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It ’ s A Gut Feeling: Abdominal Pain in Children

It ’ s A Gut Feeling: Abdominal Pain in Children. David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians. Introduction. Common Symptom Affects 10-15% of school-aged children Definition (Dr. John Apley) 3 episodes of pain over 3 months

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It ’ s A Gut Feeling: Abdominal Pain in Children

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  1. It’s A Gut Feeling: Abdominal Pain in Children David Deutsch, MD Pediatric Gastroenterology Rockford Health Physicians

  2. Introduction • Common Symptom • Affects 10-15% of school-aged children • Definition (Dr. John Apley) • 3 episodes of pain over 3 months • Interferes with normal daily activities • Any child that seeks medical attention

  3. Causes • Functional abdominal pain • 90% of children • Organic • 10% of children • How to tell if serious? • Parents want an answer • How much testing to do

  4. Functional Abdominal Pain • No treatable cause found • Irritable bowel syndrome • Hypersensitivity disorder • Visceral hyperalgia • Not wimpy kids

  5. Symptoms of Functional Pain • Age greater than 5 years-old • Pain-free periods • Periumbilical pain • No relationship to eating, stools, stress, etc • Headaches, dizziness, appear pale

  6. Symptoms of Functional Pain • Fatigue or weakness • Pains in arms and legs • School absence but good student • Pain interfering with activities out of proportion to evaluation • Often a history of colic or feeding problems • No red flags

  7. Red flags Suggesting Serious Problem • Age less than 5 years-old • Weight loss or poor growth • Pain away from the belly button • Vomiting • Night-time pain

  8. Red flags Suggesting Serious Problem • Diarrhea (night-time) • Blood in the stool • Fever • Rash or joint pain • Family history of ulcers, inflammatory bowel disease • No school absenteeism

  9. Screening Tests • Thorough history (without parents) • Physical exam including growth chart • Stool for blood • CBC • ESR • UA • Celiac screen • Missed disease rare

  10. Treatment • Avoid excessive tests • Explanation of RAP • Not faking it • Similar to headache • Encourage regular routine • School attendance • Adequate sleep

  11. Treatment • High fiber diet • Peppermint • Healthy diet • Fast food • Caffeine • Spicy foods • Identify any stressors

  12. Stressful Stimuli • Physical Stress • Recent physical illness • Milk intolerance • Constipation

  13. Stressful Stimuli, cont. • Emotional Stress • Illness in family member • School problems • Recent move

  14. Treatment • Counseling • Treat anxiety • Help family promote adaptive behaviors • Children very suggestible • Coping mechanisms • Medications • Antispasmodics • Amitriptyline

  15. Prognosis • One-third resolve within few months • One-third replace abdominal pain with new symptom • One-third continue with pain

  16. Common Causes • School avoidance • Constipation/Encopresis • Muscle pain • Urinary Tract Infection • Physical or sexual abuse • Food allergies • Parasites • Giardia, Blastocystis

  17. Common Causes, cont. • Lactose Intolerance • Onset 4-6 years-old • Bloating, diarrhea, gas • Breath test or dietary exclusion • Carbohydrate Intolerance • Fructose (fruit and juice, soft drinks) • Sorbitol (fruits, sugar-free candy and gum)

  18. Common Causes, cont. • Irritable bowel syndrome • Abnormal contractions or sensation of the intestine • Not a psychological illness • Non-ulcer dyspepsia • Diarrhea-predominant • Constipation-predominant

  19. Common Causes, cont. • Irritable bowel syndrome • Rome criteria • Pain relieved by stools • Altered stools at time of pain • Altered stool frequency at time of pain • Mucus in stools • Bloating

  20. Common Causes, cont. • Irritable bowel syndrome treatment • Probiotics • Chamomile or peppermint tea • Peppermint • Relaxation techniques • Medications • Antispasmodics • Amitriptyline

  21. Common Causes, cont. • Gastroesophageal reflux • History of spitting up as a baby • Heartburn or regurgitation • Epigastric or chest pain • Dysphagia • Treatment • Maalox or Mylanta • Acid suppression

  22. Common Causes, cont. • Eosinophilic Esophagitis • Reflux symptoms • Dysphagia • Related to food allergies • Treatment • Elimination diet • Inhaled steroids

  23. Ulcers • Somewhat rare • Night-time pain, vomiting • Etiology • Ibuprofen • Helicobacter pylori • 20% of children • Blood test, stool test, EGD

  24. Gallstones • Rare • Think if blood disorders, obesity, OCP’s • Symptoms • Upper abdominal pain after meals • Increasing pain lasting 1-4 hours • Associated with vomiting

  25. Inflammatory Bowel Disease • 25% of patients less than 18 years-old • Family history in 30% • Autoimmune disease • Ulcerative colitis • Diarrhea, urgency, blood or mucus • Crohn’s disease • Weight loss, pain, diarrhea

  26. Celiac disease • Common (1:100-200 people) • Gluten (wheat, rye, barley) • Variable symptoms • Screen with antibody tests • Diagnose with EGD • Gluten-free diet for life

  27. Cyclic Vomiting Syndrome • Migraine Equivalent • Recurrent episodes of pain and vomiting • Seasonal • Diagnosis of exclusion • Treatment • Abortive therapy (Zofran, NSAIDs) • Preventative

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