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The prognosis is good for abdominal pain in young children

Author Prof. J. Spranger, University Department of Pediatrics Mainz

The first step in cases of young children presenting with abdominal pain or non-specific gastrointestinal complaints is the exclusion of more serious causes such as cardiac insufficiency, intestinal inflammation or food intolerance. Once they can be ruled out, clinicians will have to convince parents that the abdominal pain has no organic cause and will disappear spontaneously over the years. In order to narrow down this time frame, three Finnish paediatricians examined the condition of a selected group of 175 schoolchildren 5 to 10 years after having presented with chronic recurrent abdominal pain and suspected cardiac insufficiency, which had been ruled out after they underwent an oesophagogastroduodenoscopy [1]. For this retrospective study, the patient files of the university hospital where the children were initially treated as well as the national patient and prescription registers were reviewed.

The evaluation of these medical records showed that 8 children (4%) had to be treated repeatedly for persistent functional gastrointestinal disorders, 7 of them due to a neurological predisposition to reflux (e.g. cerebral palsy). The families of the children who no longer had to rely on in- or outpatient treatment of gastroenteral complaints were given validated questionnaires on the children’s health and quality of life. Just under a third of the families contacted returned the questionnaires. About half of them, one-sixth of the initial study population, reported persistent gastrointestinal complaints in their children. However, these complaints did not affect the children’s quality of life, as the responses on the impact of the complaints on the children’s daily routine showed.

Dietary measures such as gluten-, lactose- or dairy-free diets had been introduced by 21 families without underlying medical evidence of hypersensitivity. No entries on corresponding examinations or prescriptions were found either in medical files or in the national registers.

Comment: This study illustrates the extent, benefits and limitations of a national health registry. It confirms the generally suggested good prognosis for chronic recurrent abdominal pain in young children. 

Helin N, Kolho KL, Merras-Salmio L. Parentally reported early childhood upper gastrointestinal symptoms alleviate at school age. Acta Paediat 2022;11:174–182.