-Years age with recurrent abdominal pain were enrolled in this study. A pre-designed proforma was filled and investigations like Complete Blood Count (CBC), urine and fresh stool analysis was performed in all cases. Patients presenting with upper abdominal pain with or without dyspeptic symptoms were evaluated for H. Pylori by serology. Helicobacter pylori antibody serology (value >50 i.u Elisa method) positive patients were offered endoscopy examination and endoscopic antral biopsies were done. Other tests like x-ray chest and or abdomen, barium meal study, ultrasonography of abdomen, EEG examination and tuberculin test were done as indicated. Patients were followed at 2-week interval for three months and specific treatment prescribed as per etiology identified.
Results: Out of 152 children, a female to male ratio was 2:1, age range was 2-15 years and mean age was 8.9 years. Mean duration of symptoms was 16 months. Patients presented with epigastric localization of pain 65%, 25% presented with ‘whole’ abdominal pain while 5% patients presented with pain in loins and 5% had pain in lower abdomen. Protozoal infections which included giardiasis and amoebiasis (33%) were the commonest association followed by Helicobacter pylori (31%). Endoscopy was performed in 15 cases; biopsy was positive for H.Pylori in all (100%) cases. Thirteen percent had worms in addition to giardia and entamoeba histolytica and 10% had gastro-esophageal reflux. Among other causes urinary tract infection was 5%, constipation was 3% & peptic ulcer diseases was 02%. Abdominal epilepsy, abdominal migraine, cholilithiasis, ovarian cyst, ulcerative colitis and gastric-trichobizoar all were less than 1%.
Conclusions: Recurrent abdominal pain is frequent and challenging pediatric problem. High index of suspicion and careful thorough clinical evaluation supported by stepwise laboratory work-up according to it’s clinical presentation and consideration of common treatable causes will be a cost effective approach. Balanced diet with higher fiber content, environmental cleanliness, better quality of water and good personal hygiene practices can reduce common infections with causative factors.
KEY WORDS: Recurrent Abdominal Pain Children, H.Pylori, Protozoal infection, Worms, gastro-esophageal reflux.
Pak J Med Sci January - March 2009 Vol. 25 No. 1 26-30
How to cite this article:
Memon IA, LAL MN, Murtaza G, Jamal A, Bhatti RN, Tariq S. Recurrent Abdominal Pain in Children. Pak J Med Sci 2009;25(1):26-30.
1. Prof. Iqbal A. Memon FRCP(C) DABP, FAAP
Professor of Pediatrics
2. Nand Lal Moorpani MCPS, DCH
Pediatrician,
MD Student (Karachi University)
3. Dr. G.Murtaza FCPS
Associate Professor
4. Dr. Amara Jamal, FCPS
Assistant Professor
5. Dr. RabNawaz Bhatti FCPS
Assistant Professor
6. Dr. SaminaTariq MCPS, FCPS
Senior Registrar
1-6: Paeds Unit-II,
Dow University of Health Sciences & Civil Hospital,
Karachi, Pakistan.Correspondence
Dr. M.N. LAL, ARI/CDD /IMNCI Resource Center,
Paeds Unit –II, Dow University of Health Sciences and
Civil Hospital Karachi, Pakistan.
Email: mnlal@hotmail.com
* Received for Publication: December 13, 2007
* Revision Received: January 15, 2008
* 2nd Revision Received: November 17, 2008
* Final Revision Accepted: November 22, 2008
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