Abdominal Pain in Children
Abdominal Pain in Children
Saps M, Bonilla S
J Pediatr. 2011;159:551-554
Existing evidence suggests that many school-age children experience abdominal pain lasting more than 8 weeks. These children also appear to be at high risk for later depression and school absenteeism. Traditionally, it was felt that a complex mix of psychological, social, and biological factors influenced functional abdominal pain. However, other evidence, including experimental animal models, has suggested that early manipulation of the gastrointestinal (GI) tract, either through procedures such as gastric tube placement, abdominal surgery, or even less invasive procedures such as nasogastric tube placement or suctioning, may predispose certain children to later abdominal pain. Saps and Bonilla hypothesized that children who had pyloric stenosis with surgical correction in infancy are more likely to suffer from functional abdominal pain as they get older.
The investigators conducted a cohort study of children seen for pyloric stenosis at one Midwestern children's hospital from 2000-2005. The children and their parents were contacted by investigators to obtain information on current GI symptoms. The parents completed a standardized data collection form based on accepted criteria for chronic functional abdominal pain. To meet criteria, the child must have experienced abdominal pain for at least 8 weeks' duration. The control children were 91 siblings of the patients with pyloric stenosis. The investigators identified 100 cases of pyloric stenosis seen during the study period, and the mean age of the cases at follow-up was 7.5 years. The racial/ethnic makeup of the cases was 56% Hispanic and 39% black. Most (91%) of the children had been born at term, and their average age at diagnosis of pyloric stenosis was 39 days. The mean follow-up for each child was 7 years.
Abdominal pain during the 2 months prior to the follow-up interview was much more common among the cases (20%) compared with control siblings (5.8%). The odds of meeting the primary outcome variable was 4.3 among case children (95% confidence interval 1.5-11.9). Of the children with abdominal pain, 45% had been to a pediatric emergency department or had seen a pediatric GI physician for the abdominal pain. One third of children with abdominal pain also met the more stringent criteria for functional abdominal pain. The investigators concluded that pyloric stenosis in infancy and the procedures associated with care of this condition predisposed children to chronic abdominal pain in later years.
These are very interesting results that should at least raise awareness among providers of the potential GI problems in children with corrected pyloric stenosis. Saps and Bonilla seem to focus on the possibility that the perinatal stress and manipulation associated with pyloric stenosis treatment is a potential cause of the later functional GI pain. Randomized gut manipulation in humans is not likely to be studied as a result of ethical concerns, so this will ultimately be a very difficult question to answer.
Biological evidence suggests that patients with GI malformations or maldevelopment such as gastroschisis or malrotation have higher rates of gastroesophageal reflux and motility problems as they get older. In that vein, if pyloric stenosis is viewed as another GI malformation or maldevelopment, then it becomes even harder to determine whether the children's later abdominal difficulties are the result of GI maldevelopment to begin with or a consequence of surgical and nonsurgical interventions in infancy. In the end, it appears that something about pyloric stenosis and perhaps other GI malformations predisposes these children to later GI difficulties from reflux to functional abdominal pain.
Abstract
Early Life Events: Infants With Pyloric Stenosis Have a Higher Risk of Developing Chronic Abdominal Pain in Childhood
Saps M, Bonilla S
J Pediatr. 2011;159:551-554
Study Summary
Existing evidence suggests that many school-age children experience abdominal pain lasting more than 8 weeks. These children also appear to be at high risk for later depression and school absenteeism. Traditionally, it was felt that a complex mix of psychological, social, and biological factors influenced functional abdominal pain. However, other evidence, including experimental animal models, has suggested that early manipulation of the gastrointestinal (GI) tract, either through procedures such as gastric tube placement, abdominal surgery, or even less invasive procedures such as nasogastric tube placement or suctioning, may predispose certain children to later abdominal pain. Saps and Bonilla hypothesized that children who had pyloric stenosis with surgical correction in infancy are more likely to suffer from functional abdominal pain as they get older.
The investigators conducted a cohort study of children seen for pyloric stenosis at one Midwestern children's hospital from 2000-2005. The children and their parents were contacted by investigators to obtain information on current GI symptoms. The parents completed a standardized data collection form based on accepted criteria for chronic functional abdominal pain. To meet criteria, the child must have experienced abdominal pain for at least 8 weeks' duration. The control children were 91 siblings of the patients with pyloric stenosis. The investigators identified 100 cases of pyloric stenosis seen during the study period, and the mean age of the cases at follow-up was 7.5 years. The racial/ethnic makeup of the cases was 56% Hispanic and 39% black. Most (91%) of the children had been born at term, and their average age at diagnosis of pyloric stenosis was 39 days. The mean follow-up for each child was 7 years.
Abdominal pain during the 2 months prior to the follow-up interview was much more common among the cases (20%) compared with control siblings (5.8%). The odds of meeting the primary outcome variable was 4.3 among case children (95% confidence interval 1.5-11.9). Of the children with abdominal pain, 45% had been to a pediatric emergency department or had seen a pediatric GI physician for the abdominal pain. One third of children with abdominal pain also met the more stringent criteria for functional abdominal pain. The investigators concluded that pyloric stenosis in infancy and the procedures associated with care of this condition predisposed children to chronic abdominal pain in later years.
Viewpoint
These are very interesting results that should at least raise awareness among providers of the potential GI problems in children with corrected pyloric stenosis. Saps and Bonilla seem to focus on the possibility that the perinatal stress and manipulation associated with pyloric stenosis treatment is a potential cause of the later functional GI pain. Randomized gut manipulation in humans is not likely to be studied as a result of ethical concerns, so this will ultimately be a very difficult question to answer.
Biological evidence suggests that patients with GI malformations or maldevelopment such as gastroschisis or malrotation have higher rates of gastroesophageal reflux and motility problems as they get older. In that vein, if pyloric stenosis is viewed as another GI malformation or maldevelopment, then it becomes even harder to determine whether the children's later abdominal difficulties are the result of GI maldevelopment to begin with or a consequence of surgical and nonsurgical interventions in infancy. In the end, it appears that something about pyloric stenosis and perhaps other GI malformations predisposes these children to later GI difficulties from reflux to functional abdominal pain.
Abstract
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