The patient has nonspecific abdominal pain: What’s next?

A retrospective investigation in 375 children with nonspecific abdominal pain (AP) found that most do not receive a diagnosis, many have persistent pain, and only a few are given a functional AP diagnosis. The children, who ranged in age from 4 to 12 years at the beginning of the study, were drawn from 5 primary care practices. Investigators collected information about their AP and associated symptoms, physical examinations, laboratory and radiology studies, and primary care follow-up from the index visit through a well-child outcome visit 6 to 24 months later.

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Eighteen percent of children in the study group reported persistent pain at the outcome visit. Although more than 10% of children had laboratory or radiology testing at the index visit, these evaluations generally were normal (61% of laboratory tests and 66% of radiology studies) and rarely changed clinical management or contributed to a specific diagnosis. The only diagnosis made via radiology evaluation was constipation. Of the 30% of children who received a diagnosis, the most common were constipation, functional AP, and gastroesophageal reflux disease. Of the children with no specific diagnosis, the records of only 12% made any mention of an AP-related functional disorder as part of a differential diagnosis, even though 21% of this group of children met 1 or more criteria for AP-related functional disorders at the index visit (Wallis EM, et al. Acad Pediatr. 2015;15[3]:333-339).

Commentary: It is estimated that between 2% and 4% of childhood visits to primary care providers involve a complaint of abdominal pain. Many children go without a specific diagnosis, often after multiple visits and unproductive lab and radiographic testing. In 2005, the American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain published a useful clinical report on diagnosis and management of chronic abdominal pain. Although it is now 10 years old, it is worth taking a look at this resource when you are approaching that patient who returns over and over again with a frown on his or her face and hands on the belly (Pediatrics. 2005;115[3]:812-815). -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.