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Irritable bowel syndrome: the commonest cause of recurrent abdominal pain in children

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Apley, working in Bristol, UK, defined recurrent abdominal pain (RAP) in 1958. After extensive investigations, he found that 8% of children presenting to his clinic with RAP had an organic pathology. The aims of this study were to identify (1) causes of RAP using modern methodology, (2) factors associated with organic RAP and (3) children with none-organic RAP who fulfill the diagnostic criteria for irritable bowel syndrome (IBS). Children, aged over 3 years, presenting with RAP were prospectively recruited to this study. They had a detailed questionnaire completed, a full examination with screening tests (blood for coeliac screen, Helicobacter pylori antibody titre, inflammatory markers, serum amylase, liver function tests, and full blood count, urine and stool analyses and abdominal ultrasonography). Endoscopy and oesophageal pH monitoring were performed if clinically indicated. IBS was diagnosed if the child had no organic pathology and fulfilled the Rome II criteria. Out of 103 children (median age of 10 years, mean 10.04, SD ±3.44,), 31 children (30%) had organic pathologies. Factors associated with organic pain were nocturnal symptoms (P<0. 01) and abdominal tenderness (P<0.005) and with non-organic pain were periumbilical locality (P<0.002), pain alleviation on defaecation (P<0.04) and low fibre diet (P<0.005). Of children with non-organic pain, 37/52 (51%) fulfilled the criteria for IBS (36% of the total). Conclusion:of children presenting with recurrent abdominal pain in a hospital setting, 30% have a diagnosable organic aetiology compared to 8% in Apley’s time. Irritable bowel syndrome, however, may be the commonest cause of recurrent abdominal pain and should be considered.

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C-reactive protein


gastro-oesophageal reflux disease


irritable bowel syndrome


recurrent abdominal pain


  1. Apley J (1975) The child with abdominal pains. Blackwell Scientific Publications, Oxford

  2. Apley J, Naish N (1958) Recurrent abdominal pain: a field study of 1000 school children. Arch Dis Child 33: 165–170

    CAS  PubMed  Google Scholar 

  3. Bury RG (1987) A study of 111 children with recurrent abdominal pain. Austral Paediatr J 23: 117–119

    CAS  Google Scholar 

  4. Croffi JM, Fitzgerald JF, Chong SK (2000) Recurrent abdominal pain in children. A retospective study of outcome in a group referred to a pediatric gastroenterology practice. Clin Pediatr 39: 267–274

    Google Scholar 

  5. Dimson SB (1971) Transit time related to clinical findings in children with recurrent abdominal pain. Pediatrics 47: 666–674

    CAS  PubMed  Google Scholar 

  6. Faull C, Nicol AR (1986) Abdominal pain in six-year-olds: an epidemiological study in a new town. J Child Psychol Psychiatry 27: 251–260

    CAS  PubMed  Google Scholar 

  7. Friedman R (1972) Some characteristics of children with psychogenic pain. Clin Pediatr 11: 31–53

    Google Scholar 

  8. Garber J, Zeman J, Walker LS (1990) Recurrent abdominal pain in children: psychiatric diagnoses and parental psychopathology. J Acad Child Adolesc Psychiatry 29: 648–656

    CAS  Google Scholar 

  9. Gaylord N, Carson S (1983) Assessing recurrent abdominal pain in children. Nurse Practitioner 45: 19–24

    Google Scholar 

  10. Green M (1967) Diagnosis and treatment: psychogenic, recurrent abdominal pain. Pediatrics 40: 84–89

    CAS  PubMed  Google Scholar 

  11. Hodges K, Kline J, Barbero G, Flanery R (1985) Depressive symptoms in children with recurrent abdominal pain and in their families. J Pediatr 107: 622–626

    CAS  PubMed  Google Scholar 

  12. Huestas-Ceballos A, Macanthus C, Logan S (2002) Pharmacological intervention for recurrent abdominal pain (RAP) in children. The Cochrane Systemic Review. The Cochrane Library, Issue 1, Oxford

  13. Hyams JS, Burke G, Davis PM, Treem WR, Shoup M (1995) Characterization of symptoms in children with recurrent abdominal pain: resemblance to irritable bowel syndrome. J Pediatr Gastroenterol Nutr 20: 209–214

    CAS  PubMed  Google Scholar 

  14. Liebman WM (1978) Recurrent abdominal pain in children: a retrospective survey of 119 patients. Clin Pediatr 17: 149–153

    CAS  Google Scholar 

  15. MacKeith R, O’Neil D (1951) Recurrent abdominal pain in children. Lancet ii: 278–282

    Article  Google Scholar 

  16. Mew CF, Sinatra FA (1993) Abdominal pain. In: Wyllie R, Hyams JS (eds) Pediatric gastrointestinal disease. Pathophysiology, diagnosis, and management. Saunders, Philadelphia, pp 177–186

  17. Oster J (1972) Recurrent abdominal pain, headache, and limb pains in children and adolescents. Pediatrics 50: 429–436

    CAS  PubMed  Google Scholar 

  18. Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, Staiano A (1999) Childhood functional gastrointestinal disorders. Gut 45[Suppl II]: 1160–1168

  19. Sawczenko A, Sandhu BK, Logan RF, Jenkins H, Taylor CJ, Mian S, Lynn R (2001) Prospective survey of childhood inflammatory bowel disease in British Isles. Lancet 357: 1093–1094

    Article  CAS  PubMed  Google Scholar 

  20. Stone RT, Barbero GJ (1970) Recurrent abdominal pain in childhood. Pediatrics 45: 732–738

    CAS  PubMed  Google Scholar 

  21. Thompson WG, Dotevall G, Drossman DA, Heaton KW, Druis W (1989) Irritable bowel syndrome: guidelines for the diagnosis. Gastroenterol Int 2: 92–95

    Google Scholar 

  22. Walker LS, Guite JW, Duke M, Barnard JA, Greene JW (1998) Recurrent abdominal pain: a potential precursor of irritable bowel syndrome in adolescents and young adults. J Pediatr 132: 1010–1015

    CAS  PubMed  Google Scholar 

  23. Zuckerman B, Stevenson J, Bailey V (1987) Stomachaches and headaches in a community sample of preschool children. Pediatrics 79: 677–682

    CAS  PubMed  Google Scholar 

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Correspondence to Bhupinder Sandhu.

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El-Matary, W., Spray, C. & Sandhu, B. Irritable bowel syndrome: the commonest cause of recurrent abdominal pain in children. Eur J Pediatr 163, 584–588 (2004).

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