Recurrent Abdominal Pain - Diagnosis, Treatment, and Complications

Introduction

The term 'recurrent abdominal pain (RAP)' refers to periodical pain. The pain, which occurs in at least three episodes a day, affects daily activities and lifestyle and is considered recurrent pain. The duration of pain should be a minimum of three months at regular intervals. It affects approximately ten to 20 percent of school-going children.

What Are the Disorders Involving Recurrent Abdominal Pain?

The common factor responsible for recurrent abdominal pain in children is still functional. Some of the organic causes of recurrent abdominal pain can be:

• Helicobacter Pylori Infection: Many studies have been performed to overrule whether H. pylori is the cause of recurrent abdominal pain or not. However, nothing has been stated to date. Many children suffering from recurrent abdominal pain were noticed to have H. pylori infection, but its prevalence was inconsistent with duodenal ulcers.

• Carbohydrate Intolerance: It is a common cause of recurrent abdominal pain. The most common carbohydrate children consume lactose, found in mammalian milk. Another carbohydrate responsible for recurrent abdomen pain can be sorbitol.

• Eosinophilic Esophagitis: Esophagitis is a well-stated cause of epigastric pain in children. The symptoms of esophagitis are similar to gastroesophageal reflux and can be differentiated only by mucosal biopsies. Allergic agents such as milk, soy, egg, and fish protein can also cause eosinophilic esophagitis in children.

• Gastroesophageal Reflux: GER is common in young infants, and in the majority of cases, the symptoms subside when the infant assumes a straight posture and solid food intake starts.

• Inflammatory Bowel Disease: Chronic inflammatory bowel disease (IBD) is a potential cause of recurrent abdominal pain in children. The child suffers from vague abdominal pain. Some of the other features of IBD are loss of appetite, lethargy, fever, and diarrhea.

• Abdominal Migraine: Recurrent abdominal pain can be due to migraine in children. Studies suggest that it is a precursor of a migraine headache, but the presence of a headache is not necessary. The child may suffer from abdominal pain with nausea and vomiting.

• Yersiniosis: It is an infection caused by consuming raw or undercooked pork contaminated with Yersinia enterocolitica bacteria. Yersinia enterocolitica is a gram negative bacillus bacteria. It affects young children with symptoms such as abdominal pain, fever, and diarrhea which can be bloody.

• Diseases of the Urinary Tract: Bacterial or fungal infections manifesting in the urinary system can cause recurrent abdominal pain in children.

• Dysmenorrhea: Menstrual cramps are known as dysmenorrhea. It can be the throbbing or cramping nature of abdominal pain.

• Hepatobiliary Diseases: Hepatobiliary diseases affect the liver, gallbladder, and bile ducts. It can cause severe recurrent abdominal pain.

Different surgical conditions which involve recurrent abdominal pain are:

1. Intestinal Malrotation: It is a birth defect that happens early in pregnancy, in which the fetus's intestines do not form into a coil like the normal intestine.

2. Choledochal Cyst: A congenital defect of the bile duct that helps transport bile from the liver to the gallbladder. It can cause hepatic complications and pancreatitis (inflammation of the pancreas).

3. Recurrent Intussusception: Intussusception is a birth defect in which one part of the bowel displaces into another part beside it. Recurrence of intussusception after an enema is called recurrent. Recurrent intussusception occurs after the treatment is done for the first time.

4. Meckel Diverticulitis: Incomplete obliteration of the vitelline duct leads to forming of a true diverticulum (pouch) of the small intestine. It is the most common gastric abnormality.

5. Intestinal Lymphoma: It is a rare type of high-grade, non-Hodgkin lymphoma that grows in the gut or small intestine. It develops from T- cells of white blood cells.

What Are the Severe Complications of Recurrent Abdominal Pain?

• Pain is linked with changes in bowel habits, particularly constipation, nocturnal bowel movement, and diarrhea.

• Localization of pain away from the abdomen center.

• Recurrent fever and loss of hungriness and energy.

• Unexplained pallor (pale appearance).

• Organomegaly (enlargement of the organ, which is noticed on palpation).

• Tenderness localized away from the umbilical region.

What Is the Diagnosis of Recurrent Abdominal Pain?

• The most important step in evaluating recurrent abdominal pain is a physical examination and good clinical history.

• Other than physical examination, some lab tests such as erythrocyte sedimentation rate, stool test for occult blood, and urinalysis can be performed.

• In cases of recurrent intussusception, diagnosis is very challenging. It should be examined when there is pain.

• Ultrasound: It helps to overrule disease and conditions associated with recurrent abdominal pain, such as Meckel's diverticulum and intussusception.

• Meckel Scan: To trace the Meckel diverticulum, a radioactive trace is picked by gastric mucosa that would appear as a bright spot at the right iliac fossa region.

What Is the Treatment of Recurrent Abdominal Pain?

Treatment of the disorders related to recurrent abdominal pain can subside the pain.

Such as:

• Treatment for Meckel's diverticulum is resection and removal of the pouch.

• Intestinal malrotation needs emergency surgery as it may have severe complications gradually.

What Is the Management of Recurrent Abdominal Pain?

• The most important factor in managing recurrent abdominal pain is training the child to cope with it and improve their lifestyle.

• Since medical treatment with antispasmodic drugs was not proven to be significant, it is important to counsel parents and children on coping with stress and pain. It is important to reassure that there is no serious organic disease related to recurrent abdominal pain.

• Improving lifestyle and proper diet reputation is important in managing recurrent abdominal pain.

Conclusion

Recurrent abdominal pain is a periodic pain that lasts for months at regular intervals. It can be associated with abdominal migraines, gastroesophageal reflux, and eosinophilic esophagitis. Treatment is a proper lifestyle and diet maintenance.