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Recurrent abdominal pain (RAP) refers to a condition described by Apley1 of paroxysmal abdominal pain in children between the ages of 4 and 16 years. These children are otherwise healthy, but the abdominal pain persists for more than 3 months and affects normal activity.2 RAP is very common, occurring in approximately 10% to 20 % of school-aged children.3


RAP has certain characteristic features that help to distinguish it from other sources of chronic abdominal pain in children and adolescents. Typically, patients experience episodes of pain interspersed with pain-free periods. Fewer than 10% of patients report continuous pain. Males and females are equally affected in early childhood; however RAP is more common in females in early adolescence at a ratio of 5:3.4 Children frequently describe periumbilical pain that is diffuse in location, and many children will have difficulty describing their pain. Rarely does the pain of RAP radiate to the back or chest. Children often report that their pain worsens at night and that they have difficulty falling asleep. Pain that wakes a child from sleep is not characteristic of RAP and should warrant further investigation. Approximately 50% to 70% of children will experience headaches, nausea, or dizziness during the episodes, which can be of variable severity.5 There is often a family history of migraines, irritable bowel disease, or ulcer disease.


Most cases of RAP are described as functional, which refers to a lack of readily identifiable specific biochemical, structural, infectious, or other organic abnormality. This lack of ability to diagnose a specific physiologic disorder may be a result of limitations in our understanding of RAP or of limitations in ways to test for a physiologic abnormality. Functional RAP does not imply psychogenic causes. Most children with RAP are, in general, medically and psychologically well. A subgroup of patients will have lactose intolerance, ureteropelvic junction obstruction, inflammatory bowel disease, endometriosis, or gastroesophageal reflux. In most cases of functional RAP, an underlying organic cause is rarely eventually diagnosed.6 A 5-year follow-up study by Walker et al7 reported that only 1 in 31 patients with RAP eventually received a diagnosis of a specific organic disorder. Other longitudinal studies show that only 30% of children with RAP have resolution of their pain within 5 years, and 25% to 50% continue to have symptoms as adults.4,8,9


There can be varying degrees of disability associated with RAP; however, most children with RAP are able to function well despite their symptoms. Children seen at pediatric pain clinics represent a subpopulation with more severe disability. At least 28% of children with RAP miss more than 1 out of 10 days of school. School absenteeism in children and adolescents is a sign of significant functional disability and is analogous to workman disability in adults. Patients with RAP can develop altered peer and family relationships, which may further reinforce a patient’s maladaptive behavior. In a study ...

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