SF | GASTROENTEROLOGY
March 2021 | Vol. 21 No. 3 www.medicalacademic.co.za
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This article was independently sourced by Specialist Forum.
Probiotics for ‘belly button’ PAIN PAIN Paediatric functional abdominal pain disorders (FAPDs) are commonly seen in clinical practice. Up to 25% of all children and infants worldwide are affected. There is a relatively high risk of persistence of symptoms (29%) even after 10 years of follow-up or in adulthood. FAPDs negatively impact school performance and social relationships.1,2,4
R
ome IV defines FAPDs as episodic or continuous abdominal pain that does not occur solely during physiological events such as eating. Rome IV subclassifies FAPDs into a number of clinically distinct entities, namely irritable bowel syndrome (IBS), functional dyspepsia (FD), abdominal migraine and FAPDs not otherwise specified. See box 1 for the diagnostic criteria.1,4 The Rome IV definition states that a diagnosis of FAPD is likely after appropriate medical evaluations have failed to attribute symptoms to another medical condition.1
Presentation of pain According to the American College of Gastroenterology (ACG), children describe pain around the umbilicus (belly button). The pattern of abdominal pain however is difficult to predict. Location and severity may differ. For example, some children experience a sudden onset of pain, while others describe pain that increases slowly in severity. Some are in constant pain, while in others it comes and goes.3 Furthermore, symptoms may differ. Symptoms can range from upper abdominal pain associated with nausea, vomiting and early satiety, to bloating, indigestion, or experiencing abdominal pain with bowel movements.3 The ACG cautions that other possible causes
of FAPD should be investigated (eg acid reflux, lactose intolerance, parasitic infections of the small and large intestines, Helicobacter pylori infection that may cause ulcers in the first portion of the small bowel, celiac disease, food allergies, hepatitis, gall bladder problems, an inflamed pancreas, an intestinal obstruction, appendicitis, and some rare disorders) before a definitive diagnosis is made. 3
Development of functional abdominal pain McClellan and Ahlawat explain that the development of FAPDs is likely multifactorial. There appears to be sensitisation to the range of normal physiological sensations, which result in visceral hyperalgesia. For example, sensations such as bloating or indigestion may produce pain beyond what is typically experienced by non-affected individuals.4 An initial sensitising event (eg an infection, allergy, altered gut microbiome, or motility disorder) occurs first and later progresses to hypersensitivity. Psychosocial factors such as stress or comorbid anxiety and depression are also associated with the development of hypersensitivity.4
Risk factors Age does not seem to play a role in the onset
of FAPDs. Known risk factors include:1 » Sex: Young and adolescent girls are more affected than boys (15.9% versus 11.5%). Notably, this difference was also evident at a pre-pubertal age (10 years) (9.9% girls versus 7.7% boys) » Psychosocial factors: Several studies reported that children and adolescents with FAPDs have a poor mental health status and lower quality of life compared to healthy children. Up to 50% of children with FAPD are reported to have clinically relevant anxiety or depression.1 » Genetic factors: A family history of IBS and other FAPDs has been reported as an epidemiological risk factor. For IBS, a substantial overlap in the incidence of abdominal symptoms between mothers and their children has been described. This overlap might be related to certain genes but might more likely be due to a number of social factors, including attentive parental response to child pain behaviours.1
Management and treatment interventions According to Romano et al, current treatment strategies include:2 » Support and empathy for the family with reassurance that no serious disease is present
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