Recurrent pain sufficient to disrupt normal functioning and lasting at least 3 months occurs in 10% of school-age children. Less than 10% of these children have any organic cause. The widely held belief that psychogenic pain is present in the remaining cases is unsupported. In a number of studies, it was not possible to prove the difference between such children and their families from control ones.

However, in some children it may be a sign of stress or become part of a vicious cycle of anxiety and increased pain leading to family malaise and requiring more and more invasive testing. There is evidence that anxiety can lead to dysmotility, which the child perceives as pain.

More than 90% of children with recurrent abdominal pain do not have structural abnormalities or changes in the gastrointestinal mucosa. The typical pain is centrally located, around the navel, and otherwise the children feel good. However, it is increasingly recognized that the majority have one of three specific symptom complexes that form as a result of functional disorders of intestinal motility or intestinal nerve plexuses:

• irritable bowel syndrome (usually);

• non-ulcer dyspepsia;

• abdominal migraine.

Irritable bowel syndrome is a common disease among adults, associated with impaired gastrointestinal motility and impaired perception of intra-abdominal phenomena. Studies on changes in pressure in the small intestine in children with irritable bowel syndrome suggest that abnormal strong muscle contractions occur.

Adults with the disease have also been shown to experience pain when inflating balloons in their intestines to significantly smaller volumes than controls. Therefore, there is an interaction between these two factors and both are affected by psychological factors such as stress and anxiety.

There is also often a positive family history and a characteristic set of symptoms, although not all patients have every symptom:

• Abdominal pain – often worse before or better after a bowel movement.

• Mucous stools.

• Bloating.

• Feeling of incomplete defecation.

• Constipation, often followed by normal or loose stools.

recurrent abdominal pain in children

Non-ulcer dyspepsia. Some children with abdominal pain have symptoms suggestive of an upper GI disorder:

• Pain in the epigastrium .

• Vomiting after eating.

• Belching.

• Bloating.

• Early satiety.

• Heartburn.

If these symptoms are present, Helicobacter infection must be excluded. pylori . Endoscopy fails to detect an ulcer or other lesions of the gastric or duodenal mucosa. However, gastric motility is impaired.

Abdominal migraine. Classic abdominal migraine is often associated with abdominal pain that accompanies headaches, and in some children, abdominal pain predominates. Attacks of pain are localized in the midline, paroxysmal, stereotypical and are accompanied by blanching of the face. There is usually a personal or family history of migraines. Pizotifen , a serotonin receptor antagonist, is an effective prophylactic drug in children with frequent, severe symptoms.

Gastritis and peptic ulcer. Widespread use of endoscopy in children and detection of gram-negative microorganisms Helicobacter pylori in relation to antral gastritis has focused attention on them as a potential cause of abdominal pain in children. In adults, it is well established that H. pylori is a significant predisposing factor for the development of duodenal ulcers. This relationship is less clear in children. Duodenal ulcers are uncommon in children, but they should be looked for in the presence of night pains, especially if it makes the child weak or if close relatives are known to have peptic ulcers.

H. pylori causes nodular antral gastritis, which may be accompanied by abdominal pain and nausea. It is usually detected on a biopsy of the antrum of the stomach, but may be present in microaerophilic culture. This microorganism produces urease , which serves as the basis for a laboratory study of a biopsy and a 13C breath test (after taking 13C-labeled urea by mouth). Serological tests are unreliable in children.

Treatment regimens vary, but often consist of triple therapy, such as amoxicillin, metronidazole, and clarithromycin .

Treatment of intermittent abdominal pain

It is important not only to conduct a complete history taking and research, but also to control their conduct, otherwise the assurances will be unconvincing. This will also allow you to establish that the child is developing normally and that the examination did not reveal any abnormalities. In children with irritable bowel syndrome and non- ulcer dyspepsia, it can be helpful to explain to both children and parents that “sometimes the insides of the intestines become so sensitive that some children can feel food passing through them.” It is also necessary to differentiate between “serious” and “dangerous”.

These diseases can be serious if, for example, they lead to a significant decrease in school attendance, but they are not dangerous.

Research should be dictated by clinical manifestations. Although there are many potential organic causes, most of them are rare and require further investigation only when indicated. Urinary microscopy and culture are necessary because UTIs can cause pain in the absence of other symptoms or signs.

Long-term prognosis of periodical abdominal pain in children:

• About half of children with these symptoms get rid of them soon.

• In a quarter of cases, symptoms resolve within a few months.

• In a quarter of cases, symptoms continue or return into adulthood as irritable bowel syndrome, non- ulcer dyspepsia, and cranial migraine.