Chronic Abdominal Pain
What is it?
Chronic abdominal pain is defined as recurrent or persistent abdominal pain which lasts more than 3 months.
How common is it?
Abdominal pain in children is very common. It is estimated that nearly 10% to 25% of school-aged children experience abdominal pain.
What are the causes?
There are many causes for abdominal pain. These include food protein allergies/intolerances (milk, egg, wheat, soya), sugar intolerances (fructose, sucrose, lactose), coeliac disease, constipation, inflammatory bowel disease (Crohn's disease/Ulcerative colitis), Helicobacter Pylori gastritis, small intestinal bacterial overgrowth, pancreatitis and gastroenteritis.
Surgical conditions such as bowel obstruction, appendicitis or abdominal mass can also cause abdominal pain.
What investigations are required?
We are often able to identify the medical cause for abdominal pain by carrying out appropriate investigations such as stool tests (Helicobacter pylori antigen, stool for culture and sensitivity, calprotectin level-indicator for bowel inflammation), skin prick tests for milk, egg, wheat and soya (checking for immediate food protein allergies), imaging modalities (abdominal ultrasound scan, x-ray, MRI abdomen, MRI small bowel, transit marker study), hydrogen breath tests (fructose, lactose, sucrose and glucose), 24-hour pH study, endoscopy (gastroscopy, colonoscopy) and video capsule endoscopy.
A detailed history taking is important to find out the characteristics of the pain, potential triggers and the timing of the abdominal pain.
What are the treatments?
Once the diagnosis is made, treatment can be initiated according to the underlying diagnosis. In occasional cases we may not be able to find out the organic cause for the abdominal pain, and this is often coined as functional abdominal pain. Anti-spasmodic medicine such as Buscopan, Mebeverine Hydrochloride and Pepermint Oil may be useful.
Abdominal pain can be very debilitating and can cause significant stress to the patients and the family. Psychological support (cognitive and relaxation therapy) is vitally important. Here we work closely with child psychologists who can help your child learn to cope with abdominal pain.
Important notes:
Functional abdominal pain means there is no obvious organic cause for the abdominal pain. It should only be diagnosed when common causes for abdominal pain have been ruled out.
Children with localised abdominal pain such as right iliac fossa pain is more likely to have underlying diagnosis than children with generalized central abdominal pain.
Children with unrelenting abdominal pain tend to have higher psychological overlay which is understandable as they are constantly worried about the abdominal pain. It is sometimes misperceived as high anxiety causing the abdominal pain.
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