A million-dollar work-up for abdominal pain: is it worth it?

The prognostic value of obtaining a negative endoscopy in children with functional gastrointestinal disorders

OBJECTIVES

Functional gastrointestinal disorders (FGIDs) are common. Diagnosis is based on the Rome criteria. It has been argued that performing endoscopies could help by providing reassurance and thus improve outcomes. This study was conducted to evaluate the impact of obtaining normal endoscopies in the outcome of children with FGIDs.

METHODS

Medical records of patients diagnosed with abdominal pain related-FGIDs were reviewed. To assess the child's symptoms at follow-up, parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms III (QPGS III). Primary outcome was presence of abdominal pain (AP) and secondary outcomes were AP severity.

RESULTS

A total of 301 patients were diagnosed with abdominal pain-related FGIDs. Overall, 62.6% reported persistence of AP and 37.4% were asymptomatic at follow-up. Among patients with endoscopies, 61% reported AP. Among patients without endoscopies, 64% were symptomatic (P = .76). AP frequency, AP intensity, and child's disability were similar in those with and without endoscopies.

CONCLUSION

The study does not suggest that a negative endoscopy improves the outcome of children with FGIDs.

Recurrent abdominal pain in childhood

BACKGROUND

Chronic, recurrent abdominal pain is common among children and adolescents. It interferes with everyday life, causes absence from school, and leads to frequent medical consultations, often involving burdensome diagnostic testing and protracted attempts at treatment.

METHOD

Selective review of the literature.

RESULTS

Organic causes should be ruled out with a thorough medical history and physical examination and a small number of laboratory tests. The pediatric Rome III criteria include valid diagnostic criteria for functional abdominal pain in childhood. The available data imply that this condition is best treated with cognitive behavioral therapy, rather than with medications or dietary measures.

CONCLUSION

A systematic approach to chronic recurrent abdominal pain in children and adolescents is key to ruling out organic diseases while avoiding unnecessary tests and treatments.