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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
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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.
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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
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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 ...